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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/15365-8.txt b/15365-8.txt new file mode 100644 index 0000000..250835a --- /dev/null +++ b/15365-8.txt @@ -0,0 +1,5286 @@ +The Project Gutenberg EBook of A Psychiatric Milestone, edited by +Howard Townsend, Bronson Winthrop and R. Horace Gallatin + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: A Psychiatric Milestone + Bloomingdale Hospital Centenary, 1821-1921 + +Author: Various + +Editor: Howard Townsend + Bronson Winthrop + R. Horace Gallatin + +Release Date: March 14, 2005 [EBook #15365] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK A PSYCHIATRIC MILESTONE *** + + + + +Produced by Suzanne Lybarger, Kathryn Lybarger and the +Online Distributed Proofreading Team. + + + + + + +[Illustration: THE NEW YORK HOSPITAL, DUANE STREET AND BROADWAY + +The building to the left was erected in 1808 for the exclusive use of +patients suffering from mental disorders.] + + +A PSYCHIATRIC MILESTONE + +BLOOMINGDALE HOSPITAL CENTENARY + +1821-1921 + + "Cum corpore ut una +Crescere sentimus, pariterque senescere mentem." + --LUCRETIUS + +PRIVATELY PRINTED + +BY THE SOCIETY OF THE NEW YORK HOSPITAL + +1921 + + +ANNIVERSARY COMMITTEE + +HOWARD TOWNSEND +BRONSON WINTHROP +R. HORACE GALLATIN + + + + +PREFACE + + +The opening of Bloomingdale Asylum on June 1, 1821, was an important +event in the treatment of mental disorders and in the progress of +humanitarian and scientific work in America. Hospital treatment for +persons suffering from mental disorders had been furnished by the New +York Hospital since its opening in 1792, and the Governors had given +much thought and effort to securing the facilities needed. The treatment +consisted, however, principally in the administration of drugs and the +employment of such other physical measures as were in vogue at that +time. Little attempt was made to study the minds of the patients or to +treat them by measures directed specifically to influencing their +thoughts, feelings, and behavior, and what treatment of this character +there was had for its object little more than the repression of +excitement and disordered activity. The value and importance of +treatment directed to the mind had, indeed, been long recognized, but in +practice it had been subordinated to treatment of the actual and assumed +physical disorders to which the mental state of the patient was +attributed, and, in the few hospitals where persons suffering from +mental disorders were received, means for its application were almost or +quite entirely lacking. The establishment of Bloomingdale Asylum for the +purpose of ascertaining to what extent the recovery of the patients +might be accomplished by moral as well as by purely medical treatment +marked, therefore, the very earliest stages of the development in +America of the system of study and treatment of mental disorders which +with increasing amplification and precision is now universally employed. + +A hundred years of growth and activity in the work thus established have +now been accomplished, and it seemed fitting to the Governors of the +Hospital that the event should be commemorated in a way that would be +appropriate to its significance and importance. It was decided that the +principal place in the celebration should be given to the purely medical +and scientific aspects of the work, with special reference to the +progress which had been made in the direction of the practical +usefulness of psychiatry in the treatment of illness generally, and in +the management of problems of human behavior and welfare. Arrangements +were made for four addresses by physicians of conspicuous eminence in +their particular fields, and invitations to attend the exercises were +sent to the leading psychiatrists, psychologists, and neurologists of +America, and to others who were known to be specially interested in the +field of study and practice in which the Hospital is engaged. It was +felt that, in view of the place which France and England had held in the +movement in which Bloomingdale Asylum had its origin, it would add +greatly to the interest and value of the celebration if representatives +of these countries were present and made addresses. How fortunate it +was, then, that it became possible to welcome from France Dr. Pierre +Janet, who stands pre-eminent in the field of psychopathology, and from +England Dr. Richard G. Rows, whose contributions to the study and +treatment of the war neuroses and to the relation between psychic and +physical reactions marked him as especially qualified to present the +more advanced view-point of British psychiatry. The other two principal +addresses were made by Dr. Adolf Meyer, who, by reason of his scientific +contributions and his wonderfully productive practical work in clinical +and organized psychiatry and in mental hygiene, is the acknowledged +leader of psychiatry in America, and by Dr. Lewellys F. Barker, who, +because of his eminence as an internist and of the extent to which he +has advocated and employed psychiatric knowledge and methods in his +practice, has contributed greatly to interesting and informing +physicians concerning the value and importance of psychiatry in general +medical practice. The addresses given by these distinguished physicians, +representing advanced views in psychiatry held in Europe and America, +were peculiarly appropriate to the occasion and to the object of the +celebration. They were supplemented by an historical review of the +origin and development of the Hospital and of its work by Mr. Edward W. +Sheldon, President of the Society of the New York Hospital, and by a +statement concerning the medical development, made by Dr. William L. +Russell, the Medical Superintendent. The greetings of the New York +Academy of Medicine were presented in an interesting address by Dr. +George D. Stewart, President of the Academy. + +Of scarcely less significance and interest than the addresses was the +pageant presented on the lawn during the intermission between the +sessions, depicting scenes and incidents illustrating the origin and +development of the Hospital, and of psychiatry and mental hygiene. The +text and the scenes displayed were prepared by Dr. Charles I. Lambert, +First Assistant Physician of the Hospital, and by Mrs. Adelyn Wesley, +who directed the performance and acted as narrator. The performers were +persons who were connected with the Hospital, twenty-two of whom were +patients. + +The celebration was held on May 26, 1921. The weather was exceptionally +clear, with bright sunshine and moderate temperature. The grounds, in +their Spring dress of fresh leaves and flowers, were especially +beautiful. This added much to the attractiveness of the occasion and the +pleasure of those who attended. Luncheon was served on the lawn in front +of the Brown Villa and the pageant was presented on the adjoining +recreation grounds. The beauty of the day and the surroundings, the +character of the addresses and of the speakers, the remarkable felicity +and grace with which they were introduced by the President, the dignity +and noble idealism of his closing words, and the distinguished character +of the audience, all contributed to make the celebration one of +exceptional interest and value to those who were present, and a notable +event in the history of the Hospital. + +For the purpose of preserving, and of perhaps extending to some who were +not present, the spirit of the occasion, and of placing in permanent +form an account of the proceedings and the addresses which were made, +this volume has been published by the Society of the New York Hospital. + +WILLIAM L. RUSSELL. + + + + +CONTENTS + + Page +PREFACE vii + +INVOCATION 3 + REV. FRANK H. SIMMONDS + +HISTORICAL REVIEW 7 + EDWARD W. SHELDON, ESQ. + President of the Society of the New York Hospital + +"THE CONTRIBUTIONS OF PSYCHIATRY TO THE UNDERSTANDING OF LIFE PROBLEMS" 17 + ADOLF MEYER, M.D. + Director of the Henry Phipps Psychiatric Clinic, Johns Hopkins + Hospital, and Professor of Psychiatry, Johns Hopkins University, + Baltimore, Maryland + +"THE IMPORTANCE OF PSYCHIATRY IN GENERAL MEDICAL PRACTICE" 55 + LEWELLYS F. BARKER, M.D. + Professor of Clinical Medicine, Johns Hopkins Medical School, + Baltimore, Maryland + +GREETINGS FROM THE NEW YORK ACADEMY OF MEDICINE 79 + GEORGE D. STEWART, M.D. + President of the Academy + +"THE BIOLOGICAL SIGNIFICANCE OF MENTAL ILLNESS" 89 + RICHARD G. ROWS, M.D. + Director of the Section on Mental Illnesses of the Special + Neurological Hospital, Tooting, London, England + +"THE RELATION OF THE NEUROSES TO THE PSYCHOSES" 115 + PIERRE JANET, M.D. + Professor of Psychology, College de France + +"THE MEDICAL DEVELOPMENT OF BLOOMINGDALE HOSPITAL" 147 + WILLIAM L. RUSSELL, M.D. + Medical Superintendent + +THE TABLEAU-PAGEANT 171 + +NAMES OF THOSE WHO ATTENDED THE EXERCISES 177 + +APPENDIX I 191 + COMMUNICATIONS FROM DR. BEDFORD PIERCE + Medical Superintendent of The Retreat, York, England + EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE RETREAT, + APRIL 30, 1921. + TRANSCRIPT FROM THE VISITORS BOOK OF THE RETREAT, 1803-17. + +APPENDIX II 195 + A LETTER ON PAUPER LUNATIC ASYLUMS FROM SAMUEL TUKE TO + THOMAS EDDY, 1815. + +APPENDIX III 200 + THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815. + +APPENDIX IV 209 + EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TO + ACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED + APRIL, 1815. + +APPENDIX V 212 + ADDRESS TO THE PUBLIC BY THE GOVERNORS, 1821. + +APPENDIX VI 216 + BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL, 1821 + AND 1921. + +APPENDIX VII 218 + ORGANIZATION OF BLOOMINGDALE HOSPITAL, 1821 AND 1921. + + + + +ILLUSTRATIONS + +New York Hospital and Lunatic Asylum, 1808 _Frontispiece_ + FACING PAGE +Bloomingdale Asylum, 1821 2 +Bloomingdale Asylum, 1894 80 +Bloomingdale Hospital, 1921 148 +The Tableau-Pageant 172 +Thomas Eddy 195 + + + + +THE SOCIETY OF THE NEW YORK HOSPITAL + + + + +[Illustration: BLOOMINGDALE ASYLUM + +As it appeared when it was opened in 1821. It was located near the seven +mile stone on the Bloomingdale Road, now 116th Street and Broadway.] + + + + +BLOOMINGDALE HOSPITAL CENTENARY + + +The One Hundredth Anniversary of the establishment of Bloomingdale +Hospital as a separate department for mental diseases of The Society of +the New York Hospital was celebrated at the Hospital at White Plains on +Thursday, May 26, 1921. The addresses were given in the Assembly Hall. + +Mr. Edward W. Sheldon, the President of the Society, acted as Chairman. + + +MORNING SESSION + +The exercises opened with an invocation by the Reverend Frank H. +Simmonds, rector of Grace Episcopal Church at White Plains: + +Oh, most mighty and all-merciful God, whose power is over all Thy works, +who willest that all men shall glorify Thee in the constant bringing to +perfection those powers of Thine which shall more and more make perfect +the beings of Thy creation, we glorify Thee in the gift of Thy Divine +Son Jesus Christ, the Great Physician of our souls, the Sun of +Righteousness arising with healing in His wings, who disposeth every +great and little incident to the glory of God the Father, and to the +comfort of them that love and serve him, we render thanks to Thee and +glorify Thy Name, this day, which brings to completion the hundredth +anniversary of this noble institution's birthday. Oh, Thou, who didst +put it into the hearts and minds of men to dedicate their lives and +fortunes to the advancement of science and medicine for the sick and +afflicted, we render Thee most high praise and hearty thanks for the +grace and virtue of the founders of this institution--men whose names +are written in the Golden Book of life as those who loved their fellow +men. + +We praise Thee for such men as Thomas Eddy, James Macdonald, Pliny +Earle, and these endless others, who from age to age have held high the +torch of knowledge and have kept before them the golden rule of service. +Inasmuch as ye have done it unto one of the least of these my brethren, +ye have done it unto me. + +Be pleased, oh merciful Father, to bless this day and gathering. Lift up +and enlighten our hearts and minds to a higher perception of all that is +noble, all that is true, all that is merciful. Awaken our dull senses to +the full knowledge of light in Thee, and may all that is said and done +be with the guiding of Thy Holy Spirit. + +We pray for the continued blessing of this institution and hospital, and +on all those who are striving to bring out of darkness those unhappy +souls, into the pure light of understanding. + +Bless the Governors, physicians, and nurses, direct their judgments, +prosper their undertakings, and dispose their ministry that the world +may feel the blessing and comfort of life in the prevention of disease +and the preservation of health. And may we all be gathered in this +nation to a more perfect unity of life and purpose in the desire to +spend and be spent in the service of our fellow men. + +We ask it all in the name and through the mediation of Thy Son Jesus +Christ, our Lord. Amen. + + + + +ADDRESS BY +MR. EDWARD W. SHELDON + +MR. SHELDON + + +It is with profound gratification that the Governors welcome your +generous presence to-day on an occasion which means so much to us and +which has perhaps some general significance. For we are met in honor of +what is almost a unique event in our national history, the centennial +anniversary celebration of an exclusively psychopathic hospital. A +summary of its origin and development may be appropriate. + +A hundred and fifty years ago the only institutions on this side of the +Atlantic which cared for mental diseases were the Pennsylvania Hospital, +chartered in 1751, a private general hospital which had accommodations +for a few mental cases, and the Eastern State Hospital for the insane, +at Williamsburg, Virginia, a public institution incorporated in 1768. No +other one of the thirteen Colonies had a hospital of any kind, general +or special. With a view of remedying this deplorable lack in New York, +steps were taken in 1769 to establish an adequate general hospital in +the City of New York. This resulted in the grant, on June 11, 1771, of +the Royal Charter of The Society of the New York Hospital. Soon +afterward the construction of the Hospital buildings began on a spacious +tract on lower Broadway opposite Pearl Street, in which provision was +also to be made for mental cases; but before any patients could be +admitted, an accidental fire, in February, 1775, consumed the interior +of the buildings. Reconstruction was immediately undertaken and +completed early in the spring of 1776. But by that time the +Revolutionary War was in full course, and the buildings were taken over +by the Continental authorities as barracks for troops, and were +surrounded by fortifications. When the British captured the city in +September, 1776, they made the same use of the buildings for their own +troops, who remained there until 1783. A long period of readjustment +then ensued, and it was not until January, 1791, that the Hospital was +at last opened to patients. In September, 1792, the Governors directed +the admission of the first mental case, and for the hundred and +twenty-nine years since that time the Society has continuously devoted a +part of its effort to the care of the mentally diseased. After a few +years a separate building for them was deemed desirable, and was +constructed. The State assisted this expansion of the Hospital by +appropriating to the Society $12,500 a year for fifty years. This new +building housed comfortably seventy-five patients, but ten years later +even this proved inadequate in size and undesirable in surroundings. In +the meanwhile a wave of reform in the care of the insane was rising in +Europe under the influence of such benefactors as Philippe Pinel in +France, and William and Samuel Tuke in England. Thomas Eddy, a +philanthropic Quaker Governor of the Society, who was then its Treasurer +and afterward in succession its Vice-President and President, becoming +aware of this movement, and having made a special study of the care and +cure of mental affections, presented a communication to the Governors in +which he advocated a change in the medical treatment, and in particular +the adoption of the so-called moral management similar to that pursued +by the Tukes at The Retreat, in Yorkshire, England. This memorable +communication was printed by the Governors, and constitutes one of the +first of the systematic attempts made in the United States to put this +important medical subject on a humane and scientific basis. To carry out +his plan, Mr. Eddy urged the purchase of a large tract of land near the +city and the erection of suitable buildings. He ventured the moderate +estimate that the population of the city, then about 110,000, might be +doubled by 1836, and quadrupled by 1856. In fact, it was more than +doubled in those first twenty years, and sextupled in the second +twenty. He was justified, therefore, in believing that the hospital +site on lower Broadway would soon be surrounded by a dense population, +and quite unsuited for the efficient care of mental diseases. The +Governors gave these recommendations immediate and favorable +consideration. Various tracts of land, containing in all about +seventy-seven acres, and lying on the historic Harlem Heights between +what are now Riverside Drive and Columbus Avenue, and 107th and 120th +Streets, were subsequently bought by the Society for about $31,000. To +aid in the construction and maintenance of the necessary hospital +buildings, the Legislature, by an act reciting that there was no other +institution in the State where insane patients could be accommodated, +and that humanity and the interest of the State required that provision +should be made for their care and cure, granted an additional annual +appropriation of $10,000 to the Society from 1816 until 1857. The main +Hospital, built of brownstone, stood where the massive library of +Columbia University now is, and the brick building still standing at the +northeast corner of Broadway and 116th Street was the residence of the +Medical Superintendent. The only access to this site by land was over +what was known as the Bloomingdale Road, running from Broadway and 23d +Street through the Bloomingdale district on the North River to 116th +Street, and from that fact our institution assumed the name of +Bloomingdale Asylum, or, as it is now called, Bloomingdale Hospital. +This beautiful elevated site overlooking the Hudson River and the Harlem +River was admirably fitted for its purpose. The spacious tract of land, +laid out in walks and gardens, an extensive grove of trees, generous +playgrounds and ample greenhouses, combined to give the spot unusual +beauty and efficiency. This notable work finished, the Governors of the +Society issued on May 10, 1821, an "Address to the Public"[1] which +marks so great an advance in psychiatry in our country that it deserves +study. The national character of the institution was indicated in the +opening paragraph, where it announced that the Asylum would be open for +the reception of patients from any part of the United States on the +first of the following June. Accommodation for 200 patients was +provided, and to these new surroundings were removed on that day all the +mental cases then under treatment at the New York Hospital on lower +Broadway. + +In this retired and ideal spot the work of Bloomingdale Hospital was +successfully prosecuted for three-quarters of a century. But the seven +miles that separated it from the old hospital was steadily built over, +and before fifty years had gone the growth of the city had passed the +asylum grounds. Foreseeing that they could not maintain that verdant +oasis intact for many years longer, the Governors, in 1868, bought this +300-acre tract on the outskirts of the Village of White Plains. After +prolonged consideration of the time and method of development of the +property, final plans were adopted in December, 1891, construction was +begun May 1, 1892, and two years later, under the direction of our +Medical Superintendent, Dr. Samuel B. Lyon, all the patients were moved +from the old to this new Bloomingdale. The cost of the new buildings was +about $1,500,000. From time to time the original Bloomingdale site was +sold and now supplies room, among other structures, for Columbia +University, Barnard College, the Cathedral of St. John the Divine, St. +Luke's Hospital, the Woman's Hospital, and the National Academy of +Design. With the proceeds of those sales of the old Bloomingdale, not +only was the cost of the new Bloomingdale met, but the permanent +endowment of the Society was substantially increased, and Thomas Eddy +was proved to have been both a wise humanitarian and a far-sighted +steward of charitable funds. + +In their "Address to the Public" to which I have referred, issued when +Bloomingdale Hospital was opened in 1821, the Governors of the Society +spoke of the new conception of moral treatment of the mentally afflicted +which had been established in several European hospitals and which was +supplanting the harsh and cruel usage of former days, as "one of the +noblest triumphs of pure and enlightened benevolence." In that same +spirit those founders dedicated themselves to the conduct of this +institution. Their devotion to the work was impressive. Looking back on +those early days we see a constant personal attention to the details of +institutional life that commands admiration. The standards then set have +become a tradition that has been preserved unbroken for a hundred years. +Humane methods of care, the progressively best that medical science can +devise, the utilization of a growingly productive pursuit of research, +have consistently marked the administration of this great trust. The +Governors of to-day are as determined as any of their predecessors to +maintain that ideal of "pure and enlightened benevolence." New paths are +opening and larger resources are becoming available. Under the guidance +of our distinguished Medical Superintendent, with his able and devoted +staff of physicians, a broader and more intensive development is +already under way. Animated by that resolve and cheered by that +prospect, we may thus confidently hope, as we begin the second century +of Bloomingdale's career, for results not less fruitful and gratifying +than those which we celebrate to-day. + +FOOTNOTES: + +[Footnote 1: Address of the Governors of the New York Hospital, to the +Public, relative to the Asylum for the Insane at Bloomingdale, New York, +May 10th, 1821. Reprinted by Bloomingdale Hospital Press, White Plains, +May 26, 1921. See Appendix V, p. 212.] + + + + +ADDRESS BY +DR. ADOLF MEYER + + +_The Chairman_: In celebrating our centenary we are naturally dealing +also with the larger subject of general psychiatry. Our success in this +discussion should be materially promoted by the presence with us of Dr. +Adolf Meyer, Professor of Psychiatry in the Medical School of Johns +Hopkins University, and Director of the Phipps Psychiatric Clinic, of +Baltimore. Before taking up this important work in that famous medical +centre, Dr. Meyer was actively engaged for several years in psychopathic +work in New York. He will speak to us on "THE CONTRIBUTIONS OF +PSYCHIATRY TO THE UNDERSTANDING OF LIFE PROBLEMS." + + +DR. MEYER + +When Dr. Russell honored me with the invitation to speak at this +centenary celebration of the renowned Bloomingdale Hospital, my +immediate impulse was to choose as my topic a phase of psychiatric +development to which this Hospital has especially contributed through +our greatly missed August Hoch and his deeply appreciated coworker +Amsden. I have in mind the great gain in concreteness of the physician's +work with mind and the resulting contribution of psychiatry to a better +knowledge of human life and its problems. The great gain this passing +century is able to hand on to its successor is the clearer recognition +of just what the psychiatrist actually works with and works on. + +Of all the divisions of medicine, psychiatry has suffered longest from +man's groping for a conception of his own nature. Psychiatry means, +literally, the healing of souls. What then do we actually mean by soul +or by psyche? This question has too long been treated as a disturbing +puzzle. + +To-day we feel that modern psychiatry has found itself--through the +discovery that, after all, the uncritical common-sense view of mind and +soul is not so far remote from a critical common-sense view of the +individual and its life activity, freed from the forbidding and +confusing assumptions through which the concept of mind and soul has +been held in bewildering awe. + +Strange to say, good old Aristotle was nearer an understanding than most +of the wise men and women that have succeeded him for these more than +two thousand years. He saw in the psyche what he called the form and +realization or fulfilment of the human organism; he would probably now +say with us, the activity and function as an individual or person. + +Through the disharmonies and inevitable disruption of a +self-disorganizing civilization, the Greek and Roman world was plunged +into the dark centuries during which the perils of the soul and the +sacrificial attainment of salvation by monastic life and crusades +threatened to overshadow all other concern. This had some inevitable +results: it favored all those views through which the soul became like a +special thing or substance, in contrast to and yet a counterpart of the +physical body. As long as there was no objective experimental science, +the culminating solution of life problems had to be intrusted to that +remarkable development of religious philosophy which arose from the +blending of Hebrew religion and tradition and the loftiest products of +the Greek mind, in the form which St. Paul and the early Church fathers +gave to the teachings of Christ. From being the form and activation, or +function, of the organism in life, the soul feature of man was given an +appearance in which it could neither be grasped nor understood, nor +shaped, nor guided by man when it got into trouble. From the Middle Ages +there arose an artificial soul and an artificial world of souls +presented as being in eternal conflict with the evil of the flesh--_and +thus the house of human nature was divided against itself_. + +Science of the nineteenth century came nearer bringing mind and body +together again. The new astronomical conception of the world and the +growing objective experimental science gradually began to command +confidence, and from being a destroyer of excessively dogmatic notions, +science began to rise to its modern constructive and creative position. +But the problem of _mind_ remained on a wrong basis and still does so +even with most scientists. Too much had been claimed for the psyche, and +because of the singling out of a great world of spirit, the world of +fact had been compromised and left cold and dry and unattractive and +unpromising. No doubt it was necessary that the scientist should become +hardened and weaned from all misleading expectation, and shy of all the +spurious claims of sordid superstition and of childish fancy. He may +have been unduly radical in cutting out everything that in any way +recalled the misleading notions. In the end, we had to go through a +stage of psychology without a "soul," and lately even a psychology +without "consciousness," so that we might be safe from unscientific +pretensions. All the gyrations no doubt tended to retard the wholesome +practical attack upon the problems in the form in which we find them in +our common-sense life. + +The first effort at a fresh start tried to explain everything rather +one-sidedly out of the meagre knowledge of the body. Spinoza had said in +his remarkable Ethics (III, Prop. II, Schol.): "Nobody has thus far +determined what the body can do, _i.e._, nobody has as yet shown by +experience and trial what the body can do by the laws of nature alone in +so far as nature is considered merely as corporeal and extended, and +what it cannot do save when determined by mind." + +This challenge of Spinoza's had to be met. With some investigators this +seemed very literally all there was to be done about the study of +man--to show how far the body could explain the activity we call "the +mind." The unfortunate feature was that they thought they had to start +with a body not only with mind and soul left out but also with +practical disregard of the whole natural setting. They studied little +more than corpses and experimental animals, and many a critic wondered +how such a corpse or a frog could ever show any mind, normal or +abnormal. To get things balanced again, the vision of man had to expand +to take a sane and practical view of all of human life--not only of its +machinery. + +The human organism can never exist without its setting in the world. All +we are and do is of the world and in the world. The great mistake of an +overambitious science has been the desire to study man altogether as a +mere sum of parts, if possible of atoms, or now of electrons, and as a +machine, detached, by itself, because at least some points in the +simpler sciences could be studied to the best advantage with this method +of the so-called elementalist. It was a long time before willingness to +see the large groups of facts, in their broad relations as well as in +their inner structure, finally gave us the concept and vision of +integration which now fits man as a live unit and transformer of energy +into the world of fact and makes him frankly a consciously integrated +psychobiological individual and member of a social group. + +It is natural enough that man should want to travel on the road he knows +and likes best. The philosopher uses his logic and analysis and +synthesis. The introspectionist wants to get at the riddle of the +universe by crawling into the innermost depth of his own self-scrutiny, +even at the risk--to use a homely phrase--of drawing the hole in after +him and losing all connection with the objective world. The physicist +follows the reverse course. He gives us the appreciation of the +objective world around and in us. The chemist follows out the analytic +and synthetic possibilities of his atoms and