The first days

Five days after the hospital had officially opened, the first patient finally arrived. Her name was Elizabeth B. of Londonderry Township. The 42 year old was suffering from dyspepsia and melancholy, most likely brought on by the loss of two of her three sons to scarlet fever the previous July. By late October of 1851 there were twelve patients at the hospital, six males, and six females and by the end of the first year there were 37 patients, 24 male and 13 female.

The first winter proved that the heating and ventilation system was insufficient and unsatisfactory. Various changes and additions were made to the system over the next few years but without any result. By the year 1855 the hospital population had grown to 164 patients. Also in 1855 the trustees told the governor of Pennsylvania that the hospital need immediate financial attention. In January of 1854 the state had appropriated $25,000 for the hospital, all of which had been expended, and the year 1855 was started with a debt of $12,800. The hospital's problems were not limited to money. On the afternoon of June 16, 1855, a tornado passed over the hospital, the damage caused was severe. The carriage house roof was blow off, and one wall was blown in. The north museum roof was also torn off, and the slate roof and spouting on the Main Building was badly damaged. On the night of May 12, 1859 the hospital barn was discovered on fire, the fire was reported to be the result of a former patient.

In February of 1853 the hospital received eight criminals who were diagnosed as insane from the Eastern State Penitentiary in Philadelphia. Despite the best efforts of hospital staff four of the criminals escaped. They proved to be very undesirable for the hospital and demonstrated the necessity to create better provisions for the care of the criminally insane. Inmates continued to stay at the hospital until 1913 when the Hospital for Criminal Insane was opened at Fairview.

The hospital had opened with the price of room and board for public patients set at $2.00 a week. In 1854 that price was raised to $2.50. In 1859 an act of legislature enabled the hospital to collect outstanding debts from a number of counties. In 1883 the price for public patients was again raised to $3.00 per week. By the 1860s the finical problems seemed to be under control. From the years 1861 to 1865 the hospital received between $40,000 and $45,000 ($10,000 of which was from state funding). The sale of farm and garden items also help bring money to the hospital. By 1867 the state's financial contribution had risen to $15,000 and the amount received from patients rose to $56,664.71. However hospital expenses kept pace and the surplus that year was a mere $5.17.

Overcrowding problems occurred early in the hospital's history. In 1856 the opening of the Western Pennsylvania Hospital for the Insane at Dixmont temporarily releaved some of the problem. But by 1867 overcrowding had returned and the board of trustees wrote to the governor in detail about the problem. The following year some of the bathrooms were converted into patient rooms and the infirmaries were used as wards to increase patient capacity. To try and take control of the problem it was also decided to only admit those whom had been most recently diagnosed with insanity. Patients that were recently diagnosed were seen as having a better chance of being cured. Overcrowding continued without resolve throughout the late 1860s and into the 1870s, and the looming threat of fire was always a concern. Many institutions for the insane had suffered from catastrophic fires in the past, and Harrisburg was not immune to this threat. Several fires had occurred at the hospital since it's opening, fortunately though, no fires had occurred in the Main Building.

By the late 1860's all the original hospital trustees were gone, including Dr. Kirkbride. In 1870 the Board of Public Charities was established. The board was created to standardize data reporting and to eliminate compensation over appropriations between individual hospitals. The legislation had hoped to gain control over expenditures for the growing number of public charities in Pennsylvania. The new board was seen by the older asylum superintendents, including John Curwen, as an attack on their authority in the institutions. The board's first report in 1871 actually praised the hospital and it's superintendent. The report supported his demands for larger appropriations because of over crowding, and to correct the air quality problem. However by the late 1870's superintendent John Curwen came under fire and was being accused of mishandling funds, having too many paying patients, and giving them preference over the indigent. He was also accused of being frequently absent from his duties as superintendent. All the charges came up empty handed. However during the late 1870's the superintendent was frequently gone from the hospital because of being appointed as a commissioner to help setup several new hospitals, including the new state hospital in Warren. In March of 1881 the hospital trustees simply failed to reappoint him as superintendent and instead placed his first assistant, Jerome Gerhard in charge of the hospital.