A Most Curious Choice
The mystery surrounding the establishment of the Eastern State Hospital in Williamsburg

That there shall be a hospital for the "Support of Ideots, Lunatics, and other Persons of unsound Minds."
-- Governor Francis Fauquier, June 1770

Reconstruction of Original Public Hospital
  Reconstruction of Original Public Hospital, Colonial Williamsburg

Sketch of Original Public Hospital

Basic Timeline
1766   November 6:  Issue of the need for a public hospital is first addressed in the General Assembly by Governor Francis Fauquier
           November 20:  House of Burgess passes resolution for construction of a Public Hospital

1767    April 11:  Fauquier again addresses the issue of the Public Hospital since there was no action taken during the session

1768    March 3: Governor Fauquier dies
            October 26:  Lord Botetourt arrives to take over as Governor

1769    November 15:  House of Burgess sends the request for the Public Hospital to the Committee of Propositions and Grievances
            November 29:  Assembly is presented with letter to the Governor of Pennsylvania, requesting that he take four mentally ill patients

1770    April 11:  House of Burgesses passes bill concerning the establishment of the Public Hospital

1771    Construction begins

1773    September 14:  Public Hospital first opens

1885    June 7: Fire destroys the Public Hospital

1985    Reconstruction of Public Hospital is completed

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Francis Fauquier
Governor Francis Fauquier
Bethlehem Hospital (Bedlam), London

~    On November 6, 1766, Royal Governor Francis Fauquier addressed the opening session of the House of Burgesses in Williamsburg for the first time since he had dissolved it following the Stamp Act Resolves.  He expounded upon the relationship between the Mother Country and the colonists, and expressed optimism for the future relations of these two parties.  Before concluding his speech, he added the following statement:
"It is expedient I should also recommend to your Consideration and Humanity a poor unhappy set of People who are deprived of their senses and wander about the Country, terrifying the Rest of their fellow creatures.  A legal Confinement, and proper Provision, ought to be appointed for these miserable Objects, who cannot help themselves.  Every civilized Country has an Hospital for these People, where they are confined, maintained and attended by able Physicians, to endeavour to restore to them their lost reason."
This idea was well received by the legislature, and eventually this speech led to the creation of what eventually became Eastern State Mental Hospital, the first institution devoted solely to care for the mentally disabled and insane, and one that is still in existence.  Yet prior to this speech there had been little or no serious thought given to establishing a hospital of this nature, particularly in Williamsburg.  Fauquier's motivations for pushing this issue and the community's wide acceptance of it in its early days beg many questions concerning such varied topics as crime, economics, geography, and medicine.  This web page will attempt to explore some of the major influences and behind-the-scenes action that led to the opening of the Williamsburg Public Hospital in 1773.

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Background: Care of the Insane in 18th Century Colonial Virginia

        The issue of dealing with persons suffering from mental illness was first formally addressed during the 17th century in Virginia.  Legislation in the 1660s explicitly stated how the insane should be dealt with in matters of law, treating them as orphans or widows to a large extent.  If a person was found to be of unsound mind then they would be exempt from "statues of limitation or execution of the law" until they had recovered.  For example, in 1661, records tell of the court suspending the punishment against a man who had slandered the king, finding that "hee is disturbed in his braine, talking wildly and distractedly to such things as are put to him" (Dain 5).  By the 1700s, these practices were firmly established and codified.  The sanity of a person was not established by a doctor or any professional, but rather by a survey of 12 citizens that had to testify to the person being "a Lunatic or ideot."  If this survey found the person to be perceived as insane then the court would appoint a guardian, generally a family member (but not next-of-kin).  The court would oversee the finances of the person's estate, if any, just as was done for a widow or orphan.  Some of the funds received would be preserved for the "lunatic" if and when they recovered.
        Governor Dunmore, who followed Fauquier and Botetourt, was quite confident that the insane were treated well in his colony, even prior to the establishment of the Public Hospital.  In response to an inquiry by the Board of Trade in 1772, Dunmore noted: "The method pursued in this Colony with respect to Ideots and Lunatics hath been comformable to the practise of the High Court of Chancery in England" (see Gibbs).  Even earlier, in 1770 he states that "There is perhaps no Country in the British Dominions, where persons under these unhappy circumstances are treated with more humanity or are better taken care of."  Other evidence, however, describes the insane as being placed in what today appear to be entirely appalling conditions.  Some were court designated to be under the care of family members with little experience or were given to other community members who were to provide basic care in exchange for small payments.  Many were simply allowed to drift about the countryside lacking basic care and with all needs unmet.  Most often, even if not guilty of a crime, a mentally ill person would be thrown into prison along with beggars, criminals, and others on the periphery of society.  By the time Fauquier first addressed the need for a Public Hospital, there were already a handful of mentally ill persons confined to the Public Gaol in Williamsburg.
        Yet, the problem of mentally unstable persons was not generally of great concern in the colonies, Virginia being no exception.  Very few people were concerned about it unless they had a family member or friend that was in some way affected.  The wealthy could afford to hire a slave to care for a sick person.  If a person was fairly innocuous they could be left on their own most of the time.  Mentally ill slaves were rarely dealt with directly, but in South Carolina the law stated that a Master was not responsible for the actions of a slave that was insane.  Legislation was periodically passed to deal with mental illness in a legal sense, but very little was done as far as treatment.  Only one hospital existed prior to the Public Hospital in the colonies and this was the Philadelphia Hospital, a Quaker institution, which primarily served the medical needs of the community, but had rooms for mental patients in the basement.
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17th Century Williamsburg and the Birth of the Public Hospital