elements, and the biologist +the growth and reproduction and multiplication of cells. Each sees an +open world of possibilities and is ready to follow as far as facts will +carry and as far as the imagination will soar. Each branch has created +its rules of the game culminating in the concept of objective science, +and the last set of facts to bring itself under the rules of objective +science, and to be accepted, has been man as a unit and personality. + +The mind and soul of man have indeed had a hard time. To this day, +investigators have suffered under the dogma that mind must be treated as +purely subjective entity, something that can be studied only by +introspection, or at least only with ultra-accurate instruments--always +with the idea that common sense is all wrong in its psychology. +Undoubtedly it was, so long as it spoke of a mind and soul as if what +was called so had to be, even during life, mysterious and inaccessible, +something quite different from any other fact of natural-history study. + +The great step was taken when all of life was seen again in its broad +relations, without any special theory but frankly as common sense finds +it, viz., as the activities and behavior of definite individuals--very +much as Aristotle had put it--"living organisms in their 'form' or +activity and behavior." Psychology had to wake up to studying other +minds as well as one's own. Common sense has always been willing to +study other persons besides our own selves, and that exactly as we study +single organs--viz., for what they are and do and for the conditions of +success and failure. Nor do we have to start necessarily from so-called +elements. Progress cannot be made merely out of details. It will not do +merely to pile up fragments and to expect the aggregates to form +themselves. It also takes a friend of facts with the capacity for +mustering and unifying them, as the general musters his army. Biology +had to have evolutionists and its Darwin to get on a broad basis to +start with, and human biology, the life of man, similarly had to be +conceived in a new spirit, with a clear recognition of the opportunities +for the study of detail about the brain and about the conditions for +its working and its proper support, but also with a clear vision of the +whole man and all that his happiness and efficiency depend upon. + +All this evolution is strongly reflected in the actual work of +psychiatry and medicine. For a time, it looked to the physician as if +the physiology and pathology of the body had to make it their ambition +to make wholly unnecessary what traditional psychology had accumulated, +by turning it all into brain physiology. The "psychological" facts +involved were undoubtedly more difficult to control, so much so that one +tried to cut them out altogether. As if foreshadowing the later academic +"psychology without soul and consciousness," the venerable +Superintendent of Utica, Dr. Gray, was very proud when in 1870 he had +eliminated the "mental and moral causes" from his statistics of the +Utica State Hospital, hiding behind the dogma that "mind cannot become +diseased, but only the body." To-day "mental and moral causes" are +recognized again in truer form--no longer as mere ideas and +uninvestigated suppositions taken from uncritical histories, but as +concrete and critically studied life situations and life factors and +life problems. Our patients are not sick merely in an abstract mind, but +by actually living in ways which put their mind and the entire organism +and its activity in jeopardy, and we are now free to see how this +happens--since we study the biography and life history, the resources of +adaptation and of shaping the life to success or to failure. + +The study of life problems always concerns itself with the interaction +of an individual organism with life situations. The first result of a +recognition of this fact was a more whole-hearted and practical concept +of personality. + +In 1903 I put together for the first time my analysis of the neurotic +personality, which was soon followed by a series of studies on the +influences of the mental factors, and in 1908 a paper on "What Do +Histories of Cases of Insanity Teach Us Concerning Preventive Mental +Hygiene During the Years of School Life?" All this was using for +psychiatry the growing appreciation of a broad biological view-point in +its concrete application. It was a reaction against the peculiar fear of +studying the facts of life simply and directly as we find and experience +them--scoffed at because it looked as if one was not dealing with +dependable and effective data. Many of the factors mentioned as causes +do not have the claimed effects with sufficient regularity. It is quite +true that not everybody is liable to any serious upset by several of the +handicaps sometimes found to be disastrous during the years of +development; but we have learned to see more clearly why the one person +does and the other does not suffer. Evidently, not everybody who is +reserved and retiring need be in danger of mental disorder, yet there +are persons of just this type of make-up that are less able than others +to stand the strains of isolation, of inferiority feeling, of exalted +ambitions and one-sided longings, intolerable desires, etc. The same +individual difference of susceptibility holds even for alcohol. With +this recognition we came to lay stress again on the specific factors +which make for the deterioration of habits, for tantrums with +imaginations, and for drifting into abnormal behavior, and conditions +incompatible with health. + +It was at this point that our great indebtedness to the Bloomingdale +Hospital began. Dr. August Hoch, then First Assistant of the +Bloomingdale Hospital, began to swing more and more toward the +psychobiological trend of views, and with his devoted and very able +friend Amsden he compiled that remarkable outline,[2] which was the +first attempt to reduce the new ideals of psychobiology to a practical +scheme of personality study--that clear and plain questionnaire going +directly at human traits and reactions such as we all know and can see +at work without any special theories or instruments. + +After studying in each patient all the non-mental disorders such as +infections, intoxications, and the like, we can now also attack the +problems of life which can be understood only in terms of plain and +intelligible human relations and activities, and thus we have learned to +meet on concrete ground the real essence of mind and soul--the plain and +intelligible human activities and relations to self and others. There +are in the life records of our patients certain ever-returning +tendencies and situations which a psychiatry of exclusive brain +speculation, auto-intoxications, focal infections, and internal +secretions could never have discovered. + +Much is gained by the frank recognition that man is fundamentally a +social being. There are reactions in us which only contacts and +relations with other human beings can bring out. We must study men as +mutual reagents in personal affections and aversions and their +conflicts; in the desires and satisfactions of the simpler appetites for +food and personal necessities; in the natural interplay of anticipation +and fulfilment of desires and their occasional frustration; in the +selection of companionship which works helpfully or otherwise--for the +moment or more lastingly throughout the many vicissitudes of life. All +through we find situations which create a more or less personal bias and +chances for success or failure, such as simpler types of existence do +not produce. They create new problems, and produce some individuals of +great sensitiveness and others with immunity--and in this great field +nothing will replace a simple study of the life factors and the social +and personal life problems and their working--the study of the real mind +and the real soul--_i.e._, human life itself. Looking back then this +practical turn has changed greatly the general view as to what should be +the chief concern of psychology. One only need take up a book on +psychology to see what a strong desire there always was to contrast a +pure psychology and an applied psychology, and to base a new science +directly on the new acquisitions of the primary sciences such as anatomy +and histology of the nervous system. There was a quest for the elements +of mind and their immediate correlation with the latest discoveries in +the structure of the brain. The centre theory and the cell and neurone +theory seemed obligatory starting-points. To-day we have become shy of +such postulates of one-sided not sufficiently functional materialism. We +now call for an interest in psychobiological facts in terms of critical +common sense and in their own right--largely a product of psychiatry. +There always is a place for elements, but there certainly is also a +place for the large momentous facts of human life just as we find and +live it. + +Thus psychiatry has opened to us new conceptions and understandings of +the relation of child and mother, child and father, the child as a +reagent to the relations between mother and father, brothers and +sisters, companions and community--in the competitions of real concrete +life. It has furnished a concrete setting for the interplay of emotions +and their effects. + +It has led us from a cold dogma of blind heredity and a wholesale +fatalistic asylum scheme, to an understanding of individual, familiar, +and social adjustments, and a grasp on the factors which we can consider +individually and socially modifiable. We have passed from giving mere +wholesale advice to a conscientious study of the problems of each unit, +and at the same time we have developed a new and sensible approach to +mental hygiene and prevention, as expressed in the comprehensive surveys +of State and community work and even more clearly in the development of +helps to individuals in finding themselves, and in the work in schools +to reach those who need a special adaptation of aims and means. To the +terrible emergency of the war it was possible to bring experienced men +and women as physicians and nurses, and how much was done, only those +can appreciate who have seen the liberality with which all the +hospitals, and Bloomingdale among the first, contributed more than their +quota of help, and all the assistance that could possibly be offered to +returning victims for their readjustment. + +It is natural enough that psychiatry should have erred in some respects. +We had forced upon us the herding together of larger numbers of patients +than can possibly be handled by one human working unit or working group. +The consequence was that there arose a narrowing routine and wholesale +classifications and a loss of contact with the concrete needs of the +individual case; that very often progress had to come from one-sided +enthusiasts or even outsiders, who lost the sense of proportion and +magnified points of relative importance until they were supposed to +explain everything and to be cure-alls. We are all inclined to sacrifice +at the altar of excessive simplicity, especially when it suits us; we +become "single-taxers" and favor wholesale legislation and exclusive +State care when our sense for democratic methods has gone astray. Human +society has dealt with the great needs of psychiatry about as it has +dealt with the objects of charity, only in some ways more stingily, with +a shrewd system and unfortunately often with a certain dread of the +workers themselves and of their enthusiasm and demands. Law and +prejudice surrounded a great share of the work with notions of stigma +and hopelessness and weirdness--while to those who see the facts in +terms of life problems there can be but few more inspiring tasks than +watching the unfolding of the problematic personality, seeking and +finding its proper settings, and preventing the clashes and gropings in +maladjustments and flounderings of fancy and the faulty use and +nutrition of the brain and of the entire organism. + +What a difference between the history of a patient reported and studied +and advised by the well-trained psychiatrist of to-day and the account +drawn up by the statistically minded researcher or the physician who +wants to see nothing but infections or chemistry and hypotheses of +internal secretion. What a different chance for the patient in his +treatment, in contrast to what the venerable Galt of Virginia reports as +the conception of treatment recommended by a great leader of a hundred +years ago: "Mania in the first stage, if caused by study, requires +separation from books. Low diet and a few gentle doses of purging +physic; if pulse tense, ten or twelve ounces of blood [not to be given +but to be taken!]. In the high grade, catch the patient's eye and look +him out of countenance. Be always dignified. Never laugh at or with +them. Be truthful. Meet them with respect. Act kindly toward them in +their presence. If these measures fail, coercion if necessary. +Tranquillizing chair. Strait waistcoat. Pour cold water down their +sleeves. The shower bath for fifteen or twenty minutes. Threaten them +with death. Chains seldom and the whip never required. Twenty to forty +ounces of blood, unless fainting occurs previously; ... etc." + +To-day an understanding of the life history, of the patient's somatic +and functional assets and problems, likes and dislikes, the problem +presented by the family, etc.! + +So much for the change within and for psychiatry. How about psychiatry's +contribution beyond its own narrower sphere? It has led us on in +philosophy, it has brought about changes in our attitude to ethics, to +social study, to religion, to law, and to life in general. Psychiatric +work has undoubtedly intensified the hunger for a more objective and yet +melioristic and really idealistic philosophical conception of reality, +such as has been formulated in the modern concept of integration. + +Philosophical tradition, logic, and epistemology alike had all conspired +to make as great a puzzle as possible of the nature of mental life, of +life itself, and of all the fundamental principles, so much so that as +a result anything resembling or suggesting philosophy going beyond the +ordinary traditions has got into poor repute in our colleges and +universities and among those of practical intelligence. The consequence +is that the student and the physician are apt to be hopeless and +indifferent concerning any effort at orderly thinking on these +problems.[3] + +Most of us grew up with the attitude of a fatalistic intellectual +hopelessness. How could we ever be clear on the relation of mind and +body? How could mind and soul ever arise out of matter? How can we +harmonize strict science with what we try to do in our treatment of +patients? How can we, with our mechanistic science, speak of effort, and +of will to do better? How can we meet the invectives against the facts +of matter on the part of the opposing idealistic philosophies and their +uncritical exploitations in "New Thought"--_i.e._, really the revival of +archaic thought? It is not merely medical usefulness that forced these +broad issues on many a thinking physician, but having to face the facts +all the time in dealing with a living human world. The psychopathologist +had to learn to do more than the so-called "elementalist" who always +goes back to the elements and smallest units and then is apt to shirk +the responsibility of making an attempt to solve the concrete problems +of greater complexity. The psychiatrist has to study individuals and +groups as wholes, as complex units, as the "you" or "he" or "she" or +"they" we have to work with. We recognize that throughout nature we have +to face the general principle of unit-formation, and the fact that the +new units need not be like a mere sum of the component parts but can be +an actually new entity not wholly predictable from the component parts +and known only through actual experience with the specific product. +Hydrogen and oxygen, it is true, can form simple mixtures, but when they +make an actual chemical integration we get a new specific type of +substance, water, behaving and dividing according to its own laws and +properties in a way not wholly predictable from just what we know of +hydrogen and oxygen as such. Analogy prompts us to see in plants and +animals products of physics and chemistry and organization, although the +peculiarity of the product makes us recognize certain specificities of +life not contained in the theory of mere physics and chemistry. All the +facts of experience prompt us to see in mentation a biological function, +and we are no longer surprised to find this product of integration so +different from the nature and functions of all the component parts. All +the apparent discontinuities in the intrinsic harmony of facts, on the +one hand, and the apparent impossibility of accounting for new features +and peculiarities of the new units, are shown to be a general feature of +nature and of facts: integration is not mere summation, but a creation +of ever-new types and units, with superficial discontinuities and with +their own new denominators of special peculiarities; hence there is no +reason to think of an insurmountable and unique feature in the origin of +life, nor even of mentally integrated life; no need of special mystical +sparks of life, of a mysterious spirit, etc.; but--and this is the +important point--also no need of denying the existence of all the +evidence there may be of facts which we imply when we use the deeply +felt concepts of mind and soul. In other words, we do not have to be +mind-shy nor body-shy any longer. + +The inevitable problem of having to study other persons as well as +ourselves necessarily leads us on to efforts at solution of other +philosophical problems, the problem of integrating materialism and +idealism, mechanism and relative biological determinism and purpose, +etc. Man has to live with the laws of physics and chemistry unbroken and +in harmony with all that is implied in the laws of heredity and growth +and function of a biological organism. Yet what might look like a +limitation is really his strength and safe foundation and stability. On +this ground, man's biological make-up has a legitimate sphere of growth +and expansion shared by no other type of being. We pass into every new +moment of time with a preparedness shown in adaptive and constructive +activity as well as structure, most plastic and far-reaching in the +greatest feat of man, that of imagination. Imagination is not a mere +duplication of reality in consciousness and subjectivity; it is a +substitute in a way, but actually an amplification, and often a real +addition to what we might otherwise call the "crude world," integrated +in the real activities of life, a new creation, an ever-new growth, seen +in its most characteristic form in choice and in any new volition. Hence +the liberating light which integration and the concepts of growth and +time throw on the time-honored problem of absolute and relative +determinism and on the relation of an ultra-strict "science" with common +sense. + +In logic, too, we are led to special assertions. We are forced to +formulate "open definitions," _i.e._, we have to insist on the open +formulation of tendencies rather than "closed definitions." We deal with +rich potentialities, never completely predictable. + +This background and the demands of work in guiding ourselves and others +thus come to lead us also into practical ethics, with a new conception +of the relation of actual and experimental determinism and of what "free +will" we may want to speak of, with a new emphasis on the meaning of +choice, of effort, and of new creation out of new possibilities +presented by the ever-newly-created opportunities of ever-new time. We +get a right to the type of voluntaristic conception of man which most of +us live by--with a reasonable harmony between our science and our +pragmatic needs and critical common sense. + +The extent to which we can be true to the material foundations and yet +true to a spiritual goal, ultimately measures our health and natural +normality and the value of our morality. _Nature shapes her aims +according to her means._ Would that every man might realize this simple +lesson and maxim--there would be less call for a rank and wanton +hankering for relapses into archaic but evidently not wholly outgrown +tendencies to the assumption of "omnipotence of thought," revived again +from time to time as "New Thought." Psychiatry restores to science and +to the practical mind the right to reinclude rationally and +constructively what a narrower view of science has, for a time at least, +handed over unconditionally to uncritical fancy. But the only way to +make unnecessary astrology and phrenology and playing with mysticism and +with Oliver Lodge's fancies of the revelation of his son Raymond, is to +recognize the true needs and yearnings of man and to show nature's real +ways of granting appetites and satisfactions that are wholesome. + +Hereby we have indeed a contribution to biologically sound idealism: a +clearer understanding of how to blend fact and ambition, nature and +ideal--an ability to think scientifically and practically and yet +idealistically of matters of real life. + +To come back to more concrete problems again, a wider grasp of what +psychiatry may well furnish us helps toward a new ethical goal in our +social conscience. The nineteenth century brought us the boon and the +bane of industrialism. More and more of the pleasures and satisfactions +of creation and production and of the natural rewards of the daily labor +drifted away from the sight and control of the worker, who now rarely +sees the completed result of his work as the farmer or the artisan used +to do. Few workers have the experience of getting satisfaction from +direct pride in the end result; as soon as the product is available, a +set of traders carries it to the markets and a set of financiers +determines, in fact may already have determined, the reward--just as the +reward of the farmer is often settled for him by astounding +speculations long before the crop is at hand. There is a field for a new +conscience heeding the needs of fundamental satisfactions of man so well +depicted by Carlton Parker, and psychiatric study furnishes much +concrete material for this new conscience in industrial relations--with +a better knowledge of the human needs of all the participants in the +great game of economic life. + +Psychiatry gives us also a new appreciation of the religious life and +needs of our race. Man's religion shows in his capacity to feel and +grasp his relations and responsibility toward the largest unit or force +he can conceive, and his capacity for faith and hope in a deeper and +more lasting interdependence of individual and race with the Ruler or +rules of the Universe. Whatever form it may take expresses his capacity +to feel himself in humility and faith, and yet with determination, a +more or less responsible part of the greatest unit he can grasp. The +form this takes is bound to vary individually. As physicians we learn to +respect the religious views of our fellow beings, whatever they may be; +because we are sure that we have the essentials in common; and with this +emphasis on what we have in common, we can help in attaining the +individually highest attainable truth without having to be destructive. +We all recognize relations that go beyond individual existence, lasting +and "more than biological" relations, and it is the realization of these +conceptions intellectually and emotionally true to our individual and +group nature that constitutes our various religions and faiths. +Emphasizing what we have in common, we become tolerant of the idea that +probably the points on which we differ are, after all, another's best +way of expressing truths which our own nature may picture differently +but would not want to miss in, or deny to, the other. One of the +evidences of the great progress of psychiatry is that we have learned to +be more eager to see what is sane and strong and constructively valuable +even in the strange notions of our patients, and less eager to call them +queer and foolish. A delusion may contain another person's attempt at +stating truth. The goal of psychiatry and of sound common sense is truth +free of distortion. Many a strange religious custom and fancy has been +brought nearer our understanding and appreciation since we have learned +to respect the essential truth and individual and group value of fancy +and feeling even in the myths and in the religious conceptions of all +races. + +Among the most interesting formulations and potential contributions of +psychiatry are those reaching out toward jurisprudence. Psychiatry deals +pre-eminently with the variety and differences of human personalities. +To correct or supplement a human system apparently enslaved by concern +about precedent and baffling rules of evidence inherited from the days +of cruel and arbitrary kings, the demand for justice has called for +certain remedies. Psychiatry still plays a disgraceful rôle in the +so-called expert testimony, largely a prostitution of medical authority +in the service of legal methods. Yet, out of it all there has arisen the +great usefulness of the psychiatrist in the juvenile and other courts. +There it is shown that if psychiatry is to help, it should be taken for +granted that the person indicted on a charge should thereby become +subject to a complete and unreserved study of all the facts, subject to +cross-examination, to be sure, but before all accessible to complete and +unreserved study. This would mean a substantial participation of law in +the promotion of knowledge of facts and constructive activity, and a +conception of indeterminate sentence not merely in the service of +leniency but in the service of the best protection of the public, and, +if necessary, lasting detention of those who cannot be reformed, before +they have had to do their worst. Whoever is clearly indicted for +breaking the laws of social compatibility should not merely invite a +spirit of revenge, but should, through the indictment, surrender +automatically to legalized authority endowed with the right and duty of +an unlimited investigation of the facts as they are. + +Looking back then, you can see how the history of the human thought +about what we call mind and psyche displayed some strange reactions of +the practical man, the scientist, the philosopher, and theologian toward +one of the most important and practical problems. It is difficult to +realize what it means to arrive at ever-more-workable formulations and +methods of approach. We do not have to be mind-shy _or_ body-shy any +longer. To-day we can attack the facts as we find them, without that +disturbing obsession of having to translate them first into something +artificial before we can really study them and work with them. Since we +have reached a sane pluralism with a justifiable conviction of the +fundamental consistency of it all, a satisfaction with what we modestly +call formulation rather than definition and with an appreciation of +relativity, we have at last an orderly and natural field and method from +which nobody need shy. + +The century that has passed since the inspiration of a few men of the +Society of the New York Hospital to provide for the mentally sick has +cleared the atmosphere a great deal. We can start the second century +freer and unhampered in many ways. Much has been added, and more than +ever do we appreciate the position of just such a hospital as that of +Bloomingdale as a centre of healing and as a leader of public opinion +and as a contributor to progress. + +The Bloomingdale Hospital has a remarkable function. It is a more or +less privileged forerunner in standards and policies. Without having to +carry the burdens of the whole State with its sweeping and sometimes +distant power and its forced economy, a semiprivate hospital like +Bloomingdale aims to minister to a slightly select group, especially +those who are in the difficult position of greater sensitiveness but +moderate means in days of sickness. It serves the part of our community +which more than any other sets the pace of the civilization about +us--the intelligent aspiring workers who may not have reached the goal +of absolute financial independence. It creates the standard of which we +may dream that it might become the standard of the whole State. + +When we review the roster of Superintendents--from John Neilson to Pliny +Earle and from Charles Nichols, Tilden Brown, and Samuel Lyon down to +the present head, our highly esteemed friend and coworker William L. +Russell--and the names of the members of the staff, many of whom have +reached the highest places in the profession, and last, but not least, +the names of the Governors of The Society of the New York Hospital, we +cannot help being impressed by the forceful representation of both the +profession and the public, and we recognize the wide range of influence. + +Instead of depending on frequently changing policies regulated from the +outside under the influence of the greater and lesser lights and +exigencies of State and municipal organization, the New York Hospital +has its self-perpetuating body of Governors chosen from the most +public-spirited and thoughtful representatives of our people. +Bloomingdale thus has always had a remarkable Board of Governors, who, +from contact with the General Hospital and with this special division, +are in an unusual position to see the practical aspects of the great +change that is now taking place. You see how the division of psychiatry +has developed from practically a detention-house to an asylum, and +finally to a hospital with all the medical equipment and laboratories of +the General Hospital. And you begin to see psychiatry, with its methods +of study and management of life problems as well as of specific brain +diseases, infections, and gastrointestinal and endocrine conditions, +become more and more helpful, even a necessity, in the wards and +dispensary of the General Hospital on 16th Street. The layman cannot, +perhaps, delve profitably into the details of such a highly and broadly +specialized type of work. But he can readily take a share in the best +appreciation of the