Dorothea Dix Hospital
|Dorothea Dix Hospital|
|Building Style||Kirkbride Plan|
|Architect(s)||Alexander T. Davis|
|Alternate Names||Insane Hospital of North Carolina
Dix HillThe State Hospital at Raleigh
In the autumn of 1848 when Dorothea Lynde Dix came to North Carolina, attitudes toward mental illness in this state, like the scanty facilities, remained generally quite primitive. Nevertheless, the North Carolina Legislature was not unaware of the concept of a state hospital for the mentally ill. Earlier in 1825 a resolution had been passed requesting information needed to plan for the establishment of a "lunatic asylum". Nothing came of it then, and again in 1838-1839 action stirred in this regard with no concrete results. In 1844, Governor Morehead strongly recommended that the state build institutions for the unfortunate insane, blind and deaf; but the issue died without positive action. So things stood still in the fall of 1848 with Delaware and North Carolina remaining the two states of the original thirteen which had no state institution for the mentally ill.
Dorothea toured North Carolina. The conditions for the mentally ill that she found in 36 North Carolina counties were much the same as in other states, ranging from extremely poor to above average, with a census of about a thousand mentally ill in jails, poorhouses and private homes. She returned to Raleigh and compiled the information she had gathered into a "memorial" which she hoped to present to the legislature.
The report submitted to the legislature was a county-by-county report on her findings. She emphasized the need to remove the insane from jails for their own benefit and that of other inmates. Dorothea had a practical approach as well as an idealistic one. She listed costs in other states and economies that had been achieved. She recommended "moderate employment, moderate exercise" among the approaches to the treatment of the mentally ill, along with specifics of buildings and equipment.
As 1848 drew to its closing days, Dorothea Dix faced an economy-minded legislature primarily interested in railroads and, of course, politics. Her proposals were at first met with little enthusiasm but her memorial was a powerfully written and emotional appeal. Through persistent effort she found a sponsor for it in the person of John W. Ellis of Rowan County. He presented it to the legislature and proposed that a committee of seven from each house make a study of the memorial and report back to the legislature. A bill was written and reached the floor of the assembly on December 21, 1848.
The bill spelled out the needs and requirements for a state institution for the mentally ill and requested $100,000 — a huge sum in those days — to finance the project. Opposition overcame attempts to develop a satisfactory means of raising funds for the hospital, despite the enthusiastic support by several individuals and the Raleigh newspaper. Yet at this point, chance and the results of Dorothea's kindness and concern for others brought success for the measure.
Staying at the Mansion House Hotel in Raleigh, Dorothea learned of a woman lying critically ill in one of its rooms. She went at once and set about nursing and comforting her. The sick woman, unknown to Dorothea at the time, was the wife of James C. Dobbin of Fayetteville, an influential member of the legislature. Dorothea spent all the time possible with Mrs. Dobbin. When she died on December 18th, Dorothea traveled to Fayetteville for the funeral. Deeply appreciative for Dorothea's kindness, Mrs. Dobbin-just before her death-asked her husband to support the "asylum" bill. Hearing of the defeat of the measure to raise money for the project, Mr. Dobbin hurried back to Raleigh from his wife's funeral and made a stirring plea for reconsideration of the bill, developing a workable compromise for raising the funds required. The bill passed the House in late December and the Senate, December 30, 1848.
This act provided for only $7,000 with later appropriations to be made later and for the appointment of six commissioners to select a site and oversee the erection of the hospital. These commissioners were John M. Morehead of Guildford County, Calvin Graves of Caswell County, Thomas W. Cameron of Cumberland County, George W. Mordecai and Charles L. Hinton of Wake County, and Josiah O. Watson of Johnston County. Dr. Edmund Strudwick of Hillsborough was chosen as the first "Physician and Superintendent" and placed in charge of construction. He served temporally since he was not experienced in the care of the "insane". Dr. Edward Fisher in 1853 was appointed Superintendent.