       The 1760s and 1770s were a bustling and prosperous time in Williamsburg.  The city was still the capital of the colony, and it was a politically charged and important time, elevating Williamsburg's status.  Around the time that the Public Hospital was being discussed a major new Courthouse was being built and there were plans in the works to construct a canal to one of the nearby creek landings.  The population of Williamsburg hovered around its peak, 2,000 or more when the legislature was in session.  It was this atmosphere that may well have permitted such a massive public works project, the last of its kind in Williamsburg.  There were several other factors besides the Enlightenment philosophy, discussed below, which likely played a role in the approval of the hospital.
        Around the time of that the Public Hospital was approved, Lord Botetourt had requested that the governor of Pennsylvania allow four patients to be taken into the Pennsylvania Hospital.  William Byrd carried out the task, which provided a shelter other than the jail for the mental patients until the Public Hospital could be constructed.  The letter of request was shown in the Legislature and may have conferred a sense of urgency, demonstrating that the problem of the mentally disturbed was a real one.
        In Britain and France, among other countries, the care of the mentally ill was becoming more popular and commonplace.  The colonists very closely followed trends back in the Mother Country, and this one may have been no exception.  Indeed, Virginia was so much less populous than England, that it may have appeared very impressive to the British to see that the colonists were so passionately devoted in their attention to such a minority as the insane.
        Additionally, several newspaper articles speak of crimes committed by the insane which may have led many to want not only to confine those with disordered minds for their own good, but for the protection of the general populace.  The Virginia Gazette reported on July 6, 1769 that a lunatic who was widely thought to be of no harm had committed a murder.  An editorial in the same paper asserted that if an institution had existed for the care of the insane, such a crime would not have happened.  In the following months, articles and editorials periodically appeared to the same effect, treating the issue of the insane carefully, seeing them as human individuals that needed the help of a publicly funded institution.  With the combination of these events, this desire was soon fulfilled.

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Fauquier and the Enlightenment
        Although Governor Fauquier never lived to see his Public Hospital built, it is clear that it was of great importance to him.  Although there is no historical evidence to directly substantiate the claim that Fauquier was the originator of the idea of the Williamsburg Public Hospital, it seems to be by far the most likely answer.  He brought the issue before the legislature more than once, during a time which was consumed with dealings with the Mother Country.  A bit over a year after his first speech, he addressed the House of Burgess for a second time on April 11, 1767:
          "There is a subject which gives me concern, on which I shall particularly address myself to you, as it is your peculiar province to provide means for the subsistence of the poor of any kind.  The subject I mean is the case of the poor lunaticks.  I find on your journals that it was
    Resolved, That an hospital be erected for the reception of persons who are so unhappy as to be deprived of their reason;
    And that it was
    Ordered, that the Committee of Propositions and Grievances do prepare and bring in a bill pursuant to the above resolution.  But I do not find that any thing more was done in it.  It was a measure which I think could offend no party, and which I was in hopes humanity would have dictated to every man, as soon as he was made acquainted with the call for it.  It also concerns me much on another account; for as the case now stands, I am as it were compelled to the daily commission of an illegal act, by confining without my authority, a poor lunatick, who, if set at liberty, would be mischievous to society; and I would choose to be bound by, and observant of, the laws of the country.  As I think this is a point of some importance to the ease and comfort of the whole community, as well as a point of charity to the unhappy objects, I shall again recommend it to you at your next meeting; when I hope, after mature reflection, it will be found to be more worth your attention than it has been in this."
This statement shows what for the time was an extreme amount of compassion and concern for a relatively small portion of society.  The key to this quandary may well lie in the Enlightenment principles which were so prevalent at this time.
        The 18th Century was, particularly for the aristocracy, a time of rejecting superstition and many aspects of religion, and in their place exercising skepticism and education to discover important aspects of life and the natural world.  It was the time of many great philosophers, Hume and Voltaire being among the most famous, and of reinvestigation of the individual and the worth of human life.  As such, views of the mentally ill were quite altered.  In London at this time, the insane were often viewed as comical, a side-show like amusement for the wealthy.  People would go on tours of Bethlehem Hospital (Bedlam) and enjoy a humorous and grotesque parade.  But to some involved in the Enlightenment discussions there developed a new sensitivity towards the insane.  These people rejected the idea of the mentally ill as outcasts or sacred fools, instead seeing the illness as an illness of the mind, in no way different from an illness of the physical body, and as such, treatable.  This is not to imply that science make blazed the trail for the treatment of the mentally ill; indeed, the term "science" was not in common usage until the 1830s.  Science was still a nebulous mix of approaches and ideas about large issues of the nature of life, and was often equated with objectivity and freedom from the passion of religion rather than reason or rationality.  Yet, along with these broad and important questions being asked came an appreciation of the individual and an increasing use of rationality.  Indeed, philosophers could see that they themselves, in their radical and distinct new belief systems could be perceived as insane, and therefore society needed to adjust its views of what was acceptable.  By the time of the founding of the Public Hospital, there were already institutions for the care of the mentally ill in London (Bedlam) and several in France.
        Francis Fauquier would certainly have been familiar with these institutions, being an Enlightened and broadly interested man.  He was the son of a physician and an active member of the Royal Society, demonstrating a keenly scientific mind.  He was significantly bothered by the slavery question, and wrote of how even they should have liberties, and was concerned that he be perceived as a kind and good master.  In addition, Fauquier was an advocate of other social causes, including education and the separation of church and state.  Being raised with such a state of mind, it is not too difficult to conclude that Fauquier was not making a philosophical stretch when he acted to open the Public Hospital.  But to build a hospital would be large and expensive on-taking, so many members of the legislature would had to have to be in a similar state of mind.  Likely, many of them had similar exposures to the Enlightenment philosophies.  In addition, the existence of organizations such as the "Virginian Society for the Promotion of Usefull Knowledge" in 1772 promote this assertion.  With this atmosphere, the plan for the Public Hospital could proceed.
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Execution and Realization of the Plan

