The Tuke family had instituted in their hospital a 'moral treatment' approach to care for patients, which centered upon humane and kindly behavior. Kirkbride had been influenced by the Quaker-founded York Retreat in England whose leader, Samuel Tuke, had published an account entitled, Practical Hints on the Construction and Economy of Pauper Lunatic Asylums (York, England, 1815). In 1854, he published his book, On the Construction, Organization, and General Arrangements of Hospitals for the Insane (Philadelphia), which influenced the architecture and construction particularly of state asylums, known as 'Kirkbride Hospitals,' some of which were still in use into the mid-20th century. Thomas Kirkbride provided the major influences during the 19th century on the building and organization of mental hospitals. Insanity of King George III: read before the Association of Superintendents of Insane Hospitals, May 22, 1855. In 1868, the Superintendents’ Association adopted his ' Project of a Law,' (see pages 17-22) which recommended statutory enactment to secure the rights of the mentally ill and define the civil and criminal relationships of the insane.

Ray also published several important monographs, including Mental Hygiene (Boston, 1863) and Contributions to Mental Pathology (Boston, 1873). Between 18, except for one year he published at least one article every year, mainly dealing with insanity and its legal implications.

One of the founding members of the Superintendents’ Association, he served as President from 1855 to 1859. In 1867, he moved to an active retirement in Philadelphia. After several years in private practice in Maine, he became Superintendent of the State Hospital for the Insane in Augusta in 1841, and in 1845 he moved to Providence, R.I., to supervise the building of the private Butler Hospital and became its first Superintendent. Ray received his medical degree in 1827 from Bowdoin and spent the following year visiting medical facilities in New England, England, and France. In 1838, he published A Treatise on the Medical Jurisprudence of Insanity (Boston), which served as an authoritative text for many years. Isaac Ray was the foremost forensic psychiatrist of his time.

Pestilence by Edward Jarvis