Benjamin Franklin and Dr. Thomas Bond receive a charter from the Pennsylvania legislature to open the first hospital in the American colonies for the sick, poor, and the “insane." The Pennsylvania Hospital, which is the first of its kind in the American colonies, opens the following year, providing "rooms in the basement with shackles attached to the walls." They will house several patients, but within a few years, the increased demand of families looking for places to house their family members will lead them to open the Pennsylvania Hospital for the "Insane," which will continue to operate from 1856-1998 under different names.

Two kinds of hospitals begin to emerge during this period: 1) voluntary hospitals, operated by charitable lay boards that are technically "non-denominational" but usually Protestant, and 2) public hospitals, which are descended from almshouses and operated by municipalities, counties, and the federal government.