HISTORY OF EASTERN STATE HOSPITAL

Lexington, Ky

From 1792 until 1824, the mentally disturbed residents of Kentucky were boarded out with individuals at public expense, or a few were sent to Eastern State Hospital at Williamsburg, Virginia.

In 1816, a group of public-spirited citizens in Lexington, banded together to establish a hospital to be called the Fayette Hospital. It was to be for the poor, disabled and “lunatic” members of society. A building was started that year and, in 1817, the Honorable Henry Clay gave an oration at the dedicatory ceremony; however, the building was neither finished nor occupied.

On December 7, 1822, the General Assembly of the Commonwealth of Kentucky passed an “Act to Establish a Lunatic Asylum”. Ten acres of land, along with the unfinished building of the Fayette Hospital, were purchased and thus the second oldest state mental hospital in America was established. The first patient was admitted May 1, 1824.

Samuel Theobald, M.D., a physician on the hospital staff and a member of the faculty of Transylvania University Medical School here in Lexington, wrote in 1828, a dissertation titled, Some Account of the Lunatic Asylum in Kentucky, that the goal was “the custodial care of the insane and the protection of society…Most of the lunatics admitted were incurable cases, as non-violent insane were to be maintained in private homes, being sent to the hospital when no longer tame enough to be kept at home…”

In these early years, even the custodial treatment was less than ideal and barely met the minimal needs of the residents. There was no medical staff directly associated with the hospital at this time. Any severe medical problems were treated by physicians in the community, or by faculty and students of Transylvania College School of Medicine.

In 1844, Eastern State Hospital welcomed its first medical superintendent, John Rowan Allen, M.D.: Eastern State Hospital has been under a full-time director ever since. With this change began an era of “moral treatment” during which the hospital staff strived to treat the residents humanely. (“Moral treatment” meant compassionate and understanding treatment.)

Dorthea Dix, one of America’s great philanthropists interested in better treatment of the insane, visited the hospital in 1847, and again in 1858.

Restraints including strait jackets, leather cuffs, chains, etc. were originally used and were accepted treatment for the mentally ill. Beginning with Dr. Allen’s administration, the use of such measures was largely eliminated. Following the discontinuance of Transylvania University Medical School, around the end of the Civil War, fortunes declined. The patient population increased, there was much over-crowding, and the use of restraints was re-activated.

During the late 1800’s and the early 1900’s, modes of treatment changed often, usually as a direct reflection of the degree of interest and support provided by the public. In general, hospital staff attempted to give the best treatment possible with the current knowledge and with the resources made available by the public.

In its first years, because of its being the only facility of its kind in the area, Eastern State Hospital admitted people from all over Kentucky and from nearby states. The census of the hospital has varied over the years. In 1945, the hospital was very crowded with a population of 2,000; as late as 1967, there were over 1,000 Eastern State Hospital residents.

Eastern State Hospital was an isolated institution, separate from the community around it. Many employees lived on the grounds in cottages, dormitories, separate rooms in the main hospital building, or on wards with the residents. Residents did most of the work required to operate the hospital. Among the many jobs performed by the residents were farm work; grounds and building maintenance; custodial work; cooking, serving, and dishwashing; laundry, sewing, and mending service. The hospital grew and prepared most of its foodstuffs on the hospital grounds. At one time, Eastern State Hospital grounds consisted of 400 acres, and most of this acreage was farm land. In 1956, over 300 acres were sold to IBM; at present, 88 acres make up the Eastern State Hospital grounds.

Throughout the years, deletions, improvements, and additions have been made in the physical facilities and in the treatment programs. Metrozal-shock therapy and electric-shock therapy were introduced in the 1940’s. Metrozal-shock was used for a very short period. In the early 1950’s, insulin therapy was used. In 1954, when tranquilizing drugs (used in conjunction with other therapies) were introduced, there was a decrease in insulin therapy; and by 1957, it was discontinued.

There are three main buildings where the treatment units are located: The Main Building ( a section of which is the original building, the remainder was built between 1835-1870); the Wendell Building, which was occupied in 1953; and the Allen Building, occupied in 1957.

When it was first established, the name of the hospital was the Lunatic Asylum. In 1876, it was called Eastern Kentucky Lunatic Asylum. On January 2, 1912, the General Assembly, Commonwealth of Kentucky, officially renamed the facility Eastern State Hospital.

During the 1960’s there was the growth of the community mental health system throughout Kentucky until there was a center in most counties. These centers treated many people as outpatients thereby reducing the number of persons needing admission to an inpatient facility.

In 1970, Kentucky state mental institutions converted to the geographic unit system. In the past, hospital residents had been placed on wards according to the problem or diagnosis. Under the geographic unit system, residents were placed on wards according to the geographic area of the state from which they came. This facilitated hospital and Comprehensive Care staff communication. In 1975, the hospital was again reorganized into treatment services based on patient need.

Then in 1993, the non-profit organization Bluegrass Regional Mental Health-Mental Retardation Board, Inc. became concerned about the possible closing of the hospital. Many states had implemented health care reform that included cost containment and/or cost reduction features that were realized by rapid closing of inpatient facilities. It appeared that Kentucky could soon be faced with too few inpatient options and limited alternatives to inpatient care. Bluegrass Regional MH-MR pursued the possibility of taking over management of the hospital. Planning sessions with consumers and family members, community members, staff, state officials and other concerned parties provided information that was integral to the development of a hospital management plan. In September of 1995, Bluegrass Regional MH-MR took over management of Eastern State Hospital under a contact with the Commonwealth of Kentucky. Negotiations had taken nearly two years…implementation occurred in just over two months!

Eastern State Hospital has had a long and varied history. One general trend has been a reduction in the patient population and an increase in the number of staff. At present, the patient population is less than 150 and an around the clock staff totaling approximately 400, much different from the days of over 2,000 patients and roughly the same size staff as today’s.