Overjoyed at the success of the plan, Dorothea offered to stay on to help in the selection of a site for the new hospital and to assist in many other ways. In 1851, the first commissioners of the "Insane Hospital of North Carolina" reported to the legislature: "They selected a site for the said building and after carefully examining the whole country in the vicinity of Raleigh, they chose a location west of the city and about one mile distant, on a hill near Rocky Branch to provide a water supply. This location has a commanding view of the city and is believed to be perfectly healthy." The Insane Hospital was located outside of Raleigh in pleasant surrounding countryside. It was thought that insanity was caused by social conditions and patients should be removed from family, friends and community. They purchased the 182 acres from Maria Hunter Hall and Sylvester Smith for $1,944.63. Both tracts of land were originally part of the plantation owned by Col. Theophilus Hunter in the late 1700's.
Dorothea Dix had refused to let the projected hospital be named after her, as many felt it should be. She agreed to have the site named "Dix Hill" after her grandfather, Doctor Elijah Dix. Since then the hospital has been known in the Raleigh area as "Dix Hill". Dorothea sent bibles, prayer books and pictures for the patients after the asylum opened. In 1870 she sent the asylum, at the request of the Board, an oil portrait of herself. Today the portrait is still housed on hospital property.
The first appropriations of $17,000 for the site were made for the new institution in 1849. Bond issues in 1851 and 1855 raised $100,000 and $80,000, respectively, in for the construction costs. Construction of the first building began in May, 1850 - a structure with a large central section and two wings, ultimately to have accommodations for 274 patients. Alexander T. Davis of New York City designed the Romanesque building. The two million bricks in the asylum were made only two miles away. The asylum was heated by steam and lighted by gas manufactured from coal or rosin. Two extra buildings were added. One building was for the steam boiler and gas manufacturing which was combined with a laundry. The second building was a kitchen and bakery with apartments for the staff on the second floor. There were apartments for the medical staff on the second floor of the main building. This was the first public building in Raleigh to be heated by steam heat and lighted by gas. The hospital's first unit was completed with rooms for 40 patients. On February 22, 1856, the first patient was admitted suffering from "suicidal mania". In the first nine months, fifty-one males and thirty-nine females were admitted.
It was believed that a "moral treatment" such as fixed schedules, development of routine habits, calm and pleasant surroundings, proper diet, some medications, physical and mental activities carried out in a kindly manner with a minimum of physical restraints would cure the patients. Ornamental gardens and landscaped grounds with walks were developed. A hospital farm was established to provide food for patients and staff.
Vocational work options were available to the patients. Females participated in making baskets, clothing, rugs, artificial flowers, and linens. Male patients made mattresses and brooms as well as assisted on carpentry projects. Some patients cleaned wards, worked on the farm, or in the kitchen and sewing room. Recreational activities included tennis, croquet, reading, dances, and concerts given by local choirs. In 1858 a wooden chapel was built. The four ministers from Raleigh took turns leading services weekly for the patients. Editors of the state newspapers furnished their papers to the hospital.
A cemetery was located on the asylum grounds. Marble posts with a chain along the line of graves were built. A tag contained the name of each person over his or her grave with the death of date. The hospital carpenter made the coffins.
Civil War Period
In 1853 Doctor Edward C. Fisher of Virginia, a physician with experience and training in the care of the mentally ill, guided the hospital through its initial period of development and throughout the War Between the States. Even during the war years every effort, in the face of obvious difficulties, was made to keep the asylum functioning effectively. At the beginning of the Civil War there were 193 patients. In the spring of 1865 the Union Army occupied Raleigh. That April, by order of the Union Provost Marshall, the first black patient, a Union soldier, was admitted to the asylum. Also by order of the Provose Marshall the first black resident (a female) of Raleigh was admitted. The Union Army camped all over Raleigh and on the asylum grounds. They tore down fences and burned them for firewood, as well as confiscating grain and livestock for food. During the occupation General William T. Sherman toured the asylum.