general philosophy and policy of it all. + +The shaping of the policy of a semiprivate hospital is not quite as +simple as shaping that of a State Hospital with its well-defined +districts and geographically marked zones of responsibility. +Bloomingdale has its sphere of influence marked by qualitative selection +rather than by a formal consideration. It does not pose as an invidious +contrast to the State Hospital, and yet it is intended to solve in a +somewhat freer and more privileged manner the problem of providing for +the mentally sick of a more or less specific hospital constituency, the +constituency of the New York Hospital; and since it reaches the most +discriminating and thinking part of our population, it has the most +wonderful opportunity to shape public opinion. Like all psychiatrical +institutions, it has to live down the traditional notions of the +half-informed public; it has to make conspicuous the change of spirit +and the better light in which we see our field and responsibilities. +This organization can show that it is not mere insanity but the working +out of life problems that such a hospital as this is concerned with. The +conditions for which it cares are many. Some of them are all that which +tradition and law stamp as insanity. But see what a change. +Seventy-five per cent of the patients are voluntary admissions; and more +and more will be able to use the helps when they begin to feel the need, +not merely when it becomes an enforced necessity. + +By creating for this Hospital a liberal foundation, by completing its +equipment so as to make possible a free exchange of patients and of +workers from the Hospital in the city and this place in the country, +much has been done and more will be done to set a living example of the +very spirit of modern psychopathology and psychiatry. We know now that +from 10 to 40 per cent of the patients of the gynecologist, the +gastroenterologist, and the internist generally would be better treated +if a study of the life problems were added to that of the special organs +and functions. To meet this need it should be possible to have enough +workers in this branch of the Hospital to take their share of the +consulting and co-operation work in the wards and dispensary of the +General Hospital, and perhaps even in the schools provided for the same +type of people from which you draw your patients. The grouping of the +patients can be such that the old prejudices need not reach far into the +second century of the life of the Hospital. With a man of the vision and +practical experience of Dr. Russell, there is no need for an outsider to +conjure up a picture of special practical achievements as I have done +of the more general principles to-day. + +An institution is more than a human life. Many ambitions combine and +become part of a group spirit permeating the organization and reaching +their fulfilment in the succession of leaders. The life and growth and +happy self-realization of an institution is not the bricks and +mortar--it is a living and elastic entity--never too stable, never too +finished, a growing and plastic plant--to use a metaphor that has +slipped in perhaps without arousing all the implications the term plant +might carry and does carry. + +Some years ago my wife celebrated her birthday and told her colored cook +jocosely: "Geneva, I am a hundred years old to-day." The cook's jaw +dropped and then she suddenly remarked: "Lord! you don't look dat ole." +That is the way I feel about Bloomingdale Hospital as we see it to-day +pulsating with ever-fresh life and ever-fresh problems! How different +from a simple human being, after all! The heart and wisdom of many a man +and woman has gone into the perpetuation of what a few thoughtful men +started in 1821 and the result is that it is ever renewing its youth. + +Many a dream has been realized and many a dream has given way to +another. Here and there the past may make itself felt too much. But the +spirit and its growth show in recruiting ever-new lives to meet the +present day and the days to come, and this all the more so if we can +show the younger generation that every effort is likely to have its +reasonable direct support. We all want a man like Dr. William L. Russell +to have the fullest opportunity to bring to its best expression the rich +and well-tried wisdom of over twenty-five years of devoted work in the +field. This is no doubt a time of stress when many personal and general +sacrifices may be needed to bring about the fruition and culmination of +the labors of the present generation. Yet is it not a clear opportunity +and duty, so that those who are growing up in the ranks to-day may +really be encouraged to get a solid training, always animated by the +conviction that one can be sure of the practical reward for toiling +through the many years of preparation in a psychiatric career, whether +it be as a physician or as a nurse or as an administrator? + +I cannot help feeling as I stand here that I am in a way representing +not only my own sentiments and convictions but those of our dear old +friend Hoch. We all wish that he might be with us to express himself the +warm feelings toward the Bloomingdale Hospital and its active +representatives, from the managers to the humblest workers. Hoch in his +modesty could probably not have been brought to state fully and frankly +his own share in the achievements of this Hospital. But I know how much +he would have liked to be here to express especially the warmth of +appreciation we all entertain of what our friend William L. Russell +means to us and has meant to us all through the nearly twenty-five years +of our friendship and of working together. We delight in seeing him +bring to further fruition the admirable work he did at Willard, and +later for all the State hospitals; and that which we see him do at all +times for sanity in the progress of practical psychiatry, and now +especially in the guidance of this institution. We delight in seeing his +master mind given more and more of a master's chance for the practical +expression of his ideals and convictions concerning the duties and +opportunities of such a hospital as Bloomingdale. + +Our thanks and best wishes to those who invited us to stand here to-day +at the cradle of a second century of Bloomingdale Hospital! It is a +noteworthy gathering that joins here in good wishes to those who have +shaped this ever-new Bloomingdale. With a tribute to our thoughtful and +enthusiastic friend in internal medicine, Lewellys F. Barker, to our +English coworker, Richard G. Rows, to the illustrious champion of French +psychopathology, Pierre Janet, to our friend and leader in practical +psychiatry, William L. Russell, to our friends and coworkers of the +Bloomingdale staff, and especially also to the Board of Governors who +shape the policy and control the finances, and exercise the leadership +of public opinion, I herewith express my sincerest thanks and best +wishes. + +FOOTNOTES: + +[Footnote 2: A Guide to the Descriptive Study of the Personality, with +Special Reference to the Taking of Anamneses of Cases with Psychoses, by +Dr. August Hoch and Dr. George S. Amsden.] + +[Footnote 3: See, for instance, Moebius, The Hopelessness of All +Psychology, reviewed in the Psychological Bulletin, vol. IV, 1907, pp. +170-179.] + + + + +ADDRESS BY +DR. LEWELLYS F. BARKER + + +_The Chairman_:--The Johns Hopkins Medical School lends us also to-day +Dr. Lewellys F. Barker, its Professor of Clinical Medicine. Dr. Barker +has done so much to define and settle the contradictions of mind and +matter, and has clarified so much, and in fields so varied, as teacher, +research worker, and practitioner, that we welcome this opportunity of +listening to his discussion of "THE IMPORTANCE OF PSYCHIATRY IN GENERAL +MEDICAL PRACTICE." + + +DR. BARKER + +We have met to-day to celebrate the hundredth anniversary of the +founding of a hospital that, in its simpler beginnings and in its +evolution to the complex and highly organized activities of the present, +has served an eminently practical purpose and has played an important +rôle in the development of the science and art of psychiatry in America. +I desire, as a representative of general medicine, and, especially, of +internal medicine, to add, on this occasion, my congratulations to those +of the spokesmen of other groups, and, at the same time to express the +hope that this institution, historically so significant for the century +just past, may maintain its relative influence and reputation in the +centuries to come. + +The interest taken in psychiatry by the general practitioner and by the +consulting internist has been growing rapidly of late. Some of the +reasons for this growth of interest and heightening of appreciation I +have drawn attention to on an earlier occasion.[4] Psychiatry as a whole +was for a long time as widely separated from general medicine as +penology is to-day, and for similar reasons. It was a long time before +persons that manifested extraordinary abnormalities of thought, feeling, +and behavior were regarded as deserving medical study and care, and even +when a humanitarian movement led to their transfer from +straight-jackets, chains, and prison cells to "asylums for the insane," +these institutions were, for practical reasons, so divorced from the +homes of the people and from general hospitals that psychiatry had, and +could at the time have, but little intercourse with general medicine or +with general society. Mental disorders were moral and legal problems +rather than biological, social, and medical problems. Their genesis was +wholly misunderstood, and legal, medical, social, religious, and +philosophic prejudices went far toward preventing any rational +scientific mode of approach to the questions involved or any formulation +of investigative procedures that promised to be fruitful. Even to-day +the same prejudices are all too inhibitory; but thanks to the +unprecedented development of the natural sciences during the period +since this hospital was founded, we are witnessing, in our time, a rapid +transformation of thought and opinion concerning both the normal and the +disordered mind, a transformation that is reaching all circles of human +beings, bidding fair to compel the strongholds of tradition and +prejudice to relax, and inviting the whole-hearted co-operation of +workers in all fields in a common task of overcoming some of the +greatest difficulties by which civilization and human progress are +confronted. And though the brunt of this task is borne and must be borne +by the shoulders of medical men, physicians assume the burden +cheerfully, now that they know that they can count upon the intelligent +support and the cordial sympathy of an ever-enlarging extra-medical +aggregate. No better illustration could be given, perhaps, of the change +in the status of psychiatry in this country and in the world than the +contents of the programme of our meeting to-day at which a distinguished +investigator from London tells us of the biological significance of +mental disorders, an eminent authority from Paris explains the +relationship between certain diseases of the nervous system and these +disorders, and a leading psychiatrist of this country speaks upon the +contributions of psychiatry to the understanding of the problems of +life. Psychiatry, like each of the other branches of medicine, has come +to be recognized as one of the subdivisions of the great science of +biology, free to make use of the scientific method, in duty bound to +diffuse the knowledge that it gains, and privileged to contribute +abundantly to the lessening of human suffering and the enhancement of +human joys. General practitioners of medicine and medical +specialists--at least the more enlightened of them--welcome the +developing science of psychiatry, are eager to hasten its progress, and +will gladly share in applying its discoveries to the early diagnosis, +the cure, and the prevention of disease. + +That the majority of medical and surgical specialists and even most of +the widely experienced general practitioners, though constantly coming +in contact with major and minor psychic disturbances, are, however, +still far from realizing the full meaning and value of the principles +and technic of modern psychology and of the newer psychiatry must, I +fear, be frankly admitted.[5] But dare we blame these practitioners for +their ignorance of, apathy regarding, and even antipathy to, the psychic +and especially the psychotic manifestations of their patients? Ought we +not rather to try to understand the reasons for this ignorance, this +apathy, and this aversion, all three of which seem astonishing to many +of our well-trained psychologists and psychopathologists? Are there not +definite conditions that explain and at least partially excuse the +defects in knowledge and interest and the errors in attitude manifested +by those whom we would be glad to see cognizant and enthusiastically +participant? Psychiatrists, who have taught us to understand and rescue +various types of "sinners" and "social offenders" will, I feel sure, +avoid any moralistic attitude when discussing the shortcomings of their +brethren in the general medical profession, and will, instead, seek to +discover and to remove their causes. + +As an internist who values highly the gifts that modern psychology and +psychiatry have been making to medicine, I have given some thought to +the conditions and causes that may be responsible for these professional +delinquencies that you deplore. Though this is not the time nor the +place fully to discuss them, the mere mention of some of the causes and +conditions will, perhaps, contribute to comprehension and pardon, and +may serve to stimulate us all to livelier corrective activity. Let me +enumerate some of them: + +(1) A social stigma still attaches, despite all our efforts to abolish +it, to mental disorders and has, to a certain extent, been transferred +to those that study and treat patients manifesting these disorders. + +(2) The organization of our general education is very defective since it +fails to make clear to each student man's place in the universe and any +orderly view of the world and man; it fails adequately to enlighten the +student regarding the processes of life as adaptations of organisms to +their environment, man, himself, being such an organism reacting +physically and psychically to his surroundings in ways either favorable +or unfavorable to his own preservation and that of his species; it fails +to teach the student that the human organism represents a bundle of +instincts each with its knowing, its feeling, and its striving +component, that what we call "knowledge" and what we call "character" +are gradual developments in each person, and that if we know how they +have developed in a particular person we possess clues to the way that +person will react under a given stimulus, that is to say, what he will +think, how he will feel, and how he will act; and it fails, again, +properly to instruct students regarding the interrelationships of +members of different social groups (familial, civic, economic, +occupational, ethical, national, racial, etc.); in other words, our +general educational organization is as yet far from successful in +inculcating philosophical, biological, psychological, and sociological +conceptions that are adequate symbols of reality. + +(3) Though our medical schools have made phenomenal advances in the +organization and equipment of their institutes and in provision for +teaching and research in a large number of preclinical and clinical +sciences, they have up to now almost wholly ignored normal psychology, +psychiatry, and mental hygiene. The majority of the professors in these +schools are so absorbed by the morphological, physical, and chemical +aspects of their subjects, that students rarely get from them any +inkling of the psychobiological aspect, any adequate knowledge of human +motives, or any satisfactory data regarding human behavior, normal or +abnormal.[6] It is only recently and only in a few schools that +psychiatric clinics have been established as parts of the teaching +hospitals, that medical students have been able to come into direct +contact over an appreciable period of time with the objects of +psychiatric study, that the psychic manifestations of patients have +received any direct and particular attention in the general medical and +surgical wards, and that there has been any free and constant reciprocal +exchange of thought and opinion between students of the somatic on the +one hand and students of the psychic on the other. + +(4) The language of the psychiatrist is unique and formidable. The names +he has applied to motives and impulses, to symptoms and syndromes, are +foreign to the tongue of the general practitioner who is so awed by +them that he withdraws from them and remains humbly reticent in a state +of enomatophobia; or, if he be more tough-minded, he may be amused by, +or contemptuous of, what he refers to as "psychiatric jargon" or +"pseudoscientific gibberish." There is, furthermore, a dearth of +concise, authoritative, well-written text-books on psychiatry, and the +general medical journals rarely print psychiatric papers designed to +interest the average practitioner. The most widely diffused psychiatric +reports of our time are the sensational news items of the daily press. + +(5) The overemphasis of psychogenetic factors to the apparent neglect of +important somatogenic factors by some psychiatrists has tended to arouse +suspicion regarding the soundness of the opinions and methods of +psychiatric workers in the minds of men thoroughly imbued with +mechanistic conceptions and impressed with the results of medical +researches based upon them. The ardor of the psychoanalysts, also, +though in part doubtless justified by experience, has, it is to be +feared, excited a certain amount of antipathy among the uninitiated. + +(6) The fears of insanity prevalent among the laity and the repugnance +of patients to any idea that they may be "psychotic" or "psychoneurotic" +(words that, in their opinion, refer to "imaginary symptoms," or to +symptoms that they could abolish if they would but "buck up" and exert +their "wills") undoubtedly exert a reflex influence upon practitioners +who put the "soft pedal" on the psychobiological reactions and "pull out +the stop" that amplifies the significance of any abnormal physical +findings. + +(7) Psychotherapy, to the mind of the average medical practitioner, is +(or has been) something mysterious or occult. He uses much psychotherapy +himself but it is nearly always applied unconsciously and indirectly +through some form of physical or chemical therapy that he believes will +cure. He is usually quite devoid of insight into the effect of his own +expressed beliefs and bodily attitudes upon the adjusting mechanisms of +his patients. Conscious and direct psychotherapy is left by the average +practitioner to New Thoughters, Christian Scientists, quacks, and +charlatans. If he were to use psychotherapy consciously and were to +receive a professional fee for it he would feel that he was being paid +for a value that the patient had not received. A highly respected +colleague once privately criticised a paper of mine (read before the +Association of American Physicians) on the importance of psychotherapy. +"What you said is true," he remarked; "we all use psychotherapy but we +are a little ashamed of it; and it is better not to talk about it." Even +he did not realize that every psychotherapy is also a physical therapy. + +(8) The rise of specialism, through division of labor and +intensification of interests restricted to limited fields, in practical +medicine, the necessary result and to a large extent also a cause of the +rapid growth of knowledge and technic has brought with it many +advantages, but also some special difficulties, among them (a) the +impossibility any longer of any single practitioner, unaided, to study +and treat a patient as well as he can be studied and treated by a +co-ordinated group whose special analytical studies in single domains +are adequately synthesized by a competent integrator, and (b) in the +absence of such group work, the tendency to one-sided study, partial +diagnosis, and incomplete and unsatisfactory therapy. Through the rise +of specialism, it is true, psychiatry itself has arisen and the +psychiatrist, like the skilled integrating internist, is interested in +the synthesis of the findings in all domains, for only through such +synthetic studies, such integration of the functional activities of the +whole organism, is it possible to gain a global view of the patient as a +person, to make a complete somatic, psychic, and social diagnosis, and +to plan a regimen for him that will ensure the best adjustment possible +of his internal and external relationships.[7] + +Working in a diagnostic group myself as an integrating internist, I have +been much helped by the reports of personality studies made by skilful +psychiatrists; these are linked with the special reports on the several +bodily domains (cardiovascular, respiratory, hæmic, dental, digestive, +urogenital, locomotor, neural, metabolic, and endocrine) in order +finally to arrive at an adequately co-ordinated and (subordinated) total +diagnosis from which the clues for an appropriate therapeutic regimen +can safely be drawn. If group practice is to grow and be successful in +this country, as I think likely, groups must see to it that psychiatry, +as well as the other medical and surgical specialties, is properly +represented in their make-up.[8] From now on, too, general practitioners +should, as Southard emphasized, be urged to be at least as familiar +with the general principles and methods of the psychiatrist as they are +with those of the gynecologist, the dermatologist, and the +pædiatrist.[9] Well organized group-diagnosis and general will then help +to counteract the inhibiting influence of earlier isolated specialism +upon the appreciation of psychiatry. + +This enumeration of some of the causes of the ignorance and apathy +(existent hitherto) in the general profession regarding psychiatry may +perhaps suffice as explanation. These causes are, fortunately, rapidly +being removed. We are entering upon an era in which psychiatry will be +recognized as one of the most important specialties in medicine, an era +that will demand alliance and close communion among psychiatrists, +internists, and the representatives of the various medical and surgical +specialties. + +The internist and the psychiatrist will ever have a common interest in +the obscure problems of etiology and pathogenesis of diseases and +anomalies that are accompanied by abnormalities of thought, feeling, and +behavior. Progress in this direction is bound to be slow for the studies +are exceptionally complex and there are many impediments to be removed. +Though the problems are deep and difficult, they are doubtless soluble +by the mind of man, and they exert an uncommon fascination upon those +who visualize them. Causes may be internal or external, and are often a +combination of both. The tracing of the direct and indirect +relationships between these causes and the abnormal cerebral functioning +upon which the disturbances of psychobiological adjustment seem to +depend is the task of pathogenesis. The internist who has studied the +infantile cerebropathies with their resulting imbecilities, syphilis +followed by general paresis, typhoid fever and its toxic delirium, +chronic alcoholism with its characteristic psychoses, cerebral +thrombosis with its aphasias, agnosias, and apraxias, thalmic syndromes +due to vascular lesions with their unilateral pathological feeling-tone, +frontal-lobe tumors with joke-making, uncus tumors with hallucinations +of taste and smell, lethargic encephalitis with its disturbance of the +general consciousness and its psychoneurotic sequelæ (lesions in the +globus pallidus and their motor consequences), pulmonary tuberculosis +with its euphoria, and endocrinopathies like myxoedema and exophthalmic +goitre with their pathological mental states, is encouraged to proceed +with his clinical-pathological-etiological studies in full assurance +that they will steadily contribute to advances in psychiatry. The +eclectic psychiatrist who is examining mental symptoms and +symptom-complexes ever more critically, who is seeking for parallel +disturbances in physiological processes and who considers both +psychogenesis and somatogenesis in attempting to account for +psychobiological maladjustments will welcome, we can feel sure, any help +that internal medicine and general and special pathology can yield. + +These studies in pathogenesis and etiology are fundamentally necessary +for the development of a rational therapy and prophylaxis. Already much +that is of applicable value in practice has been achieved. The internist +shares with the psychiatrist the desire that knowledge of the facts +regarding care, cure, and prevention of mental disorders may become +widely disseminated among medical men and at least to some extent among +the laity. Experts in psychiatry firmly believe that at least half of +the mental disturbances now prevalent could have been prevented, if, +during the childhood and adolescence of those afflicted, the facts and +principles of existing knowledge and the practical resources now +available could have been applied. + +We have recently had an excellent illustration of the benefits of +applied psychiatry in the remarkable results achieved during the great +war through the activities of the head of the neuropsychiatric division +of the Surgeon General's office and his staff[10] and those of the +senior consultant in neuropsychiatry and his divisional associates in +the American Expeditionary Force. In no other body of recruits and in no +other army than the American was a comparable success arrived at, and +the credit for this is due to American applied psychiatry and its wisely +chosen official representatives. + +The active campaign for the preservation of the mental health of our +people and for a better understanding and care of persons presenting +abnormal mental symptoms carried on during the past decade by the +National Committee for Mental Hygiene marks a new epoch in preventive +medicine.[11] + +The prevention of at least a large proportion of abnormal mental states +through the timely application of the principles of mental hygiene is +now recognized as a practically realizable ideal. Many important reforms +are now in process throughout the United States, no small part of them +directly attributable to the active efforts of our leading psychiatrists +and to our National Committee's [Transcriber's note: original reads +'Committe's'] work. The old "asylums" are being changed into +"hospitals." Psychiatric clinics are becoming attached to teaching +hospitals and psychiatric instruction in the medical schools is being +vastly improved. The mental symptoms of disease now receive attention in +hospitals and in private practice and at a much earlier stage than +formerly. Even the courts, the prisons, and the reformatories are +awakening to the importance of scientific psychiatry; before long +penology may be brought more into accord with our newer and juster +conceptions of the nature and origin of crime, dependency, and +delinquency. That schools of hygiene and the public health services must +soon fall into line and consider mental hygiene seriously is obvious. +The objection sometimes made that the practical problems are too vague, +not sufficiently concrete, to justify attack by public health officials +is no longer valid. In no direction, probably, could money and energy be +more profitably spent during the period just ahead than in the support +of a widely organized campaign for Mental Hygiene.