        The construction of the hospital, as many projects in the time, was far from smooth, and its early years manifested some of the fears that had existed.  The Act of Establishment for the hospital in 1770 allotted £1200 for obtaining land and constructing the building.  The legislature then allowed the very generous sum of £25 per patient per year.  This funding scheme was to be in effect for five years, at which time it would be re-evaluated.  A 12-member board of directors was created such that the legislature would not have be directly involved with operations.  The list of board members demonstrates the great importance placed in the organization of the hospital, as it reads like a "who's who" of colonial Virginia:  John Blair, Robert Carter, Peyton Randolph, George Wythe, Thomas, Everard, and Thomas Nelson being among them.  Indeed, all seven signers of the Declaration of Independence from Virginia had an either direct or indirect involvement with the hospital.  One board member, William Nelson (who later became governor) felt attached enough to the institution that he bequeathed £100 for the "maintenance of patients."  This board would choose the employees, including the Keeper, Superintendent, and visiting Physician.  By July 10, 1770, the Board was ready to receive applications from undertakers to take care of the design and construction.
        The Board purchased 8 lots, the block of Williamsburg bordered by Francis, Henry, Ireland, and Nassan Streets on December 1, 1770, for £112:
Frenchman's Map, May 11, 1782 (see link for more information)
The design accepted was by famous architect Robert Smith, well known for his work on Carpenter's Hall in Philadelphia.  The plan called for a two-story building, made primarily out of brick, measuring 100' in length and presumably with a cupola.  Although admittedly neither the architect nor the board members knew much about taking care of the mentally ill, the building did have some design features that were specifically for the accommodation of the insane.  The hospitals of Europe, as well as the Pennsylvania Hospital provided points of reference for design.  The 11'9" by 10'9" rooms were sparse, with barred windows in the original design to prevent escape.  Records from the Williamsburg blacksmith indicate that iron restraints, common for mental care at the time, were also ordered.  The stoves for heating the rooms were placed much elevated and with access to the fire only in the corridors so that none of the patients could inadvertently cause a fire.


Reconstruction of 1773 Patient Cell at the Hospital
View down the East Corridor of the Public Hospital Reconstruction

        Benjamin Powell, who had worked on other major projects, was the undertaker for the project, which proceeded slowly and with insufficient funds.  He used around £1,070 in his initial work on the building, but as was often the case in major public works in Williamsburg, the budget was exceeded.  The Board of Directors requested and received an additional £800, enough to complete the building and construct a high fence so that there would be an outside area for the patients.  Construction was complete and ready for inspection by September 14, 1773, and the Board of Directors began meeting once a week to hear the cases of patients wanting to be admitted.  On October 12, the Public Hospital's first two patients were admitted, Zachariah Mallory and Catherine Harvey.  Local officials and magistrates were encouraged and rewarded to bring people considered truly mentally ill and curable to the hospital.  Even so, the 24 rooms of the hospital were not filled until after 1800.  The hospital was intended only to take in potentially curable cases, not chronic patients, or people that were in no way harmful to themselves or others.  This, however, did not occur over time as intended.  James Galt, the former keeper of the Public Gaol, became the first keeper of the Hospital, the beginning of a long association between the Galt family and Hospital.  The history and trials that faced the hospital in the coming decades are indeed interesting, but beyond the scope of the site.