Following the Civil War, admissions continued to mount with the growth of confidence in the asylum and the public's understanding of mental illness as a disease. Additional diagnoses were added to the asylum admissions such as those persons with mental retardation. In the 1870's mentally ill criminals were transferred from Central Prison to the asylum.
In 1870 the U.S. Census reported 779 insane in North Carolina and only 242 as patients at asylum. Due to overcrowding, the legislature approved funds to build other state hospitals. In 1880 an asylum for the "colored insane" in the state opened in Goldsboro. An asylum for the "white insane" living in the western half of the state opened three years later at Morganton.
The death of Miss Dorothea Lynde Dix in 1887 was strongly felt by the staff of the asylum. In the Superintendent's report, Eugene Grissom wrote the following passage. "For more than a half of a century she stood in the vanguard of humanity, working valiantly and unceasingly for the stricken insane. Difficulty never stopped her, distance never wearied her, opposition never daunted her, refusal never subdued her, pleasure never tempted her, ease never lured her, and fame never attracted her. Her objects were the wretch insane – her field was the world – her thought the relief of the suffering – her success was their redemption, and her crown shall be the gift of Him like whom she "went about doing good". Earth bids farewell to this great spirit, who has given, if possible new beauty to the name of woman, and new splendor to the deeds of charity."
In the 1890's state hospitals were admitting alcoholics, drug users and epileptics as patients. In an effort to reduce the increasing number of patients, the legislature mandated the transfer of the insane criminals back to the central penitentiaries in the 1890's.
The Insane Law of 1899 changed the name of the asylum to "The State Hospital at Raleigh", and revised the code for admission of the mentally ill to hospitals. For the first time there was "voluntary" admission. In the early 1900's citizen pressure forced the NC Legislature to increase capacity at all state hospitals. An epileptic colony was established to the rear of the hospital on 1,155 acres of land, known as the Spring Hill Farm and the Oregon Farm. It was purchased by the state from Mrs. Elizabeth Grimes. She was the widow of William Grimes, a wealthy plantation owner from Eastern North Carolina. By 1911 a training school for the retarded in Kinston, NC removed these patients from the hospital.
Before 1898, doctors and attendants cared for the patients as part of their "on the job training." All staff lived on the hospital grounds. That year, Dr. George L. Kirby, Superintendent of the State Hospital of Raleigh, employed the first graduate nurse to teach student nurses and attendants. The Dorothea Dix School of Nursing opened in 1902 with eight female students. It continued until October 1913 when the school was reorganized and arrangements were made for the students to receive the second year of their education at Bellevue Hospital in New York City. The male school did not succeed because the salaries were too low to induce males to continue their work and study for the three-year training period. The first class graduated in June 1915. The school was incorporated in 1916. Anderson Hall was built to accommodate the school offices, classrooms and living quarters for student nurses in 1918. Specialists in other areas of treatment soon followed including dentist, social workers and staff to teach vocations and crafts to patients.
In the early 1900's the hospital installed an ice and refrigerator plant. This enabled the staff to slaughter their own meat giving the patients good quality beef at a reduced cost. They also installed a sausage factory. Water coolers were placed in the wards.
In 1912 a field was selected for a vineyard and 1,850 grape vines were planted. The hospital superintendent stated in his report "This should and doubtless will, yield an abundance of luscious fruit for the entire population and besides enough to make a sufficient quantity of the very purest and best wine for our old and feeble patients, and food flavoring for the sick." Two years later the hospital purchased a used $15,000 greenhouse from the Westbrook Sanitarium in Richmond, Virginia for $500.
During World War I building projects were put on hold. In 1918 a flu epidemic took the lives of 18 patients and 2 staff. A total of 317 patients and staff were ill in one month.