[12] Psychiatrists +can count upon internists and general practitioners to aid them in +educating the public regarding the nature and desirability of this +campaign. + +Man is now consciously participating in the direction of his own +evolution. To cite England's poet laureate, who, you will recall, is a +physician: "The proper work of his (man's) mind is to interpret the +world according to his higher nature, and to conquer the material +aspects of the world so as to bring them into subjection to the spirit." + +FOOTNOTES: + +[Footnote 4: In an address at the seventieth annual meeting of the +American Medico-Psychological Association, 1914, entitled "The Relations +of Internal Medicine to Psychiatry."] + +[Footnote 5: _Cf._ Polon (A.) "The Relation of the General Practitioner +to the Neurotic Patient," Mental Hygiene, New York, 1920, IV, 670-678.] + +[Footnote 6: _Cf._ Paton (S.) Human Behavior in Relation to the Study of +Educational, Social, and Ethical Problems. New York, 1921. Charles +Scribner's Sons, p. 465.] + +[Footnote 7: _Cf._ Meyer (A.), "Progress in Teaching Psychiatry," +Journal A.M.A., Chicago, 1917, LXIX, 861-863; see also his, "Objective +Psychobiology, or Psychobiology with Subordination of the Medically +Useless Contrast of Medical and Physical," Journal A.M.A., Chicago, +1915, LXV, 860-863; and, "Aims and Meanings of Psychiatric Diagnosis," +Am. Journal of Insanity, Baltimore, 1917, LXXIV, 163-168.] + +[Footnote 8: _Cf._ "The General Diagnostic Survey Made by the Internist +Cooperating with Groups of Medical and Surgical Specialists," New York +Medical Journal, 1918, 489,538,577; also, "The Rationale of Clinical +Diagnosis," Oxford Medicine, 1920, vol. I, 619-684; also, "Group +Diagnosis and Group Therapy," Journal Iowa State Medical Society, +113-121, Des Moines, 1921.] + +[Footnote 9: _Cf._ Southard (E.E.), "Insanity Versus Mental Disease"; +the Duty of the General Practitioner in Psychiatric Diagnosis, Journal +American Medical Association, LXXI, 1259-1261, Chicago, 1918.] + +[Footnote 10: _Cf._ Bailey (P.), "The Applicability of Findings of +Neuro-psychiatric Examinations in the Army to Civil Problems," Mental +Hygiene, New York, 1920, IV, 301; also "War and Mental Diseases," Am. J. +Pub. Health, IX, 1, Boston, 1919.] + +[Footnote 11: _Cf._ Salmon (T.W.), "War Neuroses and Their Lesson," New +York Medical Journal, CIX, 993, 1919; also, "The Future of Psychiatry in +the Army," Mil. Surgeon, XLVII, 200, Washington, 1920. + +_Cf._ "Origin, Objects, and Plans of the National Committee for Mental +Hygiene" (Publication No. 1, of the National Committee, New York City); +and, "Some Phases of the Mental Hygiene Movement and the Scope of the +Work of the National Committee for Mental Hygiene," in Trans., XV, +Internal. Congr. for Hygiene and Demography, III, 468-476, (1912), +Washington 1913.] + +[Footnote 12: _Cf._ Russell (W.L.) "Community Responsibilities in the +Treatment of Mental Disorders." Canad. J. Ment. Hygiene, 1919, I 155--. + +Hincks (C.M.), "Mental Hygiene and Departments of Health," Am. J. Pub. +Health, Boston, IX, 352, 1919; Haines (T.H.), "The Mental Hygiene +Requirements of a Community: Suggestions Based upon a Personal Survey," +Mental Hygiene, IV, 920-931, New York, 1920. + +Beers (C.W.), "Organized Work in Mental Hygiene," Mental Hygiene, 567, +New York, 1917, also, Williams (F.E.), "Progress in Mental Hygiene," +Modern Hospital, XIV, 197, Chicago, 1920.] + + + + +_The Chairman_: We had hoped to receive to-day the greetings of our +sole elder sister among American institutions, the Pennsylvania +Hospital, of Philadelphia, which since its foundation in 1751 has +pursued a career much like our own, treating mental cases in the general +hospital from the very beginning, and since 1841 maintaining a separate +department for mental diseases in West Philadelphia. Dr. Owen Copp, the +masterly physician-in-chief and administrator of that department, was to +have been here, but unfortunately has been detained. Our morning +exercises having come to an end, Dr. Russell asks me to say that your +inspection of the occupational buildings and other departments of the +Hospital is cordially invited; a pageant illustrative of the origin and +aspirations of the Hospital will be given on the adjoining lawn; and +that after the pageant our guests are desired to return to the Assembly +Hall, where we shall have the privilege of listening to addresses by Dr. +Richard G. Rows, of London, and Dr. Pierre Janet, of Paris, who have +come across the Atlantic especially to take part in this anniversary +celebration. + + + + + +ADDRESS BY +DR. GEORGE D. STEWART + +[Illustration: BLOOMINGDALE ASYLUM + +As it appeared in 1894 when it was discontinued and replaced by +Bloomingdale Hospital at White Plains, New York.] + + +AFTERNOON SESSION + +_The Chairman_: For the first seventy-five years of its existence the +New York Hospital was the nearest approach to an academy of medicine +that the city possessed. When the now famous New York Academy of +Medicine was established in 1847, a friendly and cordial co-operation +between the two institutions arose, and while the activity of this +co-operation is not as pronounced as it was, we still cherish in our +hearts a warm regard for that ancient ally in the cause of humanity. Its +President, Dr. George D. Stewart, the distinguished surgeon, has come to +extend the greetings of the medical profession of New York City. + + +DR. STEWART + +The emotions that attend the birthday celebrations of an individual are +often a mixture of joy and sadness, of laughter and of tears. In warm +and imaginative youth there is no sadness and there are no tears, +because that cognizance of the common end which is woven into the very +warp and woof of existence is then buried deep in our subconscious +natures, or if it impresses itself at all, is too volatile and fleeting +to be remembered. But as the years fall away and there is one less +spring to flower and green, the serious man "tangled for the present in +some parcels of fibrin, albumin, and phosphates" looks forward and +backward and takes in both this world and the next. In the case of +institutions, however, the sadness and the tears do not obtain--for a +century of anniversaries may merely mean dignified maturity, as in the +case of Bloomingdale, with no hint of the senility and decay that must +come to the individual who has lived so long. This institution was +founded one hundred years ago to-day; the parent, the New York Hospital, +has a longer history. Bloomingdale, as a separate and independent +concern, had its birthday a century ago. + +It is curious to let the mind travel back, and consider what was +happening about that time. Just two years before the news had flashed on +the philosophical and scientific world that Oersted, a Danish +philosopher, had caused a deflection of the magnetic needle by the +passage near it of an electric current. The relation between the two +forces was then and there confirmed by separate observations all over +the civilized world. This discovery probably created more interest at +that time than Professor Einstein's recent announcement which, if +accepted, may be so disturbing to the principia of Newton and to our +ideas of time and space. There can be no doubt that the practical +significance of Oersted's experiment was much more widely appreciated +than the theory of Einstein, for an understanding of the latter is +confined, we are told, to not many more men than was necessary to save +Sodom and Gomorrah. Its immense practical significance, however, could +have been foreseen by no man, no matter with what vision endowed. Just +two years prior to the founding of this institution the first steamboat +had crossed the Atlantic and in the same year that great conqueror, who +had so disturbed the peace of the world which was even then as now +slowly recovering from the ravages of war, breathed his last in Saint +Helena, yielding to death as utterly as the poorest hind. + +In 1815, Bedlam Hospital in South London was converted into an asylum +for the insane who were at the time called "lunatics." The name Bedlam +is a corruption of the Hebrew "Bethlehem"--meaning the House of +Bread--and while the name popularly came to signify a noisy place it was +the beginning of really scientific treatment for the tragically +afflicted insane. While the treatment of the insane in Europe was being +steadily raised to a higher plane of efficiency, America has also reason +to be proud of her record in this respect. During all the years that +have followed, Bloomingdale has been an important factor in the medical +world of New York. + +There are two phases of its existence which might be emphasized--first, +it was founded by physicians; even then and, of course, long before +doctors had proven that they were in the forefront in the promotion of +humanitarian activities. Medicine has always carried on its banners an +inscription to the Brotherhood of Man. It is worthy of note that when +Pinel and Tuke had begun to regard mental aberration as a disease and to +provide scientific hospital treatment therefor, American physicians, +prepared by study and experimentation, were ready to accept and apply +the new teachings. + +A second phase of great importance is that institutions like +Bloomingdale have promoted the study of psychology far more than any +other factor, particularly because in them the personality stripped of +some of its intricacies, the diseased personality, permits analysis, +which the normal complex has so long defied. That it is high time that +mankind was undertaking this knowledge of himself is particularly +emphasized by the unrest and aberrance of human behavior now startling +and disturbing the whole world. If mankind does not take up this self +study as Trotter has said, Nature may tire of her experiment man, that +complex multicellular gregarious animal who is unable to protect himself +even from a simple unicellular organism, and may sweep him from her +work-table to make room for one more effort of her tireless and patient +curiosity. Psychology should be taught to every doctor and to every +lettered man. + +Digressing for a moment, to every one capable of understanding it, there +should be imparted a knowledge of that simple economic law announced +from the Garden of Eden after the grounds had been cleared and the gates +closed: "By the sweat of thy brow thou shalt earn thy bread." The +economic phase indeed constitutes a highly important aspect of modern +psychology, for abnormal elements are antisocial, and from pickpockets +to anarchists flourish on the soil of pauperism. The key-note of the +future is responsibility. To the educated and enlightened man who still +asks, "Am I my brother's keeper?" Cain has bequeathed a drop of his +fratricidal blood; and he who spurns to do his share of the world's +work, electing instead to fall a burden upon the community, deserves the +fate of the barren fig-tree. + +However, amidst the social unrest, buffeted and perplexed by the cross +currents of our time, we should not be pessimistic but should look +forward with courage, parting reluctantly with whatever of good the past +contained and living hopefully in the present. As Ellis says: "The +present is in every age merely the shifting point at which past and +future meet, and we can have no quarrel with either. There can be no +world without traditions; neither can there be any life without +movement. As Heraclitus knew at the outset of modern philosophy, we +cannot bathe twice in the same stream, though as we know to-day, the +stream still flows in an unending circle. There is never a moment when +the new dawn is not breaking over the earth, and never a moment when the +sunset ceases to die. It is well to greet serenely even the first +glimmer of the dawn when we see it, not hastening toward it with undue +speed, nor leaving the sunset without gratitude for the dying light +that once was dawn." + +So to-day I bring to you from the New York Academy of Medicine +felicitations on your one hundredth anniversary and greetings to your +guests who have come from all over the world to join in your birthday +celebration. + + + + +ADDRESS BY +DR. RICHARD G. ROWS + + +_The Chairman_: Besides the Royal Charter, the New York Hospital is +indebted to Great Britain for invaluable encouragement and financial aid +in our natal struggle in Colonial days. Dr. Rows has added charmingly to +that debt by journeying from London to take part in these exercises. His +subject will be, "THE BIOLOGICAL SIGNIFICANCE OF MENTAL ILLNESS." + +As Director of the British Neurological Hospital for Disabled Soldiers +and Sailors, at Tooting, he is giving the community and the medical +world the benefit of his rich professional experience in the trying +years of war as well as in peace, and gaining fresh laurels as he +marches, like Wordsworth's warrior, "from well to better, daily +self-surpast." + + +DR. ROWS + +I must first express to you my keen appreciation of the high honor you +have conferred on me by inviting me to come from England to address you +on the occasion of the centenary celebration of the opening of this +Hospital. + +It is perhaps difficult for us to realize what resistances lay in the +way of reform at that time, resistances in the form of long-established +but somewhat limited views as to the nature of mental illnesses, as to +whether the sufferer was not reaping what he had sown in angering the +supreme powers and in making himself a fit habitation for demons to +dwell in; in the form of a lack of appreciation of the need of sympathy +for those who, while in a disturbed state, offended against the social +organism or in the form of an exaggerated fear which compelled the +adoption of vigorous methods of protecting the social organism against +those who exhibited such anti-social tendencies. The men and women of +the different countries of the world who recognized this and made it the +chief of their life's duties to spread a wider view of such conditions +and to insist that the unfortunate people should be regarded and +treated as fellow human beings will ever command our admiration. + +By the courtesy of Dr. Russell I have had an opportunity of seeing the +pamphlet in which are recorded the efforts of Mr. Thomas Eddy in the +year 1815 to move his colleagues to consider this matter.[13] The result +of those efforts was the establishment of an institution on Bloomingdale +Road. + +Various changes followed until we arrived at the Bloomingdale Hospital +of to-day with its large and trained staff of medical officers, who, +while still recognizing the difficulties of the task, are imbued with a +hope of success which has arisen on a basis of wider knowledge, but +which was unknown to many of their predecessors. To have the opportunity +of joining with you in celebrating the big advance made a hundred years +ago, of exchanging ideas with you with regard to the difficulties which +still confront us, whether in America or in England, and which demand a +united effort on the part of all who are interested in the scientific +investigation of the subject, cannot fail to afford one the liveliest +satisfaction. + +In the brief history of the Hospital prepared by Dr. Russell we find the +recommendations of another reformer, Dr. Earle, who in 1848 was +evidently still not satisfied with the treatment provided for the +sufferers from mental illness. + +Both Mr. Eddy and Dr. Earle were influenced by their observation that +even in those suffering from mania much of their behavior could not be +described as irrational. If you will allow me I will quote a sentence of +two from each. + +Mr. Eddy said: "It is to be observed that in most cases of insanity, +from whatever cause it may have arisen or to whatever it may have +proceeded, the patient possesses small remains of ratiocination and +self-command; and although they cannot be made sensible of the +irrationality of their conduct or opinions, yet they are generally aware +of those particulars for which the world considers them proper objects +of confinement." With reference to treatment Dr. Earle said: "The +primary object is to treat patients, so far as their condition will +possibly permit, as if they were still in the enjoyment of the healthy +exercise of their mental faculties." + +To superficial observation these suggestions might well have appeared as +the phantasies of dreamers and perhaps at the present day their +importance is not always fully appreciated. Recent advances in +knowledge, however, have led us beyond the moral treatment recommended a +hundred years ago and have enabled us to see that a more important +truth underlay these suggestions. + +We are all familiar with the frequent difficulty we encounter in our +efforts to discover the actual mental disturbance which is supposed to +exist in our patients. It is often a question of wit against wit as +between patient and doctor, and not infrequently a rational and +intelligent conversation may be maintained on an indifferent subject. +The fact too that the disturbance is so frequently only temporary +suggests that the loss of rational control is a less serious phenomenon +than was generally supposed and we know that the control can be +frequently restored by a period of rest or by a helpful stimulus. Quite +recently a patient who in hospital had been confused, undisciplined, +abusive, and threatening, was removed to a house of detention. The shock +of finding himself, as he said, amongst a lot of lunatics, led him to +face reality from a fresh point of view. He admitted that it had taught +him a lesson and when he revisited the hospital, if not entirely +grateful to us for the experience, he evidently bore no ill will. + +But not only is it necessary to recognize what rational powers remain to +the patient, we must also inquire how much in their disturbed mental +activity can be considered a rational reaction to the stimuli which +have operated, and still may be operating, on them. + +In connection with this I would suggest that there are two aspects to be +considered. First, what is the standard according to which we are to +judge them? Secondly, to what extent are the reactions of the patient +abnormal in kind to the driving stimulus? They may perhaps be reckoned +abnormal in degree, but, to what extent, if at all, are they abnormal in +kind? + +It may be readily admitted that the behavior of those suffering from +mental illness offends against conventional usages and is anti-social. +It must also be recognized that amongst human beings living in +aggregates some conventional usages must be evolved and insisted on in +order to insure the greatest good of the greatest number. These usages +are regarded not merely as protective measures for the body corporate, +but they are also supposed to indicate a beneficial standard for the +individual. But such a standard being adopted, observation is liable to +be limited so much to results without sufficient attention being given +to the causes which had led to those results. + +By the recent advances in scientific knowledge and in methods of +investigation we have been led to see that the conditions under +consideration cannot be understood without a study of the mechanisms on +which mental activity depends and without discovering the psychic and +physical causes, arising from without and from within, which have +disturbed the function of these mechanisms. We have learned that these +illnesses do not arise from one cause alone and that they are the result +of influences to which we all may be subject to some degree. + +The originator of these modern methods, Prof. Freud, has stimulated us +to regard the ordinary symptoms of mental illnesses as directing posts +indicating lines to be investigated, and he and others have suggested +various methods which may usefully be employed. + +It is essential that we carefully distinguish what are primary from what +are secondary symptoms. Two thousand years ago a physician, +[Transcriber's note: original reads 'physican'] Areteus, pointed out +that mania frequently commenced as melancholia, and he drew attention to +the extreme frequency of an initial depression in cases of mental +illnesses. But he did not offer any explanation of this initial state. + +Such an initial state may perhaps be, to a certain extent, understood if +we assume that the first evidences of mental disturbance consist in some +difficulty in carrying out ordinary mental processes, some difficulty in +exercise of the function of perceiving, thinking, feeling, judging, and +acting, and that any disturbance of the harmonious activity of these +functions must give rise to an emotional condition of anxiety and +depression. Some such disharmony will, by adequate investigation, be +found in a large number of cases to exist in the early states of the +illness and will be appreciated by the patient before there occur any +obvious signs, any outward manifestations of disability. + +But in any disharmony which may occur it must be recognized that the +mental mechanisms affected are those with which the patient was +originally endowed, which he has gradually trained throughout his past +experience and which he has employed more or less successfully up to the +time the illness commenced. There is no new mechanism introduced to +produce a mental illness, but a putting out of gear of those common to +the race and their disturbance is the result of the action of influences +which may befall any one of us, unbearable ideas with which some intense +emotional state is intimately associated. The normal function of these +mechanisms, simple at first and remaining fundamentally unaltered, +although possibly much modified gradually by added experiences from +within and without, depends on the maintenance of a harmonious balance +between stimuli received and emotional reaction and motor response to +those stimuli so that the feeling of well-being may arise. + +If from any cause there occurs a failure to appreciate the stimuli +clearly, if the emotional reactivity be disturbed, if the sense of value +becomes biassed in one direction or another so that the response is +recognized by the patient as abnormal there will result a disharmony and +a feeling of ill-being of the organism. Under these conditions the +processes of facilitation along certain definite lines and inhibition of +all other lines--processes which are essential to clear +consciousness--will become difficult or perhaps impossible and a mental +illness will develop. In the slighter degrees the disharmony may be +known to the patient without there being any outward manifestation to +betray the conflict going on within. In the severe degrees the mental +activity of the patient may be under the control of some dominant +emotional state so that it may be impossible for him to adapt himself to +his surroundings in a normal manner although his behavior may not appear +so irrational when we know the stimuli affecting him. Within these +extremes we discover all degrees of disturbance, and all varieties of +signs and symptoms may be encountered. + +But the signs which become obvious to superficial observation are, to a +large extent, secondary products. The primary symptoms are felt by the +patient as a disturbance of the capacity to perceive, to think, to feel, +to judge, and to act, and with these disabilities there will be +associated a certain degree of confusion and anxiety which cannot fail +to appear as the result of such alterations of function. + +The obvious signs may represent merely a more intense degree of the +primary affection, disturbed capacity together with some confusion and +anxiety; or they may represent efforts on the part of the patient to +overcome or to escape from the disturbance or to explain it to himself. +And now the total lack of knowledge of the processes on which mental +activity depends, the altered standard of judgment due to some degree of +dissociation, and the necessity of obtaining relief in some way or other +will have much to do with determining the character of the symptoms with +which we are all familiar. So many factors are concerned in the +production of these secondary characters that it is difficult to assign +to the symptoms their true value or to decide whether they possess much +value at all with regard to the fundamental disturbance which +constituted the primary illness. So often they appear to be mere +rationalizations, mere false judgments on the part of the patient; they +thus form subjects for investigation rather than fundamental +constituents of the illness. + +We, therefore, must not accept the outward and visible signs at their +face value but attempt to discover what past experiences in the life of +the patient have led to such disturbance of function, to such a change +in his mental activity. + +It will possibly be of some assistance to provide one or two examples in +order to demonstrate the importance of the past experiences as agents +capable of producing such alterations. + +The first case will illustrate the results produced by the development +of a dominant emotional tendency during early childhood. The patient up +to the fifth year of her life had been an ordinary, normal child, +attached to her mother, fond of her nurse, interested in her toys. +During the next two years she endured much bad treatment at the hands of +a new nurse which produced such an impression on her that she felt she +was a changed child. This nurse, described to me by the patient as a +handsome woman, having met the inevitable man, used frequently to meet +him clandestinely. The child was neglected, was sometimes left alone, on +one occasion in a graveyard, but she was forbidden to mention the +subject to any one under threats of being carried away by a "bogey-man." +The child became very frightened by this, to such an extent that one +night she had a severe nightmare in which a "bogey-man" came to carry +her away. At the end of two years a profound change had taken place in +her which she now describes thus: "I was a changed child; I was +separated from my mother and could no longer confide in her nor did I +wish to do things for her as I had done before; I could not enjoy my +toys; I had no confidence in myself; I was not like other children." And +from that time on, as girl and as woman, she has never felt that she has +been like others of her sex. Such a condition, being started and +confined by repetition, interfered with her free development and it was +remarkable how many incidents occurred in her life to confirm the +disability, but the germ of her serious breakdown thirty years later was +laid in her fifth and sixth years. + +The second case is that of a patient who, as a child, had some +convulsive attacks. She was therefore considered delicate and was +thoroughly spoiled. When nearly thirty she lived through a sexual +experience which caused extreme anxiety; she broke down and was admitted +to an asylum. After admission she looked across the dormitory and saw a +head appearing above the bed-clothes, the hair of which had been cut +short for hygienic reasons. With a memory of her sexual indiscretion +still vivid in her mind she jumped to the conclusion that she was in a +place where men and women were crowded together in the same room. She +got out of bed, refused to return to it, fought against the nurses and +was transferred to a single room, with the mattress on the floor and the +window shuttered. She wondered where she was and came to the conclusion +that she was in a horse-box. Then arose a feeling of terror that she +would be at the disposal of the grooms when they returned from work. The +sound of heavy footsteps of the patients passing along the corridor to +the tea-room suggested that the grooms were returning and that her room +would soon be invaded. The feeling of terror increased and she tried to +hide in the corner, drawing the mattress and clothes over her. And so +on. + +Months later when I had my first interview with her, her sole remark +during the hour was "How can I speak in a place like this?" This was +repeated almost without intermission throughout the hour. It formed a +good example of the origin of the process of perseveration, a process +frequently adopted by the patient to guard against the disclosure of a +troublesome secret. + +If we attempt to trace out some of the mechanisms employed in these two +cases we shall see that in response to definite stimuli each reacted in +a manner which cannot be considered abnormal in kind. It was normal +reaction for the child to be distressed at being separated from her +mother in such a way, to be frightened by being left in the graveyard +alone, or at the threat of her being carried away by a "bogey-man" if +she dared to mention anything of the clandestine meetings to her mother. +It was not very abnormal that after her sexual experience the other +patient while still in a confused state caused by the intense emotional +condition of anxiety, should, on seeing a head with the hair cropped +short, jump to the conclusion that there was a man in a bed in the same +ward with herself, or that she should feel frightened and wish to leave +the room. + +The mental activity in each case depended on mental content, that is, +memory of past experiences with their intense emotional states which +acted as the driving force and also made the recall of the experience go +extremely easy. The further developments after being placed in the +single room with mattresses on the floor and the window shuttered were +rationalizations also based on mental content, _i.e._, on the memory of +rooms somewhat similar to that in which she found herself and of the use +of such rooms. It is interesting to note also in the first case that in +her wildest delirium during an acute attack she lived through episodes +of her past life. One example may be given. In the course of her +delirium she thought that a "blackbird" had flown to her, touched her +left wrist and taken away all her vitality. This depended on an +experience of her going to Germany when a girl and meeting a young +German officer whom she did not like. A few years later she went to +Germany and met the officer again. Without going into full details I may +say that on one occasion when walking with him he seized her left wrist +with his right hand and attempted to kiss her; she struggled fiercely +and ran from him. Here we see that not only is her delirium based on a +past experience, but that the whole memory is symbolized in the +"blackbird" which was the emblem of the German nation in whose army the +officer was then serving. Connected with this there was also another +unpleasant episode which dated from her tenth year. Much of her delirium +was worked out in such a way that most of the details could be traced +back to experiences of her earlier life. + +But however absurd her statement regarding her being touched by a +"blackbird" and all her vitality removed might appear to superficial +observation, it must be admitted that when we know the mental content of +that patient, we cannot but see that at any rate it was not so +irrational. And not only was this recognized by the doctor, but, and +this is much more important, by the patient herself. + +It is, therefore, the mental content which must be discovered before +doctor or patient can understand the disability and before any common +ground between the two can be found. And when the mental content is +known it will be easy to recognize the affective condition of the +patient to be a normal response. It will also be specific and if intense +will dominate the patient. "Why is it I can never feel joy as I used to +do?" was the pathetic inquiry of the patient dominated by a feeling of +misery and fear. Was it not for the reason that being dominated by +misery and fear, joy could find no place? The emotion of misery because +of its intensity could more or less inhibit the feeling of joy, but joy +could not inhibit the misery. + +No repetition of the memory of the unpleasant experiences with their +associated emotion of misery and fear led to the formation of a habit of +mind and feeling. And when once such a habit of mind is established it +is remarkable by what a host of stimuli received in ordinary daily life +the cause of the disturbance can be recalled. + +This question of stimuli deserves further notice. It is not so difficult +to realize the mechanism by which a stimulus which clearly crosses the +threshold of consciousness can lead to a given reaction. But it is +perhaps difficult to imagine how so many stimuli which do not cross the +threshold of consciousness or which, if they do, are not recognized by +the patient at the time as having any reference whatever to the special +memory can yet set the memory mechanism into action. The result may not +be seen till after the relapse of some considerable period of time, as +in