Authorized in 1883 by the Legislature of Texas, Terrell State Hospital was designed in Austin by J. N. Preston and sons, built by John M'Donald, and opened in 1885 under superintendent Dr. D. R. Wallace, an internationally recognized pioneer psychiatrist. The hospital admitted 330 patients during its first year and gradually enlarged to 2,300 patients by 1920, when it was the largest hospital of its kind west of the Mississippi. None of the original buildings survives, and only the fountain in the circular park and the water tower remain from the old hospital grounds.