Eliza appears to have managed the household as well as the bookkeeping, as she occasionally issues small sums "to myself" in the ledger (e.g., Dec. 28, 1842, "Box for Eliza (myself)". Dr. Macdonald, who also appears in occasional ledger entries, usually for "lent" sums, was a longtime physician for the mentally ill, having worked for 10 years (1825-1830 and 1832-1837) at the Bloomingdale Asylum in New York City and touring European asylums as an observer for the better part of 1831. His Murray Hill asylum was a "long cherished design" ("James Macdonald, M.D.", The American Journal of Insanity, Vols. 5-6, p. 85), and was located in two secluded houses in what were then the suburbs of Manhattan, opening its doors to patients on June 1, 1841. Having outgrown these accommodations within a few short years, it was then relocated to Sanford Hall, in Flushing, Queens, where it stayed in operation at least until its founder's death in May 1849.
The ledger begins with an entry dated only 1841: "This Book cost -- $.75 | Bottle of Ink - 12-1/2 [cents]". The entry immediately following is March 27, 1841 (the purchase of a horse, for $90), and for the next three months, through the beginning of July, Eliza records the numerous purchases necessary to outfit and ready the houses for patients, including everything from carpeting and a carriage to a silver tea set, mirrors, a tin bath, a skillet, tables, hardware, buckles, "lynch-pins" for a wagon, and so on, as well as the hiring and paying (and feeding) of household staff and getting a circular printed. The first patient may have been admitted on July 14: noted here as "Albert Rogers, of Brooklyn, credit, 3 mos. Board of wife". The cost, $110, indicates that the asylum's clientele had to have been upper class. Several other "boarders" are added to the books in subsequent entries, although it is not until September 17, 1841, that one, Timothy Courow(?), is directly noted as being a patient. Naturally, as more and more boarders and/or patients become residents, the amount of food and other sundries needed increases exponentially, with vast quantities of eggs, bread, blackberries, peaches, oysters, and cakes noted in the ledger.