the case of a man who for years had been disturbed by terrific +nightmares, based on the idea of snakes coming out of the ground and +attacking him. He complained one day that he was much worse, that three +nights before he had had the worst nightmare of his life. On being +questioned as to what could have suggested snakes to him he could not +tell. A few minutes later he said: "I think I know the cause now. I +spent the evening before I had that nightmare with a sergeant who had +returned from the service in India." This friend amongst other things +had mentioned that whenever they were about to bivouac they had to +search every hole under a stone and every tuft of grass to see that +there were no snakes there. This, which had been received as an ordinary +item of information, had been the stimulus which had set his memory +mechanism into action and the nightmare between two and three o'clock in +the morning had been the result. + +The result in many instances is evidenced by an emotional state alone +and the actual memory of the original experience may not come into +consciousness. Many examples of this might be given. The sound of a +trolley wheel on a tram wire in one case gave rise to terror instead of +its normal reaction, viz., that of satisfaction at getting to the +destination quickly and without effort. This terror was produced because +the sound on the wire resembled that of a shell which came over, blew in +a dugout, killed three men, and buried the patient. No memory of this +incident came into consciousness, only a terror similar to that +experienced at the time of the original incident was experienced. Or, +the time four o'clock in the afternoon could act as a stimulus to arouse +an emotional state of misery similar to that experienced at the same +time of day during an illness some years previously. Or, passing the +house of a doctor when on a bus could produce a sudden outburst of +anxiety, giddiness, and confusion; the patient had been taken into that +house at the time of an epileptic attack. Or, showing photographs of the +front could lead to an epileptic attack which was based on the memory of +the time when the patient was wounded in the head; this has occurred on +two separate occasions separated by an interval of some months. Or, +noticing a familiar critical tone in a remark made at a dinner-table +could lead to an acute change of feeling so that the subject who, +before dinner, had felt she would like to play a new composition on the +piano so as to obtain the opinion of the guest who had exhibited the +critical tone, after dinner felt incapable of doing so. Her feelings had +been hurt on many former occasions by critical remarks made by him in +that tone. The critical remarks were not called to memory but there +arose the feeling that under no circumstances could she play that piece +to him. + +Of special importance also are the experiences of childhood. An unhappy +home or unjust treatment as a child may warp the development of the +personality, lead to a lack of self-confidence, to the predominance of +one emotional tendency, and so prevent that balanced equilibrium which +will allow a rapid and suitable emotional reaction such as we may +consider normal. This may lead to a failure of development or a loss of +the sense of value, because the existence of one dominating emotional +tendency so often produces a prejudiced view which may render a just +appreciation of our general experience almost impossible and may +seriously disturb our mental activity. + +And if, as Bianchi suggests, all mental activity depends on a series of +reflex actions, or, as Bechterew and Pavlov have insisted, a series of +conditioned reflexes becomes established, it will assist us to +understand how such stimuli can give rise to mental disturbances, to +mental illnesses. We shall see that there may be something of real +importance underlying such remarks as "I felt I was a changed child"; or +"It is because of the treatment I received from my father that I have +taken life so seriously." "I have never imagined that what I went +through in my childhood could so influence me now"; or "I have never had +confidence in myself and often when I have appeared vivacious and +interested I have had an awful feeling of incapacity and dread within +myself." + +The outward and obvious manifestations, therefore, are not necessarily a +true index of our mental and emotional conditions. This is true of all +mental illnesses, even the most severe. + +One patient who had been in an asylum more than ten years illustrated +this in a most striking manner. His outward manifestations led one to +feel that he thought he possessed the institution in which he was +confined and also the surrounding property and that the authorities were +a set of usurpers and thieves who kept him incarcerated in order that +they might enjoy what was really his money and his property. On one +occasion I said to him, "George, what is that incident in your life +which you cannot forget and which has troubled you so seriously?" The +reply was a flood of abuse. I put the question to him several times +without getting any further answer, but when I came to leave the ward, +George came up behind me and whispered over my shoulder, "Who told you +about it?" No abuse, no shouting as usually occurred, but a whisper, +"Who told you about it?" Was not George running away from a memory with +its emotion which was unbearable to an idea which allowed him to be +angry with others instead of with himself? Many examples of this might +be given and really might be found by us in our own experience. It is +the mental content which is important, a mental content which can be +recalled by various stimuli, and which will be more persistently with us +the more intense is the emotion associated with it. + +But the basis of the condition is not completely understood when we have +apparently arrived at the psychic cause of the disturbance. + +It is recognized that the emotions are accompanied by physical changes, +changes which are specific for each emotional state. The physical +changes which normally are associated with fear differ from those of joy +or anger. This has been appreciated for a long time but recent +researches have recalled other reactions to us. Reactions in the +internal glands which further knowledge will probably prove to be of +great importance, in fact to form an integral part of the sum of +activities, connect with mental processes. The secretions of the glands +exert an influence on the sensibility and reaction of the organs +connected with psychic phenomena and their functions themselves are +affected by reactions occurring in the nervous system. Revival of a +memory may thus affect the functions of these glands, and the changes +produced in them may react on the sensibility and reactivity of the +nervous mechanisms. If this be so, it will be evident that the organism +works as a whole, that a disturbance of one organ may interfere with the +function of another and that in the repetition of all these influences +we may find an explanation of the chronicity of many of these illnesses. +A study of the activities and interactivities of all the organs of the +body is therefore essential and must be made before we shall understand +the biological significance of mental illness. + +FOOTNOTES: + +[Footnote 13: See Appendix III, p. 200.] + + + + +ADDRESS BY +DR. PIERRE JANET + + +_The Chairman_: Our country may be hesitating a little--I hope it will +not be for long--in joining a league of nations to prevent war, but +there can be no doubt of our immediate readiness to co-operate +internationally to prevent and reduce disease. Our distinguished guest +from gallant France, Dr. Pierre Janet, professor in the College of +France, evidently feels confident of our sympathy and willingness to +collaborate in this latter respect, for he has ventured across the +ocean, with Madame Janet, in response to our urgent invitation. His +introduction to an audience of American psychiatrists would be quite out +of place. His fame as a pathological psychologist has circled the world. +In the science of medicine he is a modern Titan. For to-day's address he +has chosen as a subject, "THE RELATION OF THE NEUROSES TO THE +PSYCHOSES." + + +DR. JANET + +Mr. President, my dear colleagues, ladies, and gentlemen: The Americans +and the French have met on the battle-fields and they have faced +together the same sufferings for the defense of their common ideal of +civilization and liberty; it is right that they should meet likewise +where Science stands up for the protection of health and human reason, +and that they should celebrate together the Festivals of Peace. The +President and the organizers of this Congress have greatly honored me in +asking me to represent France at the celebration of the centenary of the +Bloomingdale Hospital; but above all they have procured me a great +pleasure in offering me the opportunity of coming again to this +beautiful land, of meeting once more friends who had welcomed us kindly +in former days; our old friends of past happy days who have become still +dearer to us since they have been tried during the bad days. + +Allow me, in the first place, to present you with the best wishes of the +French Government who have had the kindness to charge me to interpret +the sentiments of sympathy which they feel for all manifestations +tending to render the relations that unite our two countries closer and +more fruitful. The Academy of Moral and Political Sciences has equally +charged me to assure you that it is happy to be represented by one of +its members at the commemoration of the centenary of Bloomingdale +Hospital that has so brilliantly and generously continued the tradition +of Pinel and Esquirol. The Academy takes a lively interest in the +psychological and moral studies of this Congress that seek the cure of +diseases of the mind and the lessening of mental disorders. The +Medico-Psychological Society, the Society of Neurology, the Society of +Psychology, the Society of Psychiatry of Paris are happy to take part in +these festivals and are desirous of associating still more closely their +work to that of the scientific societies of the United States. + +The celebration of the centenary of a lunatic asylum gives birth to-day +to a national festivity in which all civilized nations participate. This +is a fact that would have well astonished the first founders of lunatic +asylums, the Pinels, the Esquirols, the William Tukes, and the first +organizers of Bloomingdale. The public opinion respecting the diseases +of the mind, the care to be given to lunatics, is vastly different to +what it was a century ago. This transformation of ideas has taken place, +in a great measure, as a result of the studies devoted to neuroses and +that is why it seems to me interesting to present you to-day with a few +reflections on the connections which unite neuroses and psychoses; for +it is the discovery of these connections that has shown to the man sound +in mind, or who imagines himself to be so, how near he always was to +being a lunatic and how wise it was always to consider the lunatic as a +brother. + +Formerly a lunatic was considered as a separate being, quite apart from +other members of society. The old prejudices which banished the patient +from the tribe as a useless and dangerous individual had diminished no +doubt with respect to the diseases of the body, which were more and more +regarded as frequent and natural things to which each of us might be +exposed. But these prejudices persisted with respect to some sexual +diseases that were still considered ignominious and chiefly with respect +to diseases of the mind. No doubt some intelligent and charitable +physicians took interest in the lunatic, endeavored to spare him many +sufferings, to defend him, to take care of him. But the people feared +the lunatic and despised him as if he had been struck by some +malediction which excommunicated him. I have seen lately a patient's +parents upset with emotion, as they had to cross the gardens of the +asylum to visit their daughter, at the single thought that they might +catch sight of a lunatic. This individual, in fact, had lost in the eyes +of the public the particular quality of man, reason, which, it appears, +distinguishes us from beasts; he seemed still living, but he was morally +dead; he was no longer a man. + +No doubt it was a dreadful misfortune when some member of a family +became insane, but this terrible calamity, which nothing could make one +anticipate or avoid, was happily exceptional, like thunderbolts. The +other men and even the members of the family presented nothing similar +and regarded themselves with pride as very different to this wretched +being transformed into a beast. This victim of heavenly curse was +pitied, settled comfortably in a nice pavilion at Bloomingdale and never +more spoken of. People still preserve on this point ideas similar to +those they had formerly about tuberculosis, known only under the form of +terrible but exceptional pulmonary consumption. Now it has at last been +understood that there are slight tuberculoses, curable, but tremendously +frequent. It will be the same with mental disorders; one day it will be +recognized that under diverse forms, more or less attenuated they exist +to-day on all sides, among a crowd of individuals that one does not feel +inclined to consider as insane. + +Little by little, in fact, men have had to state with astonishment that +all lunatics were not at Bloomingdale. Outside the hospital, in the +family of the unfortunate lunatic, or even in other groups, one observed +strange complaints, moanings relating to lesions which were not visible, +inability to move notwithstanding the apparent integrity of the organs, +contradictory and incomprehensible affirmations; in one word, abnormal +behaviors, very different to normal behaviors, regularized by the laws +and by reason. + +What was the meaning of these queer behaviors? At first they were very +badly understood; they were supposed to have some connection with being +possessed (with the devil), with miasmata, vapors, unlikely +perturbations of the body and animal spirits that circulated in the +nerves. One spoke, as did still Prof. Pomme at the end of the eighteenth +century, "of the shrivelling up of the nerves."[14] But above all, one +preserved the conviction that these queer disorders were very different +to the mental disorders of lunacy. These peculiar individuals had, it +was said, all their reason; they remained capable of understanding their +fellow creatures and of being understood by them; they were not to be +expelled from society like the poor lunatics; therefore their illness +should be anything but the mental disorders of lunacy. + +Physicians, as it is just, watched their patients and only confirmed +their opinion by fine scientific theories. They christened these new +disorders by the name of neuroses, reserving the name of psychoses for +the mental disorders of lunatics. During the whole of the nineteenth +century the radical division of neuroses and psychoses was accepted as a +dogma; on the one side, one described epilepsies, hysterias, +neurasthenias; on the other, one studied manias, melancholias, +paranoias, dementias, without preoccupying oneself in the least with the +connections those very ill-defined disorders might have the ones with +the others. This division was accentuated by the organization of the +studies and the treatment of the patients. The houses that received the +neurotic patients and the insane were absolutely distinct. The +physicians who attended the ones and the others were different, and even +supplied by different competitions. In France, even now, the recruiting +of asylum house pupils and hospital house pupils, the recruiting of +asylum doctors and that of hospital doctors, give an opportunity for +different competitions. One might almost say that these two categories +of house pupils and doctors have quite a different education. The result +was that the examination of the patients, the study thereof, and even +their treatment, were for the most part often conceived in quite a +different manner. For example, neuroses were studied publicly; the +examination was on elementary sensibilities, the movements of the limbs, +and especially reflexes; the insane were more closely examined in the +mental point of view, in conversations held with them by the physician +alone. Their arguments, their ideas were noted more than their +elementary movements. Strange to say, just when the psycho-therapeutic +treatments by reasoning and moralizing with the patients were being +developed, they stood out the contrary of what one might have +supposed--that this treatment should be applied to neurotic patients +alone. It was admitted that lunatics were probably not able to feel this +moral and rational influence; they were treated by isolation, +shower-baths, and purgatives. + +This complete division did not fail to bring about singular and +unfortunate consequences. In a hospital such as La Salpetrière the tic +sufferers, the impulsive, those beset with obsessions, the hysterical +with fits and delirium were placed near the organic hemiplegics and the +tabetics who did not resemble them in the least, and completely +separated from the melancholic, the confused, the systematical raving, +notwithstanding evident analogies. If Charcot who, moreover, has brought +about so much progress in these studies, committed some serious errors +in the interpretation of certain phenomena of hysteria, is it not +greatly due to his having studied these neurotic patients with the +neurology methods without ever applying psychiatry methods? Is it not +strange to refuse psychological treatment precisely to those who present +psychological disorders to the highest degree, and to place the insane +who thinks and suffers altogether outside of psychology? + +In fine, this distinction between the neurotic sufferer and the mental +sufferer was mostly arbitrary and depended more than was believed on the +patient's social position and fortune. Important and rich families could +not be resigned to see one of their members blemished by the name of +lunatic, and the physician very often qualified him as neurasthenic to +please the family. A few years ago this distinction of the patients and +of the physicians gave rise to a very amusing controversy in the +newspapers. The professor of the clinic for diseases of the nervous +system asserted that neurotic sufferers should be patients set apart for +neurologist physicians alone, whereas the alienist should content +himself with real lunatics. The professor of the clinic for mental +diseases protested with much wit and claimed the right of attending +equally the neurotic patients. All this proved a great confusion in the +ideas. + +Notwithstanding these difficulties, Charcot's studies themselves on +hysterical accidents began to make people's minds uneasy and to modify +conceptions of neuroses. They showed that neurotic sufferers presented +disorders in their thoughts, that many of their accidents, in all +appearance physical, were in connection with ideas, with the +_conviction_ of paralysis, of illness, with the remembrance of such or +such an event which had determined some great emotion. Without doubt, +this interpretation of hysteria, which I have myself contributed to +extend, must never be exaggerated, and it must not be concluded from +this that every neuropathic accident always and solely depends on some +remembrance or some emotion. In my opinion, this is only exact in a very +limited number of cases; and then it only explains the particular form +of such or such an accident and not the entire disease. Without doubt it +seems to me exaggerated to-day to see in neuroses those psychological +disorders alone, whereas the disorders of the circulation, the disorders +of internal secretions, the disorders of the functions of the +sympathetic which will be spoken of just here must also have a great +importance. But, however, this observation proved very useful at that +moment. A remembrance, an emotion, are evidently psychological +phenomena, and to connect neuropathic disorders with facts of the kind +is to include the study thereof with that of mental disorders. At this +time, in fact, they began to repeat on all sides a notion that had +already been indicated in a more vague manner; it is that neuroses were +at the root, were in reality diseases of the mind. + +If such is the case, what becomes of the classical distinction between +neuroses and psychoses? No one can deny that the latter are above all +diseases of the mind and we have here to review the reasons which seem +to justify their complete separation. Will it be said that with +psychoses the disorders of the mind last very much longer? But some +patients who enter the asylum with a certificate of insanity are very +frequently cured in a few months and some neuropathic disorders may last +years. I could name you patients who since thirty years keep the same +obsessions, and who at the age of fifty still ask themselves questions +upon their pact with heaven, as they did at the age of twenty. Shall we +speak of the consciousness the patient has of his state? But this +consciousness may be complete in certain melancholies and very +incomplete in certain impulsions. + +Is it necessary to insist on the presence or absence of anatomical +lesions which one tries to ascertain at the post-mortem examination? +Shall we say with Sandras, Axenfeld, Huchard, Hack, Tuke, that neuroses +are diseases without lesions? One finds lesions in general paralysis +which is ranged with insanity and we find some also in epilepsies which +are considered as neuroses; one no more finds lesions in melancholic +conditions than in conditions of obsessions. Besides, as I have often +repeated, this absence of lesions is of no importance; it is quite in +keeping with our ignorance. Every one admits that organic alterations +more or less momentary, but actually not suspected, must exist in +neuroses as in other diseases. Neuroses as well as psychoses are much +more likely to be diseases with unknown lesions than diseases without +lesions, and it is impossible to take this characteristic into account +to distinguish the ones from the others. + +In reality, the notion of lunatic has lost its former superstitious +signification and it has taken no precise medical signification. That +word is now the term of the police language. It indicates only an +embarrassment felt by the police before certain persons' conduct. When +an individual shows himself to be dangerous for others, the public +administration has the habit of defending us against him by the system +of threats and punishments. As a rule, in fact, when a normal mind is in +question, threats can stop him before the execution of crime, and +punishments, when crime has been committed, can prevent him from +beginning again; that is the psychological fact which has given birth to +the idea of responsibility. But in certain disorders it becomes evident +that neither threats nor punishments have a favorable effect, for the +individual seems to have lost the phenomenon of responsibility. When an +individual shows himself to be dangerous for others or for himself, and +that he has lost his responsibility, we can no longer employ the +ordinary means of defense; we are obliged to defend ourselves against +him, and defend him against himself by special means which it is useless +to apply to other men; we are obliged to modify legal conduct toward +him. All disorders of the mind oblige us to modify our social conduct +toward the patient, but only in a few cases are we obliged to modify at +the same time our legal conduct; and these are the sort of cases that +constitute lunacy. + +This important difference in the police point of view is of no great +importance in the psychological point of view nor in the medical point +of view, for the danger created by the patient is extremely varied. It +is impossible to say that such or such a disorder defined by medicine +leaves always the patient inoffensive and that such another always +renders him dangerous. There are melancholies, general paralytics, +insane who are inoffensive, and whom one should not call lunatics; there +are impulsive psychasthenics who are dangerous and whom one shall have +to call lunatics. The danger created by a patient depends a great deal +more upon the social circumstances in which he lives than upon the +nature of his psychological disorders. If he is rich, if he has no need +to earn his living, if he is surrounded by devoted watchfulness, if he +lives in the country, if his surroundings are simple, the very serious +mental disorders he may have do not constitute a danger. If he is poor, +if he has to earn his living, if he lives alone in a large town and his +position is delicate and complex, the same mental disorders, exactly at +the same degree, will soon constitute a danger, and the physician will +be forced to place him in an asylum with a good certificate. This is a +practical distinction, necessary for order in towns, which has no +importance in the point of view of medical science.[15] If we put these +accidental and slightly important differences on one side, we certainly +see a common ground in neuroses and psychoses. The question is always an +alteration in the conduct, and, above all, in the social conduct, an +alteration which tends, if I am not mistaken, toward the same part of +the conduct. + +The conduct of living beings is a special form of reaction by which the +living being adapts himself to the society to which he belongs. The +primitive adaptations of life are characterized by the organization of +internal physiological functions. Later on they consist in external +reactions, in displacements, in uniform movements of the body which +either keep him from or draw him near to the surrounding bodies. The +first of these movements are the reflex movements, then are developed +those combinations of movements which we called perceptive or suspensive +actions in keeping with perceptions. Later came the social acts, the +elementary intellectual acts which gave birth to language, the primitive +voluntary acts, the immediate beliefs, then the reflected acts, the +rational acts, experimental, etc. As I said formerly, there is, in each +function, quite a superior part which consists in its adaptation to the +particular circumstance existing at the present moment. The function of +alimentation, for instance, has to exercise itself at this moment when I +am to take aliments on this table in the midst of new people, that is to +say, among whom I have not yet found myself in this circumstance, +wearing a special dress and submitting my body and my mind to very +particular social rites. In reality it is nevertheless the function of +alimentation, but it must be noted that the act of dining, when wearing +a dress suit and talking to a neighbor, is not quite the same +physiological phenomenon as the simple secretion of the pancreas. +Certain patients lose only the superior part of this function of +alimentation which consists in eating in society, in eating in new and +complex circumstances, in eating while being conscious of what one is +doing, and in submitting to rules. Although the physiologist does not +imagine that these functions are connected with the exercise of sexual +functions in humanity, there is a pathology of the betrothal and of the +wedding-tour. + +It is just on this superior part of the functions, on their adaptation +to present circumstances, that the disorders of conduct +(self-government) which occupy us to-day bear. If one is willing to +understand by the word "evolution" the fact that a living being is +continually transforming himself to adapt himself to new circumstances, +neuroses and psychoses are disorders or halts in the evolution of +functions, in the development of their highest and latest part.[16] + +This halt in evolution can be connected with different physiological +causes, hereditary weaknesses of origin, infections, intoxications, +disorders of internal secretions, disorders of the sympathetic system. +These diverse etiologies will most likely be of use later to distinguish +between forms of these diseases; but to-day the common character of +neuroses and psychoses is that this diminution of vitality bears upon +the highest functions of self-government. + +Whatever be the disorders you may consider, aboulias, hysterical +accidents, psychasthenic obsessions, periodical depressions, +melancholics, systematized deliriums, asthenic insanity, you will always +find a number of facts resulting from this general perturbation. + +In plenty of cases, the acts, far from being diminished, appear +exaggerated; the patient moves about a great deal, he accomplishes acts +of defense, of escape, of attack, he speaks enormously, he seems to +evoke many remembrances and combine all sorts of stories during +interminable reveries. But pray examine the value and the level of all +these acts; they are mere gestures, shocks of limbs, laughter, sobs, +reactions simply reflex or perceptive, in connection with immediate +stimulation, with inhibition, without choice, without adaptation by +reflection. The thoughts that fill these ruminations are childish and +stupid, just as the acts are vulgar and awkward; there is a manifest +return to childhood and barbarism. The behavior of the agitated +individual is well below that which he should show normally. It is easy +to explain these facts in the language we have adopted. The agitation +consists in an activity, more less complete, in inferior tendencies very +much below those the subject should normally utilize. + +It is that in reality the agitation never exists alone, it is +accompanied by another very important phenomenon which it dissimulates +sometimes, I mean the depression characterized by the diminution or the +disappearance of superior actions, appertaining to the highest level of +our hierarchy. It is always observed that with these patients certain +actions have disappeared, that certain acts executed formerly with +rapidity and facility can no longer be accomplished. The patients seem +to have lost their delicacy of feeling, their altruism, their +intelligent critique. The stopping of tendencies by stimulation, the +transformation of tendencies into ideas, the deliberation, the endeavor, +the reflection; in one word, both the moral effort and the call upon +reserves for executing painful acts are suppressed. There exists visibly +a lowering of level, and it is right to say that these patients are +below themselves. + +The two phenomena, agitation and depression, are almost always +associated in neuroses as well as in psychoses. It is likely that their +union depends upon some very general law, relating to the exhaustion of +psychological forces. It is probable that the superior phenomena exact +under a form of concentration, of particular tension, much more power +than acts of an inferior order, although the latter seem more violent +and more noisy. "When the force primitively destined to be spent for the +production of a certain superior phenomenon has become impossible, +derivations happen, that is to say, that this force is spent in +producing other useless and especially inferior phenomena."