Dancing and music had become an important form of entertainment by this time. Patients, nurses and male attendants assembled twice a week to enjoy dancing. Dancing lessons were given to the nurses and male attendants and they gave them to the patients. The hospital superintendent stated in his report "All of them thoroughly enjoy the music, the effect is so apparent that music should be credited as one of the most potential remedies for the insane." In 1924 a moving picture machine was added to the patient Amusement Hall. And was later replaced by a "talking" movie machine. Movies were loaned for free by local merchants. Annual BBQ's, tennis courts and a ballpark all added to the patient lives.
In 1922 Raleigh medical doctors and surgeons provided their services to the patients and staff. Two years later a building was erected for this purpose. By 1925 the census grew to 1,600. A department for white alcoholics was developed. The "insane convicts" were transferred back to the hospital into a new building erected for this purpose. The legislature had passed an act that patients of this type should be cared for in this institution instead of the state's prison. Due to the large number of patients, the new building was immediately too small and beds were placed in the hallways.
In 1926 a spectacular fire destroyed the main building and nine wards. The origin of the fire was believed to be a blowtorch used in soldering tin by workmen who were repairing the roof. Over 400 patients were quickly moved outside. The NC National Guard from Raleigh assisted staff with patients and maintaining order. Students from State College also offered their assistance with the patients. There was no loss of life. All Raleigh firefighting equipment was on hand to battle the fire. Durham Fire Department also sent personnel. Low water pressure prevented the firemen from extinguishing the fire quickly. Later the damaged buildings were repaired.
By the 1930's there were over 2,000 patients. New buildings were erected financed by the Public Works Administration. In 1936 the Dorothea Dix School of Nursing was operating according to the standards set by the NC Board of Nursing. Students received the second year of their education at the General Hospital of the Medical College of Virginia in Richmond. The Richmond college required that all students must have their tonsils removed before arriving at their institution. That same year the Dorothea Dix School of Nursing began to offer a three-month affiliation in psychiatric nursing for senior students in approved nursing schools.
World War II Era
During World War II the Dorothea Dix School of Nursing became a member of the U.S. Cadet Nurse Corps, increasing student enrollment by sixty percent. The Corps recruited students in approved nursing schools to ease the nursing shortage. Funds received by the school from the Corps purchased needed equipment and books with the creation of a reference library. An annex was added to Anderson Hall to provide additional housing for student nurses. In the forties the student nurses traveled to Morisania Hospital in New York City for their second year of education. The number of student nurses decreased so much that by the third year the nursing education program was discontinued with the last class graduating in 1949.
The report of a study commission appointed by Governor Eringhaus resulted in hydrotherapy, shock therapy, and recreational facilities being added to hospital services. As a consequence of this study, a unified Board of Control for all state hospitals and schools was established. Citizen pressure resulted in the State Mental Health Act of 1945. This provided for a State Superintendent of Mental Hygiene. It also revised terms describing patients from "insane or lunatic" to "mentally disordered" and from "idiot or feebleminded" to "mentally defective".
By 1946 all the mental hospitals were so crowded that the legislature appropriated funds to purchase U.S. Army Camp Butner. It opened in 1947 as the fourth state hospital with 750 patients.
The Hill Burton Act of the U.S. Congress in 1946 made funds available to the states for hospital construction. In 1953 a state bond issue made possible the erection of three new buildings at the State Hospital at Raleigh including a chapel with renovations and additions to existing buildings. At this time the original main portion of the hospital was torn down and replaced. The two original wings remain. Now the hospital had over 4,000 inpatients and outpatients under its care.
The Second World War made the public aware of the numbers of men rejected for service because of mental illness. Necessity for returning soldiers with mental illness to active service speeded up treatment procedures. In 1946 the U.S. Congress passed the National Mental Health Act providing for grants for research in the cause and treatment of mental illness and for personnel training. These grants resulted in improved therapy so that many patients could be released sooner. Studies had shown that long term placement in large institutions did not help them get well. Furthermore, with the new drug therapy, many patients were released and follow-up care in the communities where they lived was needed. Many patients were discharged over the next twenty years.