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Conclusions and Comments Concerning the Eastern State Hospital

        In many ways, the Eastern State Hospital was ahead of its time, and the later philosophies it instated at times continued this trend (see below).  That it was built at all was the greatest innovation of its time.  It was built before the need was very great, as witnessed by the long period that went by before it reached capacity.  Furthermore, it suffered terrible times of marginal operation under unfavorable conditions, one historian remarking: "The Eastern State Hospital's greatest achievement during its early years was to continue to function at all..." (Dain 27).  But as time went on addition after addition had to be made to the hospital to hold the increasing number of patients.  Yet we are brought back to the issue of exactly why the hospital was built when it was.  Several possible factors have been presented here.  First, the economic and political climate in Williamsburg directly prior to the Revolutionary War made it able to accommodate such a large expenditure.  Secondly, the Enlightened social philosophy, particularly of Governor Fauquier likely played a major role, a result of trends in other countries and evolving perspectives on mental illness.  Additionally primary sources from the 1700s demonstrate that at times the issue of having no place to treat or house the mentally ill could manifest itself in violent ways.  At the same time, the colony was being forced to give money to Pennsylvania while they housed some mental patients that had no place to go in Virginia.  Finally, a bit of Williamsburg pride might have played a role for some members of the legislature, with the colony gaining the status of first in the New World to construct a hospital solely for mental patients.  The exact logic and series of events may never be clearly understood, but the great importance placed on the hospital in Williamsburg was important to the history of the city, the colony, and to the development of Psychiatric practices in America.

Three Movements in Patient Care (as defined by the Colonial Williamsburg Foundation)

    A. Age of Restraint (1773-1835)
    B. Moral Management Era (1836-1862)
    C. Custodial Care Regime (1862-1885)

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Works Cited
Dain, Norman  Disordered Minds: The First Century of Eastern State Hospital in Williamsburg, VA 1766-1866  Charlottesville: University of Virginia Press,

Elizabeth, et al.  "William and Mary Crossroads Research Project 2001: Eastern State Hospital"  College of William and Mary.  Accessed 08 December 2003.
    Available: http://fsweb.wm.edu/crossroads/firstpage.htm

Gibbs, Patricia A. and Rowe, Linda H.  The Public Hospital, 1766-1885.  Williamsburg, VA: The Colonial Williamsburg Foundation Library Research Report
    Series -240, 1990

Jones, Granville L., "The History of the Founding of the Eastern State Hospital of Virginia." American Journal of Psychiatry, 110:9, 1954.

"MacKenzie, Henry The Man of Feeling, Chapter XX" from Gay, Peter, ed.  The Enlightenment: A Comprehensive Anthology.  New York: Simon and
    Schuster, Inc., 1973.

McCandless, Peter.  Moonlight, Magnolias, and Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era.  Chapel Hill:
    University of North Carolina Press: 1996.

McDonald, Travis C. Jr.  The Public Hospital: An architectural History and a Chronicle of Reconstruction Vol. 1/4  Williamsburg, VA: Architectural
    Research Department of the Colonial Williamsburg Foundation: 1980.

Outram, Dorinda The Enlightenment.  Great Britain: Cambridge University Press, 1995.

Paynter, Richard K. Jr., Response to Letter, Colonial Williamsburg Foundation.  August 31, 1970.  Colonial Williamsburg Rockefeller Library Requests.

The Public Hospital: 1773-1885.  Pamphlet: Colonial Williamsburg Foundation, 2002.

Zwelling, Shomer S.  Quest for a Cure: The Public Hospital in Williamsburg, 1773-1883.  Williamsburg, VA: The Colonial Williamsburg Foundation, 1985

Images came from Colonial Williamsburg's website and personal pictures.
The Bedlam plate is the Hogarth Engraving and can be found here.
The Frenchman's Map is from Swem Library's Special Collections, online here.
Francis Fauquier's portrait can be found here.

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Helpful Links
Colonial Williamsburg
The College of William and Mary
Eastern State Hospital Website
Frenchman's Map
History 220 Class Webpage
A History of Eastern State Hospital

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About This Project

This website is a research project for History 220, Williamsburg, Colonial & Revolutionary
The College of William and Mary
Williamsburg, Virginia
It was created December, 2003 by Jeremy Wacksman
click here to send e-mail

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