[17] + +A very great number of phenomena observed in neuroses and psychoses are +in connection with depression and agitation. Convulsive attacks, diverse +fits of agitation, prove to us that before the fit there existed +disproportion between the quantity and the tension of the psychological +forces, and that the spending of forces during the fit re-establishes +the equilibrium. But at the same time, after this spending, one observes +a notable lowering of the mental level, a real psycholepsy. It is very +likely that studies of this kind will produce some day the key of the +epilepsy problem, for vertigos and certain epileptic fits are certainly +phenomena of relaxation, the meaning of which we do not comprehend +because we do not study sufficiently the state of psychological tension +before and after the accidents. + +The difficulty of accomplishing superior acts, the exhaustion resulting +from their accomplishment, renders them fearful to the patient who has +the fear, the phobia of these acts, just as he has the terror of that +depression which gives the feeling of the diminution of life. The +shrinking of activity and conscience, phobias, negativisms, generally +take their starting point in this fear of exhaustion caused by some +difficult action. In other cases the patient feels incapable of +accomplishing correctly the reflected acts necessary to social and moral +life, and feeling no longer protected by reflection, he is afraid of +willing or believing something, as one is afraid of walking in a +dangerous path, when one cannot see. The vertigo of life produces itself +like the vertigo of heights, when one is not sure of oneself. + +Depressed patients have felt, wrongly or rightly, a certain excitation +after a certain action. Through some curious mechanism, certain acts, +instead of exhausting them, have raised their psychological tension. The +need, the desire to raise themselves inspires them with the wish to +renew such acts, and we behold the impulsions to absorb poisons, +impulsions to command, to theft, to aggression, to extraordinary acts, +varied impulsions which play a great part in psychoses as well as in +neuroses. + +I shall not insist any more on a very interesting phenomenon in +connection with the oscillations of the mind and which still plays a +great part in these diseases. I am speaking of the change of feeling +which may accompany the same action in the course of the oscillations of +the mind. At the level with the reflected action, more or less complete, +the thought of an action which appears important and of which one often +thinks, determines interrogations, doubts, scruples. If the individual +descends one degree, if he becomes quite incapable of reflecting and +therefore of doubting, the same action he continues to think about may +present itself under the form of an impulsion more or less irresistible. + +There are patients who in the first stage have the fear and horror of +committing an act and who in the second stage are driven to accomplish +it. In other cases a subject may make use of an action as a means of +exciting and raising himself; he seeks it, and the thought of this +action is accompanied by love and desire. Let him become depressed and +he will no longer be able to accomplish this same action without +exhausting himself; he is then reduced to dread it and take an aversion +to it. That which was an object of love becomes an object of hatred. +Thence these turnings of mind that are so often to be observed in the +course of neuroses and psychoses. In a score of my observations the +frenzy of persecution and hatred presents itself as an evolution of +those obsessions of love and domination. + +These are very curious facts that one observes in the oscillations of +the mind, in particular when the psychasthenic depression becomes more +serious and transforms itself in psychasthenic delirium, which is more +frequent than one generally imagines. As a rule the properly so-called +psychasthenic has only disorders of the reflection; he doubts but he +does not rave. But under different influences, his depression may +augment, and when he drops below reflection he has no longer the doubts, +the hesitations, he no longer shows manias of love and of direction, he +transforms his obsessions into deliriums and often his loves into +hatreds. + +These are a few examples of the perturbations of conduct common to +neurotic sufferers and the diseased in mind. One perceives that the same +laws relating to the diminution of force and the lowering of the +psychological tension intervene in the same way with the one as with the +others. The distinctions, which have been established for social reasons +and practical conveniences, no longer exist when one tries to find, by +analysis of the symptoms, the nature of neuroses and psychoses. + +The latter reflection shows us, however, that in certain cases, at +least, there is a certain difference in degree between neuroses and +psychoses. The evolution of the human mind has been formed by degrees, +by successive stages, and we possess in ourselves a series of superposed +layers which correspond to diverse stages of the psychological +development; when our forces diminish we lose successively these diverse +layers commencing with the highest. It is the superior floors of the +buildings that are reached first by the bombardments of the war and the +cellars are not destroyed at first; they acquire even more importance, +as people are beginning to inhabit them. Well, according as the +depression descends more or less deeply, the disorders which result from +the loss of the superior functions and the exaggerated action of the +inferior ones become more and more serious and are appreciated +differently. The superior psychological functions are, in my opinion, +experimental tendencies and rational tendencies. They are tendencies to +special actions in which man takes in account remembrances of former +acts and of their results, in which he enforces on himself by a special +effort obedience to logical and moral laws. A little fatigue and a +slight degree of exhaustion are sufficient for such an action to become +difficult and impossible to prolong for a long time. Furthermore, the +disorders of the experimental conduct or of the rational conduct are +very frequent. These disorders only reach the superior actions which are +not absolutely necessary to the conservation of social order. They can +be easily repaired by inferior acts: if the man does not obey pure moral +principles, at least he can conduct himself in appearance in an +analogous manner through fear of the prison. Also, these disorders of +the superior functions are considered as slight; they are called errors, +or faults, and it is admitted that the subjects remain normal beings. + +At the other extremity of the hierarchical series of tendencies the acts +are simply reflex. When the disease descends to this level, when the +elementary acts can no longer be executed correctly, we do not hesitate +either, and we consider these disorders (related with known lesions) as +organic diseases of the nervous system. But between these two terms we +note disorders in behavior which are more difficult to interpret. These +disorders are too grave and too difficult to modify by our usual +processes of education and punishment for us to consider them as mere +errors or as moral faults; they are variable; they are not accompanied +by actually visible lesions and we have trouble in classing them among +the acknowledged deteriorations of the organism. There is the province +of neuroses and psychoses, intermedium between that of rational errors +and that of organic diseases of the nervous system. It corresponds to +the disorders of medium psychological functions, to the group of these +operations which establish a union more or less solid between the +language and the movements of limbs and which give birth to our wills +and beliefs. + +Can one establish, in this group, a distinction between neuroses and +psychoses that rests on some more precise notion and that is not limited +to distinguishing them in a legal point of view? A more profound +knowledge of the mechanisms of the will and belief would perhaps permit +us to do so. We are capable of wills and beliefs of a superior order +when we reach decision after reflection. The operation of reflection +which hinders tendencies and maintains them in the shape of ideas, which +compares ideas and which only decides after this deliberation, +constitutes the highest form of the medium operations of the human mind. +Lower, still, there exists will and belief, but they are formed without +reflection, without stoppage of ideas, without deliberation; they are +the result of an immediate assent which transforms verbal formulas into +wills and beliefs as soon as they strike the attention, as soon as they +are accompanied by a powerful sentiment. The immediate assent is the +inferior form of these tendencies. + +If one wished to establish a scientific distinction between neuroses and +psychoses, I should say, in a summary fashion, that in neuroses the +reflection alone is disturbed, that in psychoses the immediate assent +itself is affected. The shrinkage of the conscience, doubts, aboulias, +obsessions, scruples are always disorders of the reflected will and +belief. On the contrary, irresistible impulsions, deliriums, +indifferences which suppress desires and only allow elementary +agitations to subsist, show alterations in the immediate assent, in the +will, and the primitive belief and must be considered as psychoses. +Below could be placed the disorders of elementary intelligence, the +disorder of the perceptive and social functions which characterize the +mental deficiencies of imbeciles and idiots. One might also distinguish +these disorders according to the degree of depth the destruction of the +edifice has reached, according to the more or less distant state of +evolution to which the patient goes back. But these psychological +classifications are purely theoretical, and in practice many other +factors intervene which oblige us to consider such a patient as +incapable of doing any harm and such another as dangerous; this is the +only difference to-day between neuroses and psychoses. Later on, without +doubt, we shall be able to substitute for these simply symptomatical and +psychological diagnostics, some etiological and physiological +diagnostics. We shall be able from the very outset to recognize that a +disorder, in all appearance slight and which is not deeply set, presents +a bad prognosis, and we shall be able to foresee a serious and deep +psychosis in the future. To-day, without doubt, one can often +distinguish from the outset the future general paralytic from the simple +neurasthenic. But in the actual state of science this ability to +distinguish is not frequent and the future evolution of a depressed +state can scarcely be foreseen with precision. + +Certain individuals pass in a few years from psychasthenic depression +with doubts and obsessions to psychasthenic deliriums with stubbornness +and negativism, then to asthenic insanity with irremediable and complete +want of power. Is it necessary to say that we made a mistake in our +diagnostic and that from the first demential psychosis should have been +recognized? I am not convinced of this: these diseases, excepting a few +cases with rapid evolution, are not characterized from the outset. +Without doubt we must note that these depressions which disturb the +reflective tendencies of young patients in full period of formation, +are dangerous and can bring on still deeper depressions of the +psychological tension. But that evolution is rarely fatal; it can very +often be checked, and it seems to me fair to preserve the distinction +between neuroses and psychoses considered as different degrees of +psychological decadence. + +Neuroses are, therefore, the intermedium between the errors and the +faults which appeared to us almost normal, and alienation which seemed +exceptional and distant from us. The first appearances of that +depression which in a continuous manner descends to alienation are to be +found already in the disorders of character which seemed to be quite +insignificant. The miser, the misanthrope, the hypocrite are described +by the writer before they are claimed by the physician. A great number +of neuropathic disorders which I have described are related to the +popular type of mother-in-law. This type is not necessarily that of a +woman whose daughter has married, but the type of a depressed woman of +about fifty, aboulic, discontented with herself and others, domineering, +and jealous, because she suffers from the mania of being loved though +she is incapable of acquiring any one's affection. All exhaustions, all +moral failings have the closest connection with neuroses and psychoses. + +These reflections prove to us that the alienist physician should +interest himself more and more in the treatment of neuroses even slight, +to rectifying the disorders of temper, to the education of the young, to +the direction of the moral hygiene of his country. On many of these +points America leads the way; your works of social hygiene, the good +battle you are righting against alcoholism, are examples for us. You are +the new world, younger, not rendered so inactive by secular habits. You +can act more easily than we. We may have the advantage, in the old +world, of the experience of old people and the habit of observation, but +we are slack in reform and action. "If youth had experience and old age +ability," says one of our proverbs. We must remain united and join your +strength to our experience for the greater progress of the studies which +are dear to us and for the greater good benefit of our two countries. + +FOOTNOTES: + +[Footnote 14: _Cf._ Janet, P., Les névroses, 1909, p. 370.] + +[Footnote 15: _Cf._ Les Médications psychologiques, 1920, I, p. 112.] + +[Footnote 16: "Les Nevroses," 1909, p. 384.] + +[Footnote 17: _Cf._ Janet, P., "Obsessions et Psychestenic," 1903, vol. +I, p. 997.] + + + + +ADDRESS BY +DR. WILLIAM L. RUSSELL + +[Illustration: BLOOMINGDALE HOSPITAL, WHITE PLAINS, NEW YORK, 1921] + + +_The Chairman_: The year 1921 is rich in anniversaries for the New +York Hospital. Next October we plan to celebrate the one hundred and +fiftieth anniversary of the granting of our charter. To-day we are +occupied with the Bloomingdale Centenary. A fortnight ago the +twenty-fifth annual graduating exercises of our Training School for +Nurses were held in this room. This year also marks the decennial of Dr. +Russell's term of office as Medical Superintendent. When his devoted +predecessor, Dr. Samuel B. Lyon, asked in 1911 to be relieved from +active duty and became our first Medical Superintendent Emeritus, we +were most fortunate in securing as his successor Dr. Russell. Coming to +this institution after a broad psychiatric and administrative +experience, he has taken up our special problems with deep insight and +gratifying success. He has selected for his subject this afternoon "THE +MEDICAL DEVELOPMENT OF BLOOMINGDALE HOSPITAL." No one can speak with +greater authority on a theme of which it may be said _quorum magna +pars_--fortunately not only _fuit_--but _est_ and _erit_ as well. + + +DR. RUSSELL + +The object of this celebration is not merely to glorify the past and +least of all is it to laud the present. What we hope from it is that it +will establish a milestone, not only to mark the progress thus far made +but to point the way to a path of greater usefulness. The advances in +medical science and practice and in the specialty of psychiatry during +the past hundred years fill one with wonder and hope. It is worth while +to review them merely to obtain this help. The outlook for the century +to come is, however, so far as can be anticipated, still brighter. + +To review the past is, at a time like this, not unprofitable. It may +prevent us, in our zeal for the new, from discarding what is valuable in +the old, and from overvaluing some things which may have outlived their +usefulness. We must be careful that we do not fall into errors similar +to those from which the medical profession was rescued by the movement +of which Bloomingdale Asylum was an offspring. It should be recalled +that the establishment of the asylum was due to the initiative of the +Governors of the New York Hospital, especially Mr. Eddy, rather than to +the active interest and direction of physicians. The object of the +establishment was, according to Mr. Eddy, to afford an opportunity of +ascertaining how far insanity may be relieved by moral treatment alone, +which, he says, "it is believed, will, in many instances, be more +effective in controlling the maniacs than medical treatment." The moral +management he referred to, though advocated by Pinel and a few others, +some of whom were benevolent and intelligent laymen, had not been +accepted by physicians as a distinct form of medical treatment. Few +physicians of the period had accepted management of the mind as +described and practised by Pinel as being a distinct medical procedure, +as having the same value in overcoming mental disorders as the drastic +medical remedies which they were accustomed to employ, or as having any +exclusive healing power. This is clearly shown by the case records of +the mental department of the New York Hospital which have been preserved +since 1817, and of those of Bloomingdale Asylum for some years after its +opening in 1821. It is plainly set forth in Dr. Rush's book on diseases +of the mind, which was first published in 1810 and again in a fourth +edition in 1830. Rush was physician to the Pennsylvania Hospital and his +book was the principal, if not the only, one of the period by an +American author. American physicians like their European brothers, had, +as Pinel observes, "allowed themselves to be confined within the fairy +circle of antiphlogisticism, and by that means to be deviated from the +more important management of the mind." Rush believed that madness was a +disease of the blood-vessels of the brain of the same nature as fever, +of which it was a chronic form. "There is," he says, "not a single +symptom that takes place in an ordinary fever, except a hot skin, that +does not occur in an acute attack of madness." He found in his autopsy +observations confirmation of this view and concludes that "madness is to +phrenitis what pulmonary consumption is to pneumony, that is, a chronic +state of an acute disease." The reason for believing that madness was a +disease of the blood-vessels, which seemed to him most conclusive, was +"from the remedies which most speedily and certainly cure it being +exactly the same as those which cure fever or disease in the +blood-vessels from other causes and in other parts of the body." The +treatment he recommended and which was generally employed was copious +blood-letting, blisters, purges, emetics, and other severe depleting +measures. When Bloomingdale Asylum was established, therefore, the +provision for moral treatment did not contemplate that this should be +applied by the physician or that he should have full control of the +resources by means of which it could be applied. The records do not +indicate that either the physicians or the Governors realized that this +might be necessary or advantageous. The present system of administration +in which the chief physician is also the chief executive officer of the +institution was a result of an evolution which took many years to reach +its full consummation. + +Pinel, many years before Bloomingdale Asylum was opened, had shown by +the most careful observation and practice that the management and +discipline of the hospital was a most powerful agent in the treatment of +the patients. The manner in which he was led to this conclusion is a +remarkable example of the scientific method. When he became physician to +the Bicetre he found that the methods of classification and treatment +recommended in the books seemed to be inadequate, and, desiring further +information, he says: "I resolved to examine myself the facts which were +presented to my attention; and, forgetting the empty honor of my titular +distinction as a physician, I viewed the scene that opened to me with +the eye of common sense and unprejudiced observation.... From systems of +nosology, I had little assistance to expect; since the arbitrary +distributions of Sauvages and Cullen were better calculated to impress +the conviction of their insufficiency than to simplify my labor. I, +therefore, resolved to adopt that method of investigation which has +invariably succeeded in all the departments of natural history, viz., to +notice successively every fact, without any other object than that of +collecting materials for future use; and to endeavor, as far as +possible, to divest myself of the influence, both of my own +prepossessions and the authority of others. With this view, I first of +all took a general statement of the symptoms of my patients. To +ascertain their characteristic peculiarities, the above survey was +followed by cautious and repeated examinations into the condition of +individuals. All our new cases were entered at great length upon the +journals of the house." Having thus studied carefully the course of the +disease in a number of patients who were subjected only to the guidance +and control made possible by the management of the hospital under the +direction of a remarkably highly qualified Governor, it came to him with +the force of a new discovery that this man who was not a physician was +doing more for the patients than he was, and that insanity was curable +in many instances by mildness of treatment and attention to the state of +mind exclusively. "I saw with wonder," he says, "the resources of nature +when left to herself, or skilfully assisted in her efforts. My faith in +pharmaceutic preparations was gradually lessened, and my scepticism +went at length so far as to induce me never to have recourse to them, +until moral remedies had completely failed." So convinced did he become +of the significance and importance of the management and discipline of +the hospital in the treatment of the patients, that, when a few years +later, he wrote his "Treatise on Insanity," he states that one of the +objects of his writing it was, "to furnish precise rules for the +internal police and management of charitable establishments and asylums; +to urge the necessity of providing for the insulation of the different +classes of patients at houses intended for their confinement; and to +place first, in point of consequence, the duties of a humane and +enlightened superintendency and the maintenance of order in the services +of the Hospitals." + +Pinel's views had apparently not been fully understood or adopted by the +physicians of America at the time Bloomingdale Asylum was planned and +established. Dr. Rush did not mention him in his book, and Mr. Eddy, in +his communication to the Governors of the New York Hospital, referred +only to the writings of Drs. Creighton, Arnold, and Rush and the Account +of the York Retreat by Samuel Tuke. + +When Bloomingdale Asylum was opened, the form of organization +introduced was that under which the department at the New York Hospital +had been conducted. Mr. Laban Gardner was made Superintendent or Warden +with two men and three women keepers to aid him in the control and +management of the seventy-five patients. There was an Attending +Physician who visited once a week and a Resident Physician, neither of +whom received salaries. There is nothing in the records to indicate that +in the beginning, the Governors of the Hospital looked upon the moral +treatment of the patients, which was the object for which the +institution was established, as the task of the Physicians. The aim was +to furnish employment, diversion, discipline, and social enjoyment, +without much attempt at precision or close medical direction and +control. For a time the results were considered to be satisfactory. In +1824, however, a joint Committee of the Board reported that they were +impressed by the necessity of improving the moral treatment, and +recommended that two discreet persons be appointed to take charge of +such of the patients as might from time to time be in a condition to be +amused or employed on the farm or in walking exercises in the open or in +classes to be designated by the Resident Physician "with," however, "the +approbation of the Superintendent," who you will recall was not a +physician. These patients were, the report recommends, to be +particularly under the charge of the Resident Physician when thus +employed or amused "out of the Asylum." At this time, the Attending and +Resident Physicians were placed on a small salary, and the Resident +Physician was instructed to "devote a greater portion of his time and +attention to the moral part of the establishment and to communicate to +the Committee such improvements as his experience shall suggest to be +useful and necessary in carrying into more complete effect the system of +moral treatment and to report from time to time to the Committee the +effect of the measure adopted." This seems to have been the beginning of +a realization that the moral management of the patients was inseparable +from medical treatment and must necessarily be the task of the +physician. Seven years after this, in 1831, the Committee found it +advisable to spread upon the minutes an "interpretation and +regulations," relating to the Superintendent and Matron of the Asylum +and to the Asylum physicians, to the effect that the Committee +understood that the regulations "placed the moral treatment on the +physician alone, under the direction of the Asylum Committee, and that +the responsibility remains with him alone, that this treatment commenced +with the reception of the patient, the ward where he shall be placed, +his exercises, amusement, admission of friends, the time of discharge +from the house.... And that all orders to nurses and keepers which the +physicians may think necessary to carry these orders into effect _shall +be communicated through the Superintendent_" (or Warden). In 1832, the +Resident Physician, Dr. James Macdonald, who had just returned from +Europe after having spent a year in visiting the institutions for mental +disorders there, made a report in which he rather significantly referred +to the impracticability of making a sharp distinction between the +medical and moral treatment of the patients, it being difficult to say +where the one ended and the other began, or to put one into successful +operation without bringing in the other. At this time the position of +Attending Physician was abolished and the Resident Physician was made +the Chief Medical Officer of the Asylum. It was not until 1837 that an +amendment to the by-laws regulating the powers of the physician and the +Warden was adopted which gave to the physician the power of appointing +and discharging at pleasure all the attendants on the patients, while to +the Warden was reserved the power of appointing and dismissing all other +employees. Fourteen years had thus elapsed since the opening of the +Asylum before the physician was given control of even the nursing +service. The first Annual Report of the Resident Physician of the +Asylum to be published appeared in 1842. In this, Dr. William Wilson +makes a general statement in regard to the beneficial effects of the +moral as well as the medical treatment pursued in the institution, and +refers particularly to occupations, exercise in the open air, amusement, +religious services, and he asks that a workshop be erected for the men. +It is evident that by this time the authority of the physician in the +management of the institution had been extended and it is perhaps +significant that in his report of the following year Dr. Wilson refers +to a plan for distribution of food which had been evolved in +co-operation with the Warden. Under the direction of Dr. Pliny Earle, +who was appointed physician to the Asylum in 1844, treatment directed to +the mind was further elaborated and systematized, and the place of the +physician in the management of the hospital was more firmly established. + +This brief survey indicates how, in the development of the work of the +institution, it required years of practical experience to show to the +Governors that, in order to secure for the patients the treatment which +the Asylum had been established to furnish, it was necessary to extend +the powers and duties of the physician so that he could control and +direct the internal management and discipline, and all the resources +for social as well as individual treatment. This extension was continued +until finally the present form of organization was adopted in which the +chief physician is also the chief executive officer of the institution. +This was, however, not fully accomplished until 1877. It is now +universally recognized that the physician must be the supreme head of +the organization, and all American institutions and most, if not all, of +those in other countries are now similarly organized. + +In the early development of Bloomingdale Asylum, this extension of the +influence and authority of the physician is the outstanding medical +fact. It did away with division of responsibility and removed from +discussion the question of moral as distinct