A Noble Monument of Wisdom and Mercy: St. Elizabeths Hospital, 1852-1899

St. Elizabeths Hospital in Washington D.C., an asylum to treat the soldiers, sailors, and indigent citizens of the District, was designed to be a model institution. When it opened in 1855, the hospital represented hope for a cure for insanity by promising treatment that was built on the idea that a precisely controlled, therapeutic environment could calm the mind. The hospital was built using the Kirkbride Plan for asylum design and management. Architecture and nature were essential elements to the ordered environment of the asylum and the treatment provided to patients.
The purpose of this research was to identify, describe, and analyze the history and design of nineteenth century St. Elizabeths Hospital, particularly related to the use of nature and the built environment in the treatment of mental illness. Using traditional historical methods and a social history and architectural history framework, the research placed St. Elizabeths as central to the nineteenth century American Asylum Movement. The hospital was indeed a crossroads of ideas and actions of the leaders of the time, including reformers, politicians, physicians, architects, landscape gardeners, and nurses; the focus being the interaction between the patient and the environment for health and well-being.
Primary sources were obtained from the archival collections of the National Archives and Records Administration, the Library of Congress, the National Library of Medicine, and the Houghton Library at Harvard University. An analysis of the façade and grounds of St. Elizabeths and the Athens Lunatic Asylum, in Athens Ohio provided data that were instrumental in understanding the scale of the building and surrounding grounds as experienced by the hospital’s patients and staff. An analysis of interior of the Trans-Allegany Lunatic Asylum in Weston, West Virginia provided data on the circulation within a Kirkbride building.
While all who contributed to the design, construction, and care provided at the hospital were optimistic that nature and architecture could cure mental illness, the overcrowding at St. Elizabeths following the American Civil War proved that a cure was elusive. As the nineteenth century came to a close, the overcrowding impacted the landscape of the hospital and the care provided to those suffering from mental illness. Despite the move away from treatment that was based on nature, the history of St. Elizabeths Hospital revealed much about the use of the environment in nineteenth century American asylums. That history also provides a foundation for critical examination of the therapeutic environment of hospitals today.