In 1949 first year medical students were given summer jobs in the occupational and recreational therapy departments. This enabled the students to learn more about the patients and provide additional services to the patients. Recreational activities included music, radio, shuffleboard, square dancing, basketball, badminton, croquet, miniature golf, baseball, bingo and movies. A local Latin high school played several football games on hospital property, which provided additional entertainment for the patients.
By 1951 the state hospitals at Raleigh and at Butner had begun residency programs for doctors. Although the nursing school closed in 1949, nursing students from programs in the area continued to receive psychiatric experience at the Raleigh Hospital.
To help remove the stigma for discharged patients of having been at a state hospital, an act was passed in 1959 by the North Carolina Legislature to change the names of the state hospitals. The name of the State Hospital at Raleigh was changed to the Dorothea Dix Hospital to honor Dorothea Lynde Dix.
In 1962 the Federal Community Mental Health Centers Act provided funding for follow-up services for released patients in their own communities. The next year the NC Legislature created the development of community mental health centers and a central mental health department to administer mental health care statewide. In 1970 thanks to the development of many mental health centers, the census at Dorothea Dix Hospital dropped to 2,200.
As a result of the Civil Rights Act of 1964 requiring designation of public facilities, Dorothea Dix Hospital no longer served the eastern counties of North Carolina for the white and Indian mentally ill. They now accepted the mentally ill of "all races" in 22 counties in South Central North Carolina.
In 1973 a complete revision of the mental health code was enacted by the legislature. The code revised several times since provided for patients' rights. This resulted in changes in physical facilities to provide more patient privacy and also in the treatment of patients. The type of hospital admission included voluntary commitment by which a patient could be released on his own written notice. Involuntary commitment patients, by the court, have the right to a hearing in a District Court under specific conditions to determine if that patient could be released from the hospital. The code also provided that patients have a right to treatment, to privacy, and the right to be treated with dignity. A bill of rights is posted in each state hospital. In order to insure the patients of their rights, a patient advocate is provided.
In 1974 the hospital had 2,354 acres of land which included three lakes and 1,300 acres for the farm. There were 282 hospital buildings equipped to handle 2,756 patients.
Dorothea Dix Hospital is now situated on a beautiful 425 acre tract of land, accentuated by oak and pecan trees, on the south side of the City of Raleigh. There are more than 120 separate buildings on the site, many of which were constructed during 1910-1930 and 1960-1980. The buildings are used for patient care, offices, shops, warehouses and other activities in support of the hospital. There are a number of buildings assigned as administrative offices for the Department of Human Resources and for the NC Farmer's Market. The hospital has the capacity to accommodate 682 patients. Declining census in recent years has dropped to an average of 350-400. To serve the 3,000 plus patients yearly, the hospital employees a staff of 1,300 to cover the range of services necessary to operate a modern psychiatric hospital seven days a week, twenty-four hours a day. The current annual operating budget of more than $60,000,000 derives from appropriations authorized by the North Carolina General Assembly, from patient care receipts and from federal grants.
Other institutions-regional, county-based and local are now are an integral part of the state-wide program for mental health, currently functioning under the Division of Mental Health Services of the North Carolina Department of Human Resources. The original geographical area of responsibility has been reduced from all of North Carolina to that being the psychiatric hospital for the seventeen-county of South Central Region, under the general supervision of a regional director and the direction of the hospital director. In its Division of Forensic Services, Dorothea Dix Hospital continues to serve the whole state in dealing with questions and problems raised in the courts relative to mental illness. It also provides neurological, medical and surgical services for cases that are referred to it by other mental health institutions in parts of the state. Professional and technical training and clinical psychiatric research are major factors in the hospital's mission and a continuing effort is made to keep the ratio of staff to patients at a level to insure effective treatment and care.
In his 1874 hospital report, Superintendent Eugene Grissom wrote: "It was discovered that the insane were not beasts and demons, but men whom disease had left disarmed and wounded in the struggle of life and whom, not unoften, some good Samaritan might lift up, and pour in oil and wine, and set anew on their journey rejoicing."
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