from medical treatment. +Thereafter a harmonious and effective application of all the resources +of the institution to the problems of the patients became more easily +and certainly possible. Since then, the resources for treatment directed +to the mind have been developed as steadily and fully as those required +for the treatment of physical conditions. The use of the organized +agencies which were regarded by the founders as the main reliance in +moral treatment, namely occupations, physical exercises and games, +diversion, social contacts, and enjoyment, and management of behavior +has been greatly extended, and specialized departments have been +created for their application with system and growing precision. Great +advances have also been made in the methods of examining the minds of +the patients and of determining the mental factors in their disorders +and the means of restoring their capacity for adjustment to healthy +thinking and acting. Psychiatry has been furnished with a body of +well-arranged facts, and with a technic which is not inferior in system +and precision to that of many other branches of medicine. In the study +and management of the minds of the patients the physician is thus +enabled to apply himself to the task as he does to any other medical +problem. + +The advances in general medical science and practice have also +necessitated great elaboration of the resources for the study and +treatment of the physical condition of the patients. Instruments of +precision, laboratories, x-ray departments, dental and surgical +operating rooms, massage and hydrotherapy departments, facilities for +eye, throat, nose, and ear examinations and treatment, and all the other +means of determining disease processes and applying proper treatment +have been supplied and the methods and standards of modern clinical +medicine and surgery are utilized. It can now be clearly seen that it is +necessary to direct attention to the whole personality of the patient, +including his original physical and mental constitution, the physical as +well as the mental factors which may be operating to produce his +disorder, and the environmental conditions to which he has been and may +again be exposed. In the treatment of mental disorders it is necessary +to beware of what Pinel found to be the fault of the physicians and +medical authors of his time, who he says were more concerned with the +recommendation of a favorite remedy than with the natural history of the +disease, "as if," he says, "the treatment of every disease without +accurate knowledge of its symptoms involved in it neither danger nor +uncertainty," and he quotes the following maxim of Dr. Gault: "We cannot +cure diseases by the resources of art, if not previously acquainted with +their terminations, when left to the unassisted efforts of nature." +Exclusive attention to the physical condition and factors, or to the +mental condition and factors, or concentration on one theory or one form +of treatment to the exclusion of all others is sure to lead to neglect +of that careful general inquiry into the whole personality of the +patient, into the conditions out of which his disorder arose, and into +all the manageable factors in the situation which is so essential to +intelligent and effective treatment. Notwithstanding the great benefit +which has been derived from physical measures in the study and +treatment of mental disorders, and the well-founded hopes of greater +advances in this direction, the main task still continues to be what +Pinel calls the management of the mind. Experience and increasing +knowledge show that this is a task which can only be successfully +performed by the physician and by means of organized resources which are +under medical direction and control. The hospital for mental disorders +furnishes the means of providing social as well as individual treatment. +It is a medical mechanism and for its proper management and use it is +required of physicians that they accept the burden of much executive +work and give their attention to many subjects and activities that may +interfere seriously with what they have been taught to regard as more +strictly professional interests. Like Pinel, one must be willing to +forget the empty honor of one's titular distinction as a physician, and +do whatever may be necessary to make the institution a truly medical +agency for the healing of the sick. Considerable progress has been made +in developing executive assistants to relieve the physicians of much of +the administrative work which requires little or no medical supervision +and direction. Special provision for the training of such executives +has, however, received insufficient attention. This question might, with +great advantage, be taken up by the hospitals and colleges. Nothing +would add more to the quality of the service which the hospitals render +than to supplement the work of the physicians by that of well educated +and highly trained executive assistants who would themselves find an +extremely interesting and productive field for their efforts. + +A period has now been reached in this field of work when what amounts to +a movement not inferior in significance and importance to that of a +hundred years ago, seems to be in active operation. The character and +scope of this movement and the lines of its progress have, to some +extent, been indicated in the illuminating formulations which have been +presented here to-day. The medical study and treatment of the mind is no +longer so exclusively confined within the walls of institutions nor to +the type or degree of disorder which necessitates compulsory seclusion. +Psychiatry is extending out from the institutions into the communities +by means of out-patient clinics and social workers, through newly +created organized agencies, through informed individuals, physicians, +nurses, and lay workers, and through the general spread of psychiatric +knowledge. This process is being expedited by the efforts of organized +bodies such as the National and State Committees and Societies for +Mental Hygiene, and the public is rapidly learning what can properly be +expected of institutions, officials, physicians, nurses, and other +responsible individuals in whom special knowledge and ability are +supposed to be found. As in the prevention of tuberculosis, so, in the +prevention of mental disorders, the informed public is likely to start a +campaign which the medical profession may have to make haste to follow +in order to maintain its needed leadership. Although much is yet +required to improve the facilities necessary in carrying on the present +work, it seems to us that at such a time a further extension of the +activities of an institution such as Bloomingdale Hospital may be +necessary to enable it to fulfil its possibilities for greater +usefulness. To extend the work our experience indicates that a +department in the city at the General Hospital would be of great +advantage. During the past few years the oversight of discharged +patients has grown to such an extent that it seems as though some +organized method of carrying it on may soon become necessary. This and +out-patient work generally could be best attended to in a city +department. Much emergency work and preliminary observation and the +treatment of certain types of cases now frequently subjected to +unfortunate delays, neglect, and unskilful treatment would also be thus +provided for. It can be seen too that developments in construction and +organization which would furnish organized treatment for types of +disorders which are not so incapacitating as the pronounced psychoses +might be of advantage in the treatment of both adults and children. The +property on which the Hospital is located is large enough to permit of +further extensions and developments which could be as closely connected +with, or as widely separated and distinguished from, the present +provision as circumstances required. In this way much needed provision +for the treatment of persons suffering from the psychoneuroses and minor +psychoses could be furnished. Better provision for a further period of +readjustment after a patient is ready to leave the Hospital but not yet +ready to face the risk of ordinary conditions in the community is a felt +want. A group of supervised homes or an occupational colony might best +serve this purpose. The more extensive use of the Hospital as a teaching +centre is also a subject for consideration. A School for Nurses is now +conducted, and much instruction is given in the occupational +departments. More, however, could be done, especially in medical +teaching, which could be best carried on in a department in the city and +would tend to advance the standard of medical service throughout the +Hospital. + +The lines of further development are, perhaps, not yet perfectly clear +in all directions. It seems certain, however, that they will lead toward +a broader field of usefulness, in which the hospital will be regarded as +a responsible agency for dealing with psychiatric problems in the +community which it serves and will take part with other agencies in +extending psychiatric knowledge and in applying it to prevention, and to +the management of mental disorders as an individual and social problem +beyond the walls of the institution. We hope that this meeting will +prove a real starting point for this development. We are greatly +indebted to those who have taken part in it both as speakers and as +audience. We are especially indebted to those who came across the sea to +be with us. It is peculiarly fitting that representatives of France and +of England should have been here, for to Pinel, the Frenchman, and to +Tuke, the Englishman, are due more than to any others whose names we +know the foundations of the modern institutional treatment of mental +disorders. + + + + +_The Chairman:_ This, ladies and gentlemen, concludes our exercises. As +the representative of the Governors, I find it quite impracticable, in +supplementing what Dr. Russell has just said, to express adequately our +admiration of and gratitude to these eminent scientists and apostles of +light for their presence here and for their inspiring addresses. These, +if I may be permitted to appraise them, seem to make a notable addition +to medical literature, and, with the permission of their authors, we +purpose, for our own gratification and for the benefit of the +profession, to have all of the addresses preserved in a volume recording +this centenary celebration. In due course a copy of this volume will be +sent to each of our guests. The celebration itself, I think you will all +agree with me, has been a moving one, with an underlying note of +philanthropic endeavor as high as the stars. You heard its refrain in +the pageant on the lawn this afternoon. As I have listened to-day to +these words of profound wisdom, uttered in so noble a spirit of human +ministry, my mind has gone back to the sentence from Cicero's plea for +Ligarius,[18] which formed the text for Dr. Samuel Bard's eloquent +appeal in 1769, mentioned this morning, for the establishment of the New +York Hospital, and which may be freely rendered, "In no act performed by +man does he approach so closely to the Gods as when he is restoring the +sick to the blessings of health." And surely when that restoration to +health consists in "razing out the written trouble of the brain" and +reviving in the patient the conscious exercise of divine reason, it is +difficult to imagine a more Godlike act. + +FOOTNOTES: + +[Footnote 18: Homines enim ad Deos nulla re proprius accedunt, quam +salutem hominibus dando.] + + + + +THE TABLEAU-PAGEANT + +[Illustration: SCENE FROM THE TABLEAU PAGEANT PRESENTED ON THE GROUNDS +OF BLOOMINGDALE HOSPITAL, MAY 26, 1921] + + +SYNOPSIS + +While the Symbolic Father Time bears witness, the Muse of History, as +the Narrator, after alluding to the remote past, briefly summarizes the +incidents leading up to the establishment of the Society of the New York +Hospital by Royal Charter in 1771. The succeeding scenes are +self-revealing. The familiar picture of Pinel at Salpetrière depicts +conditions in that period. Several portraits of personalities intimately +associated with the early history of Bloomingdale Hospital follow. +These, together with an episode from the life of Dorothy Dix, stimulate +our imagination with reference to the revival of interest in the care of +the mentally ill in the first half of the last century. The closing +scenes suggest the great advance which has taken place during the +century, and the part that work and play take to-day in re-establishing +and maintaining life's balances. Finally, in symbolic processional, +tribute is paid to Hygeia, the goddess of Health and Happiness. + + +CHARACTERS AND SCENES IN TABLEAU-PAGEANT + +Music: Orchestra + Overture + +_Prologue_ + +The Muse of History (Narrator): Adelyn Wesley +Spirit of the Past (Time): Dr. D. Austin Sniffen + +Music: Orchestra + "Amaryllis" + + +SCENE I + +COURT OF KING GEORGE III.--GRANTING OF THE CHARTER + +Characters: + King George III + Queen Charlotte + Prince of Wales + Court Chamberlain + Court Ladies + Emissaries + Cherokee Chief + Gavot + +Minuet + + Through dramatic license, this scene takes place in the Court of + King George III. Colonial emissaries, accompanied by a North + American Indian, attend, and are graciously granted by the King a + Royal Charter establishing the Society of the New York Hospital, + along with a seal, insignia, and a money gift. A bit of color and + romance attaches to the Cherokee's appearance in the scene. + +Music: Orchestra + "God Save the King" + "Minuet Don Juan" + "Largo" + "Amaryllis" + + +SCENE II + +PINEL À LA SALPETRIÈRE [Transcriber's note: original reads +'SALPTERIÈRE'] + +Characters: + Pinel + Patients + Aides and Attendants + + A courtyard scene in Salpetrière in 1792. Hopelessness and chained + despair are pictured. Pinel enters, is saddened and indignant at + the sight of so much unnecessary suffering, and instantly orders + the chains to be struck off. The historic episode closes in a + graphic tableau depicting the gratitude of the released. + +Music: Orchestra + "Kammenoi Ostrow" + + +SCENE III + +PORTRAITS--PERSONALITIES OF THE PAST + + +Thomas Eddy, of the Board of Governors, 1815-1827. + +Dr. James Macdonald, First Resident Physician, 1825-1837. + +Dr. Pliny Earle,[Transcriber's note: original reads 'Early'] Organizer, + 1844-1849. + +Miss Eliza Macdonald, daughter of Dr. Macdonald, unveils the portrait of +her father. + +Music: Orchestra + "Long, Long Ago" + + +SCENE IV + +DOROTHY LYNDE DIX BEFORE A LEGISLATIVE COMMITTEE + +Characters: [This instance of 'Characters:' added by transcriber] + Dorothy L. Dix + Members of the Committee + Chairman + + Miss Dix appears before a Committee of the Legislature and is heard + in an impassioned appeal on behalf of adequate provision and care + for the mentally ill. The scene closes with the Committee + indicating their approval and congratulating Miss Dix on her + successful effort. + +Music: Orchestra + "Maryland, My Maryland" + "Columbia, the Gem of the Ocean" + + +SCENE V + +OCCUPATIONAL-RECREATIONAL ACTIVITIES + +Men's Crafts +Women's Crafts +Men's Sports +Women's Sports + +Maypole Dance + + Supplementing the general medical work, the therapeutic value of + organized occupational and recreational activities is gaining + increasing recognition. Those arts and crafts lending themselves to + graphic presentation are here selected: dyeing, weaving, spinning, + basketry, caning, modelling, painting, pottery, metal work, net + making, gardening, etc.: and similarly, in the recreative + activities, tennis, golf, hockey, baseball, croquet, bowling, + skiing, and skating. A Maypole dance closes the scene. + +Music: Orchestra + "Boccherina" + "Henry VIII, Maypole Dance" + + +SCENE VI + +INSPIRATIONS + +Characters: + Hygeia + La Belle France + Britannia + Columbia + + The closing scene is in the nature of a processional symbolizing + international unity of purpose and a determination to pursue, until + finally attained, the goal of Health and Happiness, personified by + the goddess Hygeia. + +Music: Orchestra + "Marseillaise" + "God Save the King" + "Battle Hymn of the Republic" + "The Star Spangled Banner" + "Tammany" + + + + +NAMES OF THOSE WHO ATTENDED THE EXERCISES[19] + +E. Stanley Abbot, M.D. Philadelphia, Pa. +Louise Acton White Plains, N.Y. +Elizabeth I. Adamson, M.D. White Plains, N.Y. +William H. Alleé, M.D. Ridgefield, Conn. +Thaddeus H. Ames, M.D. New York City. +Mrs. George S. Amsden White Plains, N.Y. +Mrs. Isadora Anschutz White Plains, N.Y. +Grosvenor Atterbury New York City. + +Pearce Bailey, M.D. New York City. +Amos T. Baker, M.D. Bedford Hills, N.Y. +Mrs. Amos T. Baker Bedford Hills, N.Y. +Lewellys F. Barker, M.D. Baltimore, Md. +Clifford W. Beers New York City. +Christopher C. Beling, M.D. Newark, N.J. +Harrison Betts, M.D. Yonkers, N.Y. +Anna T. Bingham, M.D. New York City. +Mrs. Martha Bird Middletown, N.Y. +Charles E. Birch, M.D. White Plains, N.Y. +J. Fielding Black, M.D. White Plains, N.Y. +Mrs. J. Fielding Black White Plains, N.Y. +G. Alder Blumer, M.D. Providence, R.I. +Leonard Blumgart, M.D. New York City. +J. Arthur Booth, M.D. New York City. +Miss Helen Booth New York City. +S.M. Boyd Scarsdale, N.Y. +Mrs. S.M. Boyd Scarsdale, N.Y. +Mrs. Sidney C. Borg New York City. +Rose Bell Bradley New York City. +V.C. Branham, M.D. New York City. +Holly Brown White Plains, N.Y. +Helen Brown, M.D. New York City. +Sanger Brown, 2d, M.D. New York City. +Miss Elizabeth O. Buckingham Chicago, Ill. +Alfred C. Buckley, M.D. Frankford, Philadelphia, Pa. +Alice Gates Bugbee, M.D. White Plains, N.Y. +Jesse C.M. Bullowa, M.D. New York City. +William Browning, M.D. Brooklyn, N.Y. +Marie von H. Byers New York City. +Karl M. Bowman, M.D. White Plains, N.Y. +Mrs. Karl M. Bowman White Plains, N.Y. +Edna L. Byington White Plains, N.Y. + +C.N.B. Camac, M.D. New York City. +C. Macfie Campbell, M.D. Boston, Mass. +Mrs. C. Macfie Campbell, M.D. Boston, Mass. +Robert Carroll, M.D. Asheville, N.C. +Mrs. Robert Carroll Asheville, N.C. +Louis Casamajor, M.D. New York City. +Ross McC. Chapman, M.D. Towson, Md. +Helen Childs White Plains, N.Y. +Mrs. Anne Choate Pleasantville, N.Y. +E.H. Clarke New York City. +Miss Marjory Clark, R.N. New York City. +Joseph Collins, M.D. New York City. +Michael Collins White Plains, N.Y. +Arthur S. Corwin, M.D. Rye, N.Y. +Mrs. Margaret Cornwell New Rochelle, N.Y. +Henry A. Cotton, M.D. Trenton, N.J. +Edith Cox White Plains, N.Y. +C. Burns Craig, M.D. New York City. +Henry W. Crane New York City. +Raymond S. Crispell, M.D. New York City. +Mrs. Seymour Cromwell Mendham, N.Y. +Hugh S. Cummings, M.D., + Surgeon-General U.S. + Public Health Service Washington, D.C. + +Charles L. Dana, M.D. New York City. +Thomas K. Davis, M.D. New York City. +Henderson Brooke Deady, M.D. New York City. +John W. Dean White Plains, N.Y. +Mrs. Aline S. Devin Eliot, Maine. +Allen Ross Diefendorf, M.D. New Haven, Conn. +William Elliott Dold, M.D. Astoria, L.I., N.Y. +George Drake White Plains, N.Y. +John W. Draper, M.D. New York City. +Nataline Dullas White Plains, N.Y. +Charles S. Dunlap, M.D. New York City. +Mrs. Alfred F. DeNike White Plains, N.Y. + +R. Condit Eddy, M.D. New Rochelle, N.Y. +Joseph P. Eidson, M.D. White Plains, N.Y. +Mrs. Emma Eldridge Tuckahoe, N.Y. +Charles A. Elsberg, M.D. New York City. +William Else, M.D. New York City. +Everett S. Elwood, + Secretary State + Hospital Commission Albany, New York. + +Mrs. Ezra H. Fitch New York City. +Ralph P. Folsom, M.D. New York City. +Harold E. Foster, M.D. Boston, Mass. +Diana Fowler White Plains, N.Y. +Florence Fuller White Plains, N.Y. +Isaac J. Furman, M.D. New York City. + +Leslie Gager, M.D. New York City. +William C. Garvin, M.D. Kings Park, N.Y. +Arnold Gesell, M.D. New Haven, Conn. +Bernard Glueck, M.D. New York City. +J. Riddle Goffe, M.D. New York City. +S. Philip Goodhart, M.D. New York City. +Miss Annie W. Goodrich, R.N. New York City. +Phyllis Greenacre, M.D. Baltimore, Md. +Menas S. Gregory, M.D. New York City. +Miss Pauline P. Gunderson White Plains, N.Y. + +Louis J. Haas White Plains, N.Y. +Thomas H. Haines, M.D. New York City. +Miss Dorothy Hale New York City. +Miss Natalie Hall White Plains, N.Y. +Robert B. Hammond, M.D. White Plains, N.Y. +Miss Elisa Hansen White Plains, N.Y. +Milton A. Harrington, M.D. Alfred, N.Y. +Isham G. Harris, M.D. Brooklyn, N.Y. +George A. Hastings New York City. +Winifred Hathaway New York City. +Edna Haverstock White Plains, N.Y. +C. Floyd Haviland, M.D. Middletown, Conn. +F. Ross Haviland, M.D. Brooklyn, N.Y. +Charles E. Haynes, M.D. New York City. +Eunice W. Haydon New York City. +Miss Katherine F. Hearn, R.N. White Plains, N.Y. +Edna Hemingson White Plains, N.Y. +George W. Henry, M.D. White Plains, N.Y. +Mrs. George W. Henry White Plains, N.Y. +Marcus B. Heyman, M.D. New York City. +Beatrice M. Hinkle, M.D. New York City. +L.E. Hinsie, M.D. New York City. +P.F. Hoffman, M.D. White Plains, N.Y. +John F. Holden, M.D. White Plains, N.Y. +Hubert S. Howe, M.D. New York City. +Thomas Howell, M.D. New York City. +J. Ramsay Hunt, M.D. New York City. +Helen Hunt White Plains, N.Y. +Miss Augusta M. Huppuch New York City. +Richard H. Hutchings, M.D. Utica, N.Y. + +Frank N. Irwin, M.D. New York City. + +Martha Joffe White Plains, N.Y. +Walter B. James, M.D. New York City. +Mrs. Walter James White Plains, N.Y. +Professor Pierre Janet, M.D. Paris, France. +Madame Pierre Janet Paris, France. +M.E. Jarvis, M.D. New York City. +Rev. Oscar Jarvis White Plains, N.Y. +Walter Jennings Cold Spring Harbor, L.I., N.Y. +Miss Gudron Johannessen, R.N. White Plains, N.Y. +Miss Marguerite Jewell White Plains, N.Y. +Miss Florence M. Johnson. New York City. +Kenneth B. Jones, M.D. Thiells, N.Y. +Miss Minnie Jordan, R.N. New York City. + +Mrs. De Lancey A. Kane New Rochelle, N.Y. +Lilian A. Kelm New York City. +James P. Kelleher, M.D. New York City. +Foster Kennedy, M.D. New York City. +Marion E. Kenworthy, M.D. New York City. +John Joseph Kindred, M.D. Astoria, L.I., N.Y. +George W. King, M.D. Secaucus, N.J. +Hermann G. Klotz, M.D. White Plains, N.Y. +George W. Kline, M.D. Boston, Mass. +George H. Kirby, M.D. New York City. +Henry Klopp, M.D. Allentown, Pa. +Augustus S. Knight, M.D. New York City. +Frank Henry Knight, M.D. White Plains, N.Y. +Mary S. Kirkbride Albany, N.Y. +Walter M. Kraus, M.D. New York City. +Edward J. Kempf, M.D. New York City. + +Alexander Lambert, M.D. New York City. +Charles I. Lambert, M.D. White Plains, N.Y. +Mrs. Charles I. Lambert White Plains, N.Y. +Arthur G. Lane, M.D. Greystone Park, N.J. +G. Alfred Lawrence, M.D. New York City. +W.A. Lawrence, M.D. White Plains, N.Y. +Ruth W. Lawton White Plains, N.Y. +Helen Letson White Plains, N.Y. +Samuel Leopold, M.D. Philadelphia, Pa. +Maurice J. Lewi, M.D. New York City. +Mrs. Maurice J. Lewi New York City. +Miss Ella H. Lowe White Plains, N.Y. +Walter E. Lowthian, M.D. White Plains, N.Y. +F.R. Lyman, M.D. Hastings-on-Hudson, N.Y. +Samuel B. Lyon, M.D. New York City. +Winslow Lyon New York City. + +William H. McCastline, M.D. New York City. +John T. McCurdy, M.D. New York City. +Carlos F. MacDonald, M.D. New York City. +D.W. McFarland, M.D. Greens Farms, Conn. +Miss Eliza Macdonald Flushing, L.I., N.Y. +John W. Mackintosh White Plains, N.Y. +Daniel W. Maloney White Plains, N.Y. +Grace F. Marcus, M.D. White Plains, N.Y. +L. Markham, M.D. Amityville, N.Y. +Miss Anna Maxwell, R.N. New York City. +John F.W. Meagher, M.D. Brooklyn, N.Y. +Adolf Meyer, M.D. Baltimore, Md. +Carlos J. Miller, M.D. White Plains, N.Y. +Henry W. Miller, M.D. Brewster, N.Y. +Mrs. R. Van C. Miller New York City. +George W. Mills, M.D. Central Islip, N.Y. +Henry Moffett, M.D. Yonkers, N.Y. +Mrs. Maude G. Moody New York City. +Miss Madeline Moore White Plains, N.Y. +Joseph W. Moore, M.D. Beacon, N.Y. +Eugene T. Morrison, M.D. New Rochelle, N.Y. +Miss Cecil Morrison White Plains, N.Y. +Richard W. Moriarty, M.D. White Plains, N.Y. +Herman Mortensen, R.N. White Plains, N.Y. +Walter W. Mott, M.D. White Plains, N.Y. +Florence Munn White Plains, N.Y. + +Theodore W. Neumann, M.D. Central Valley, N.Y. +Ethan A. Nevin, M.D. Newark, N.J. +Miss Christine M. Nuno New York City. + +George O'Hanlon, M.D. New York City. +James M. O'Neill Harrison, N.Y. +Herman Ostrander, M.D. Kalamazoo, Mich. +Mary F. O'Grady White Plains, N.Y. + +Flavius Packer, M.D. Riverdale, N.Y. +Mrs. Flavius Packer Riverdale, N.Y. +Irving H. Pardee, M.D. New York City. +Jason S. Parker, M.D. White Plains, N.Y. +Frederick W. Parsons, M.D. Buffalo, N.Y. +Miss Margaret Patin White Plains, N.Y. +Stewart Paton, M.D. Princeton, N.J. +Christopher J. Patterson, M.D. Troy, N.Y. +Guy Payne, M.D. Cedar Grove, N.J. +Arthur M. Phillips, M.D. New York City. +Charles W. Pilgrim, M.D., Chairman, + State Hospital Commission, N.Y. Central Valley, N.Y. +Mason Pitman, M.D. Riverdale-on-Hudson, N.Y. +Miss Leah Pitman White Plains, N.Y. +Miss Adele S. Poston, R.N. White Plains, N.Y. +Howard W. Potter, M.D. Thiells, N.Y. +Wilson M. Powell New York City. +Mrs. Margaret J. Powers New York City. +Miss Nina Prey New York City. +W.B. Pritchard, M.D. New York City. +Morton Prince, M.D. Boston, Mass. +Rose Pringle, M.D. White Plains, N.Y. +Sylvanus Purdy, M.D. White Plains, N.Y. + +Paul R. Radosvljevich, M.D. New York City. +E. Benjamin Ramsdell, M.D. New York City. +Edwin G. Ramsdell, M.D. White Plains, N.Y. +Mortimer W. Raynor, M.D. New York City. +Lawrence F. Rainsford, M.D. Rye, N.Y. +Mrs. Lawrence F. Rainsford Rye, N.Y. +Henry A. Riley, M.D. New York City. +Miss Elise Reilly White Plains, N.Y. +Frank W. Robertson, M.D. New York City. +M.A. Robinson, M.D. New York City. +William C. Roden, R.N. White Plains, N.Y. +A.J. Rosanoff, M.D. Kings Park, N.Y. +Miss Catherine Ross, R.N. White Plains, N.Y. +John T.W. Rowe, M.D. New York City. +Richard G. Rows, M.D. London, England. +Frederick D. Ruland, M.D. Westport, Conn. +William L. Russell, M.D. White Plains, N.Y. +Mrs. William L. Russell White Plains, N.Y. +Earnest F. Russell, M.D. New York City. +Paul L. Russell White Plains, N.Y. +Mrs. Paul L. Russell White Plains, N.Y. +Walter G. Ryon, M.D. Poughkeepsie, N.Y. +Miss Helen K. Ryce Poughkeepsie, N.Y. + +Miss Helen Sayre White Plains, N.Y. +Thomas W. Salmon, M.D. New York City. +Mrs. Thomas W. Salmon New York City. +Irving J. Sands, M.D. Brooklyn, N.Y. +James P. Sands, M.D. Philadelphia, Pa. +William C. Sandy, M.D. New York City. +Miss E. Saul New York City. +William G. Schauffler, M.D. Princeton, N.J. +Paul Schlegman, M.D. White Plains, N.Y. +H. Ernest Schmid, M.D. White Plains, N.Y. +Miss Gertrude Schmid White Plains, N.Y. +Augusta Scott, M.D. New York City. +Major Louis L. Seaman, M.D. New York City. +Edward W. Sheldon New York City. +George Sherrill, M.D. Stamford, Conn. +Miss Eloise Shields, R.N. White Plains, N.Y. +Lewis M. Silver, M.D. New York City. +Mrs. A. Slesingle New York City. +Mrs. Anna C. Schermerhorn New York City. +Rev. Frank H. Simmonds White Plains, N.Y. +Clarence J. Slocum, M.D. Beacon, N.Y. +Mrs. Clarence J. Slocum Beacon, N.Y. +Augustine J. Smith New York City. +Miss M. Smith, R.N. Titusville, Pa. +Philip Smith, M.D. New York City. +Rev. George H. Smyth Scarsdale, N.Y. +D. Austin Sniffen, D.D. White Plains, N.Y. +John D. Southworth, M.D. New York City. +Edith E. Spaulding, M.D. New York City. +M. Allen Starr, M.D. New York City. +Samuel A. Steele White Plains, N.Y. +William Steinach, M.D. New York City. +George S. Stevenson, M.D. New York City. +Adolf Stern, M.D. New York City. +Emil Strateman White Plains, N.Y. +Israel Strauss, M.D. New York City. +Frank K. Sturgis New York City. +Miss Mary Ruth Swann, R.N. Washington, D.C. +C.C. Sweet, M.D. Ossining, N.Y. +Sarah Swift White Plains, N.Y. + +William B. Terhune, M.D. New Haven, Conn. +William J. Tiffany, M.D. New York City. +Walter Clark Tilden, M.D. Hartsdale, N.Y. +Frederick Tilney, M.D. New York City. +Walter Timme, M.D. New York City. +Howard Townsend New York City. +E. Clark Tracy, M.D. White Plains, N.Y. +Walter L. Treadway, M.D. Washington, D.C. +Miss Gertrude Trefrey, R.N. White Plains, N.Y. + +Miss Mary G. Urquhart White Plains, N.Y. + +J.L. Van deMark, M.D. Albany, N.Y. +T.J. Vosburgh, M.D. White Plains, N.Y. +Henry J. Vier, M.D. White Plains, N.Y. + +Emory M. Wadsworth, M.D. Brooklyn, N.Y. +Miss Lillian D. Wald, R.N. New York City. +Professor Howard C. Warren Princeton, N.J. +Mrs. Caroline E. Washburn White Plains, N.Y. +Miss Martha Washburn White Plains, N.Y. +G.F. Washburne, M.D. Hastings-on-Hudson, N.Y. +Chester Waterman, M.D. New York City. +James J. Waygood, M.D. White Plains, N.Y. +Mrs. James J. Waygood White Plains, N.Y. +R.G. Wearne, M.D. New York City. +Edward W. Weber, M.D. White Plains, N.Y. +Israel S. Wechsler, M.D. New York City. +Miss Kathryn I. Wellman. White Plains, N.Y. +Mrs. Adelyn Wesley New York City. +Lt. Col. Arthur W. Whaley, M.D. New York City. +Mrs. Arthur W. Whaley New York City. +Miss Margaret Wheeler Short Hills, N.J. +Payne Whitney New York City. +Frankwood E. Williams, M.D. New York City. +Rodney R. Williams, M.D. Poughkeepsie, N.Y. +O.J. Wilsey, M.D. Amityville, N.Y. +John E. Wilson, M.D. New York City. +Miss A. Wilson New York City. +J.M. Winfield, M.D. Brooklyn, N.Y. +G. Howard Wise New York City. +Miss Frances E. Wood White Plains, N.Y. +Robert C. Woodman, M.D. Middletown, N.Y. +Robert S. Woodworth, Ph.D. New York City. + +Rev. John C. York Brooklyn, N.Y. + +Edwin G. Zabriskie, M.D. New York City. +Charles C. Zacharie, M.D. White Plains, N.Y. + +FOOTNOTES: + +[Footnote 19: If any names are omitted it is because these names and +addresses were not obtained.] + + + + +APPENDICES + + + + +APPENDIX I + +COMMUNICATIONS FROM DR. BEDFORD PIERCE, MEDICAL SUPERINTENDENT OF THE +RETREAT, YORK, ENGLAND + + +May 5th, 1921. + +DEAR DR. RUSSELL: + +I have read with much pleasure your pamphlet giving the history of +Bloomingdale Hospital. The reproduction in facsimile of Thomas Eddy's +communication[20] is especially interesting and it will be placed with +the records of the early days of the Retreat. + +We have looked through the Minutes, which are complete from the opening +of the Retreat in 1796, and also examined a large number of original +letters of William and Samuel Tuke respecting the Institution, but have +not succeeded in tracing the letter from S. Tuke to William Eddy, to +which you refer. As you are probably aware, S. Tuke was the grandson of +William Tuke, the founder, and when he published the History of the +Retreat in 1812 he was but twenty-eight years of age. This book had a +far-reaching influence on the treatment of the insane, and it is +remarkable that a man untrained in medicine and without university +education should have been able to write it. The book is now very rare, +but as we have three duplicate copies, I am authorized by the Directors +of the Retreat to present your Hospital with one of them. I have already +sent you a copy of an address of my own dealing with Psychiatry in +England at about the time your Hospital was instituted. + +The use of the term "moral treatment" as opposed to treatment of +physical disease has in recent years become especially interesting. It +is clear that Tuke and Pinel foresaw that psychotherapeutic treatment is +necessary, and their efforts were directed towards providing effective +"sublimation" of misdirected psychical energy. + +One is pleased to see in your report the extent to which organized +occupations are developed at Bloomingdale--a pleasure not unmixed with +envy at seeing the picture of the men's occupational pavilion, and the +prospective erection of a similar building for women. + +In the early days of the Retreat large numbers of visitors came from all +parts of the world. There is a gap in the Visitors' Book between +1800-1815, and the list of visitors is not complete. + +We have copied out the names of the American Visitors, together with an +entry by John W. Francis, M.D., in 1815. It is interesting to note that +an American woman Friend, Hannah Field, was accompanied to the Retreat +by Elizabeth Fry. In 1818 a party of North American Indians visited the +Retreat and signed the Visitors' Book with pictorial representations of +their names. These we have had photographed and I send the prints +herewith. + +May I congratulate you on the centenary of your Hospital and also +congratulate you and the Governors on its remarkable development and +progress. Here at the Retreat we carry on using the original buildings +still, striving to give our patients modern treatment in premises now +almost ancient, but which do not appear so out of date in this City of +York. York congratulates New York upon its wonderful prosperity, and we +gladly recognize its development in the practice of psychiatry fully +corresponds with its development in other directions. + +I remain, + +Yours sincerely, + +BEDFORD PIERCE. + + +EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE RETREAT + +The Retreat, York + +Meeting of Directors held on April the 30th, 1921 + +Copy of Minute No. 8 + +At this Meeting of the Directors and Agents of York Retreat we hear with +pleasure that the Bloomingdale Hospital, the section of the Society of +the New York Hospital devoted to the Treatment of Mental Diseases, is to +celebrate next month the centenary of its foundation. The facsimile +reproduction of the letter of Thomas Eddy which has been presented to +the Retreat Library is specially interesting to us as it acknowledges +the pioneer work at the Retreat and specially refers to correspondence +with Samuel Tuke. We have pleasure in sending to the Governors of the +Bloomingdale Hospital a copy of Samuel Tuke's classical work "The +Description of the Retreat" in the belief that the principles therein +set forth are of lasting importance. We send our hearty congratulations +to the Bloomingdale Hospital on its century of good work and wish it +every success in the future. + +Signed, + +CHARLES WEOMANS, _Chairman_. + +OSCAR F. RUMLEN, _Treasurer_. + + * * * * * + +TRANSCRIPT FROM THE VISITORS BOOK OF THE RETREAT + +EARLY AMERICAN VISITORS + + +1803. 3 mon 11th. _Abrm. Barker_, New Bedford, Massachusits, a young man + (a Friend) on a tour; has been in Russia, Denmark, Sweden & + Holland. (In William Tuke's writing) + +1815. Nov. 30. _John W. Francis_, M.D. of N. York. J.W. Francis is not + wholly ignorant of the State of the Lunatic Asylums in North + America, and he has visited almost all the institutions for the + Insane that are established in England. He now embraces this + opportunity of stating that after an examination of the Retreat + for some hours, he should do injustice to his feelings were he + not to declare that this establishment far surpasses anything of + the kind he has elsewhere seen, and that it reflects equal credit + on the wisdom and humanity of its conductors. + + Perhaps it is no inconsiderable honour to add that institutions + of a similar nature and on the same plan are organizing in + different parts of the United States. The New World cannot do + better than imitate the old so far as concerns the management of + those who labour under mental infirmities. J.W.F. + +1816. 1 Mon 4. _Sharon Carter_, Philadelphia. + +1816. 1 mon. _Wm. S. Warder_, from Philadelphia. + +1816. 2 mon 21. Rev. Thomas H. Gallaudet, who visits Europe for the + purpose of qualifying himself to superintend an Asylum for the + Deaf and Dumb, proposed to be established in Hartford, + Connecticut, of the United States of America. + +1816. 4 mon 8th. _Archibald Gracie_, Junr., New York. + +1816. April 29th. _George F. Randolph_, Philadelphia. _John Hastings_, + Baltimore. + +1816. 6 mon 19th. _Charles Longstreth_, from Philadelphia. + +1816. 6 mon 19th. _Jacob Smedley_, from Philadelphia. + +1817. 7 mon. _Henry Kollock_, of Savannah, Georgia. + _Dr. Wm. Parker_, Savannah. + _G.C. Versslanchi_, of New York. + +1817. 11/24. _Hannah Field_, North America, with Elizabeth Fry. + +1817. 12 Mo. _G.J. Browne_, United States of America (Cincinnati). + +[Illustration: [*HANDWRITING: Thy Assured Friend, Thomas Eddy*] + +In 1815 Thomas Eddy, one of the Governors of the Society of the New York +Hospital, presented a communication in which he advocated the +establishment in the country of a branch for the moral treatment of the +insane. This led to the establishment of Bloomingdale Asylum.] + +FOOTNOTES: + +[Footnote 20: Bloomingdale Hospital Press.] + + + + +APPENDIX II + +A LETTER ON PAUPER LUNATIC ASYLUMS[21] + + +The Governors of the New York Hospital, conceiving that the very +judicious remarks and sentiments contained in the following letter, +might be highly useful to the community, as well as to the institution +with which they are connected, have requested the same to be published. +The work alluded to in the letter, called, "Practical hints on the +construction and economy of Pauper Asylums," is believed to be one of +the most valuable and interesting works of the kind ever published. This +work was sent by the author to one of the Governors, and is now +deposited in the Hospital library. It is very desirable that it should +be republished in this country; but as such republication would be +expensive, on account of the few copies that would be wanted, the +Governors have directed, that if any person, or trustees of any public +institution, in any part of the United States, should be desirous of +obtaining a copy of this very valuable work, with a view to aid them in +erecting a similar Asylum, or the improvement of any already +established, that a manuscript copy shall be furnished them, upon an +application to the subscriber, + +THOMAS EDDY. + +New-York, 12th month, 30th, 1815. + + +YORK, 7mo. 17th, 1815. + +To Thomas Eddy, + +Our mutual friend, L. Murray, has put into my hands a letter and +pamphlet, lately received from thee, respecting the erection of an +asylum for lunatics near New-York.[22] He has wished me to make any +remarks which may occur to me on the perusal; but, having just +published a few hints on the construction and economy of Pauper Lunatic +Asylums, which contain much of the information thou requests, I shall +have but little to add. Those hints, however, relating to institutions +for the poorest class of society, must be applied with some +modifications to establishments for persons of different pervious +habits, and for whom a greater portion of attendance can be afforded. +The great objects, however, which are stated in the hints to be so +important for the comfort of lunatics, apply equally to those of all +ranks and classes. + +From the sum you propose to receive from the patients, intended to +occupy the new building, I conclude you are providing for patients of +the middle ranks of life, a class hardly less to be commiserated, when +thus afflicted, than the very poorest, since the expense and difficulty +of private management, may bring to ruin a respectable family, as well +as expose it to great personal dangers. There would, I think, be +considerable objection to the accumulation of 40 patients of this class, +in three contiguous rooms, as proposed in the hints for pauper lunatics. +You purpose building for 50 patients, and as you probably intend to +accommodate both sexes, the number of each sex may be very suitable for +the accommodation of three contiguous rooms, which, of course, need not +be so large as those in the Wakefield Asylum. It would be difficult to +offer a detailed plan, without knowing more than we do of your local +circumstances, and the classes of patients you purpose to admit. I +doubt, however, whether you can do better than to adopt the general form +of the Wakefield Asylum, and as you are providing for only a small +number, it deserves consideration whether all the rooms might not be +advantageously placed on the ground floor. This plan affords great +facilities to easy inspection, and safe communication with airing +grounds, and the roof might project so far over the building, as to form +an excellent collonnade for the patients; which seems peculiarly +desirable under an American Sun. + +With these views, I send a sketch drawn by the Architect whose plan is +to be adopted at Wakefield; and though it may not be, in many respects, +adapted to your particular wants, yet I hope it will not be altogether +useless. Should it be thought too expensive, I think the rooms, 1, 2, +and 3, might be dispensed with, and rooms marked "attendants, sick and +bath," might be appropriated to the patients during the day. The +attendants room is not a requisite, though it has been thought that it +would be more agreeable to patients of superior rank, not to have the +society of a servant. This, however, chiefly applies to the +convalescents, and these might occupy the room marked 'sick', whilst the +middle class, and the attendants, would be in the centre, marked +"attendants." A sick and bath room might probably be obtained in the +galleries: if you are inclined for the sake of appearance, to make the +centre building two stories high, you might bring the wings nearer to +the centre, and accommodate most of the convalescent patients with bed +rooms in the upper story. In this case, perhaps it would be desirable to +give the wings a radiating form. You will however be best able to modify +the sketch to your particular wants, if the general idea should meet +your approbation. + +I observe with pleasure, that one leading feature of your new +institution, is the introduction of employment amongst the patients, an +object which I am persuaded is of the utmost importance in the moral +treatment of insanity. It is related of an institution in Spain, which +accommodated all ranks, and in which the lower class were generally +employed, that a great proportion of these recovered, whilst the number +of the Grandees was exceedingly small. It will however, require great +address to induce patients to engage in manual labour, who have not been +accustomed to it previously to their indisposition, and it must be +admitted, that where the reluctance on the part of the patient is great, +the irritation which compulsory means are likely to excite, will +probably be more injurious to the patient, than the exercise will be +beneficial. The employment of insane persons should, as far as it is +practicable, be adapted to their previous habits, inclinations and +capacities, and, though horticultural pursuits may be most desirable, +the greatest benefit will, I believe, be found to result from the +patient being engaged in that employment in which he can most easily +excel, whether it be an active or a sedentary one. If it be the latter, +of course sufficient time should be allotted to recreation in the air. +Some persons imagine, that exercises of diversion, are equally +beneficial with those that are useful. The latter appear to me to +possess a decided preference, by imparting to the mind that calm feeling +of satisfaction, which the mere arts of amusement, though not to be +neglected, can never afford. To the melancholy class, this is an +important distinction between amusing and useful employments, and labour +is to be prefered for the maniacal class as less calculated to stimulate +the already too much excited spirits. + +It is proposed that the new asylum should be placed a few miles from the +city. The visitors to it, (I do not mean the medical ones) will, I +presume, be residents in New-York, and from what I have seen of the zeal +of persons under such appointments in this country, it appears +desirable, to render the performance of this duty, so important for the +welfare of asylums, as easy as it can be with propriety. One mile +perhaps would not be objectionable, and might probably afford as good +air and retirement, as a greater distance. + +I need hardly say, I was much gratified to find by the pamphlet, that +the importance of moral treatment in the cure of insanity, was duly +appreciated in America. When we consider, as Lord Bacon observes, +speaking of common diseases, that "all wise physicians in the +prescription, of their regimen to their patients, do ever consider +accidentia animi, as of great force to further or hinder remedies or +recoveries;" it is difficult to account for the general neglect of moral +considerations in the treatment of deranged mind. I hope, however, +though in many instances medicine may not be employed with advantage, +and its indiscriminate use has been seriously injurious, that we shall +not abandon it as altogether useless, in what we term disease of the +mind. All the varieties, included under this general term, have been +produced by physical causes: by external accidents, by intoxication, the +improper use of medicines, repelled eruptions, obstructed secretions, +&c. In some instances, dissection has discovered, after death, the cause +of the mental affection, and though, in many instances, no physical +cause can be detected, yet, when it is considered, how limited are the +investigations of the anatomist, and that the art is so imperfect, that +diseases occasioning instant death, cannot always be discovered on the +most minute dissection, it is not unreasonable to suppose, that the body +is in all cases the true seat of the disease. + +All I would infer from this speculation is, the importance of having +judicious medical attendants, to watch the progress of the disorder, to +be ready to apply their art as bodily symptoms may arise, and to +ascertain, with greater precision than has hitherto been done, "how and +how far the humours and effects of the body, do alter and work upon the +mind; and how far the passions and apprehensions of the mind, do alter +and work upon the body." Even if the disease is not confined to the +corporal organs of mind, but extends to the pure and eternal +intelligence, medical aid may still be useful from the well known +reciprocal action of the two parts of our system upon each other. + +I hope my unknown friend will excuse the length and freedom of this +letter: its length has much exceeded my intentions, yet I may have +omitted information which the experience of the Retreat might afford, +and which would have been useful to promoters of the New-York Asylum, +Should this be the case, I shall be glad to answer, as well as I am +able, any questions which they may propose; and, with the best wishes +for the success of their benevolent and important undertaking, + +I remain, respectfully, + +Thy friend, + +SAMUEL TUKE. + +FOOTNOTES: + +[Footnote 21: A letter on Pauper Lunatic Asylums, by Samuel Tuke, New +York, 1815. Reprinted Bloomingdale Hospital Press, June 3, 1919.] + +[Footnote 22: Appendix III.] + + + + +APPENDIX III + +THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815[23] + + +Of the numerous topics of discussion on subjects relating to the cause +of humanity, there is none which has stronger claims to our attention, +than that which relates to the treatment of the insane. + +Though we may reasonably presume, this subject was by no means +overlooked by the ancients, we may fairly conclude, it is deservedly the +boast of modern times, to have treated it with any degree of success. + +It would have been an undertaking singularly interesting and +instructive, to trace the different methods of cure which have been +pursued in different ages, in the treatment of those labouring under +mental derangement: and to mark the various results with which they were +attended. The radical defect, in all the different modes of cure that +have been pursued, appears to be, that of considering mania a _physical_ +or _bodily_ disease, and adopting for its removal merely physical +remedies. Very lately, however, a spirit of inquiry has been excited, +which has given birth to a new system of treatment of the insane; and +former modes of medical discipline have now given place to that which is +generally denominated _moral management_. + +This interesting subject has closely engaged my attention for some +years, and I conceive that the further investigation of it may prove +highly beneficial to the cause of humanity, as well as to science, and +excite us to a minute inquiry, how far we may contribute to the relief +and comfort of the maniacs placed under our care. In pursuing this +subject, my views have been much extended, and my mind considerably +enlightened, by perusing the writings of Doctors Creighton, Arnold, and +Rush; but, more particularly, the account of the Retreat near York, in +England. Under these impressions I feel extremely desirous of submitting +to the consideration of the Governors, a plan to be adopted by them, for +introducing a system of moral treatment for the lunatics in the Asylum, +to a greater extent than has hitherto been in use in this country. The +great utility of confining ourselves almost exclusively to a course of +moral treatment, is plain and simple, and incalculably interesting to +the cause of humanity; and perhaps no work contains so many excellent +and appropriate observations on the subject, as that entitled, _The +Account of the Retreat_. The author, Samuel Tuke, was an active manager +of that establishment, and appears to have detailed, with scrupulous +care and minuteness, the effects of the system pursued toward the +patients. I have, therefore, in the course of the following remarks, +with a view of illustrating the subject with more clearness, often +adopted the language and opinions of Tuke, but having frequently mixed +my own observations with his, and his manner of expression not being +always adapted to our circumstances and situation, I have attempted to +vary the language, so as to apply it to our own institution; this will +account for many of the subsequent remarks not being noticed as taken +from Tuke's work. + +It is, in the first place, to be observed, that in most cases of +insanity, from whatever cause it may have arisen, or to whatever extent +it may have proceeded, the patient possesses some small remains of +ratiocination and self-command; and although many cannot be made +sensible of the irrationality of their conduct or opinions, yet they are +generally aware of those particulars for which the world considers them +proper objects of confinement. Thus it frequently happens, that a +patient, on his first introduction into the asylum, will conceal all +marks of mental aberration; and, in some instances, those who before +have been ungovernable, have so far deceived their new friends, as to +make them doubt their being insane. + +It is a generally received opinion, that the insane who are violent, +may be reduced to more calmness and quiet, by exciting the principle of +_fear_, and by the use of chains or corporal punishments. There cannot +be a doubt that the principle of fear in the human mind, when moderately +and judiciously excited, as it is by the operation of just and equal +laws, has a salutary effect on Society. It is of great use in the +education of children, whose imperfect knowledge and judgment, occasion +them to be less influenced by other motives. But where fear is _too +much_ excited, and especially, when it becomes the chief motive of +action, it certainly tends to contract the understanding, weaken the +benevolent affection, and to debase the mind. It is, therefore, highly +desirable, and more wise, to call into action, as much as possible, the +operation of superior motives. Fear ought never to be induced, except +when an object absolutely necessary cannot be otherwise obtained. +Maniacs are often extremely irritable; every care, therefore, should be +taken, to avoid that kind of treatment that may have any tendency +towards exciting the passions. Persuasion and kind treatment, will most +generally supersede the necessity of coercive means. There is +considerable analogy between the judicious treatment of children and +that of insane persons. Locke has observed "the great secret of +education is in finding out the way to keep the Child's Spirit easy, +active and free; and yet, at the same time, to restrain him from many +things he has a mind to, and to draw him to things which are uneasy to +him." Even with the more violent and vociferous maniacs, it will be +found best to approach them with mild and soft persuasion. Every pains +should be taken to excite in the patient's mind a desire of esteem. +Though this may not be sufficiently powerful to enable them to resist +the strong irregular tendency of their disease; yet, _when properly +cultivated_, it may lead many to struggle to overcome and conceal their +morbid propensities, or at least, to confine their deviations within +such bounds as do not make them obnoxious to those about them. This +struggle is highly beneficial to the patient; by strengthening his mind, +and conducing to a salutary habit of self-restraint, an object, no +doubt, of the greatest importance to the care of insanity by _moral +means_. + +It frequently occurs, that one mark of insanity is a fixed false +conception, and a total incapacity of reasoning. In _such_ cases, it is +generally advisable to avoid reasoning[24] with them, as it irritates +and rivets their false perception more strongly on the mind. On this +account, every means ought to be taken to seduce the mind from unhappy +and favourite musings; and particularly with melancholic patients; they +should freely partake of bodily exercises, walking, riding, +conversations, innocent sports, and a variety of other amusements; they +should be gratified with birds, deer, rabbits, etc. Of all the modes by +which maniacs may be induced to restrain themselves, regular employment +is perhaps the most efficacious; and those kind of employments are to be +preferred, both on a moral and physical account, which are accompanied +by considerable bodily action, most agreeable to the patient, and most +opposite to the illusions of his disease. + +In short the patient should be always treated as much like a rational +being as the state of his mind will possibly allow. In order that he may +display his knowledge to the best advantage, such topics should be +introduced as will be most likely to interest him; if he is a mechanic +or an agriculturalist, he should be asked questions relating to his art, +and consulted upon any occasion in which his knowledge may be useful. +These considerations are undoubtedly very material, as they regard the +comforts of insane persons; but they are of far greater importance as +they relate to the cure of the disorder. The patient, feeling himself of +some consequence, is induced to support it by the exertion of his +reason, and by restraining those dispositions, which, if indulged, would +lessen the respectful treatment he wishes to receive, or lower his +character in the eyes of his companions and attendants. + +Even when it is absolutely necessary to employ coercion, if on its +removal the patient promises to control himself, great reliance may +frequently be placed upon his word, and under this engagement, he will +be apt to hold a successful struggle with the violent propensities of +his disorder. Great advantages may also be derived, in the moral +management of maniacs, from an acquaintance with the previous +employment, habits, manners, and prejudices of the individual: this may +truly be considered as indispensably necessary to be known, as far as +can be obtained; and, as it may apply to each case, should be registered +in a book for the inspection of the Committee of the Asylum, and the +physician; the requisite information should be procured immediately on +the admission of each patient; the mode of procuring it will be spoken +of hereafter. + +Nor must we forget to call to our aid, in endeavouring to promote +self-restraint, the mild but powerful influence of the precepts of our +holy religion. Where these have been strongly imbued in early life, they +become little less than principles of our nature; and their restraining +power is frequently felt, even under the delirious excitement of +insanity. To encourage the influence of religious principles over the +mind of the insane, may be considered of great consequence, as a means +of cure, provided it be done _with great care and circumspection_. For +this purpose, as well as for reasons still more important, it would +certainly be right to promote in the patient, _as far as circumstances +would permit_, an attention to his accustomed modes of paying homage to +his Maker. + +In pursuing the desirable objects above enumerated, we ought not to +expect too suddenly to reap the good effects of our endeavours; nor +should we too readily be disheartened by occasional disappointments. It +is necessary to call into action, as much as possible, every remaining +power and principle of the mind, and to remember, that, "in the wreck of +the intellect, the affections very frequently survive." Hence the +necessity of considering _the degree_ in which the patient may be +influenced by moral and rational inducements. + +The contradictory features in their characters, frequently render it +exceedingly difficult to insure the proper treatment of insane persons; +to pursue this with any hopes of succeeding, so that we may in any +degree ameliorate their distressed condition, renders it indispensably +necessary that attendants only should be chosen who are possessed of +good sense, and of amiable dispositions, clothed, as much as possible, +with philosophical reflexion, and above all, with that love and charity +that mark the humble Christian. + +Agreeably to these principles, I beg leave to suggest the following +regulations to be adopted, in accomplishing the objects in view. + +1st. No patient shall hereafter be confined by chains. + +2nd. In the most violent states of mania, the patient should be confined +in a room with the windows, etc., closed, so as nearly to exclude the +light, and kept confined if necessary, in a straight jacket, so as to +walk about the room or lie down on the bed at pleasure; or by strops, +etc., he may, particularly if there appears in the patient a strong +determination to self-destruction, be confined on the bed, and the +apparatus so fixed as to allow him to turn and otherwise change his +positions. + +3rd. The power of judicious kindness to be generally exercised, may +often be blessed with good effects, and it is not till after other moral +remedies are exercised, that recourse should be had to restraint, or the +power of fear on the mind of the patient; yet it may be proper +sometimes, by way of punishment, to use the shower bath. + +4th. The common attendants shall not apply any extraordinary coercion by +way of punishment, or change in any degree the mode of treatment +prescribed by the physician; on the contrary, it is considered as their +indispensable duty, to seek by acts of kindness the good opinion of the +patients, so as to govern them by the influence of esteem rather than of +severity. + +5th. On the first day of the week, the Superintendent, or the principal +keeper of the Asylum, shall collect as many of the patients as may +appear to them suitable, and read some chapters in the Bible. + +6th. When it is deemed necessary to apply the strait-jacket, or any +other mode of coercion, by way of punishment or restraint, such an ample +force should be employed as will preclude the idea of resistance from +entering the mind of the patient. + +7th. It shall be the duty of the deputy-keeper, immediately on a patient +being admitted, to obtain his name, age, where born, what has been his +employment or occupation, his general disposition and habits, when first +attacked with mania; if it has been violent or otherwise, the cause of +his disease, if occasioned by religious melancholy, or a fondness for +ardent spirits, if owing to an injury received on any part of the body, +or supposed to arise from any other known cause, hereditary or +adventitious, and the name of the physician who may have attended him, +and his manner of treating the patient while under his direction. + +8th. Such of the patients as may be selected by the physician, or the +Committee of the Asylum, shall be occasionally taken out to walk or ride +under the care of the deputy-keeper; and it shall be also his duty to +employ the patients in such manner, and to provide them with such kinds +of amusements and books as may be approved and directed by the +Committee. + +9th. The female keeper shall endeavour to have the female patients +Constantly employed at suitable work; to provide proper amusements, +books, etc., to take them out to walk as may be directed by the +Committee. + +10th. It shall be the indispensable duty of the keepers, to have all the +patients as clean as possible in their persons, and to preserve great +order and decorum when they sit down to their respective meals. + +11th. It shall be the duty of the physician to keep a book, in which +shall be entered an historical account of each patient, stating his +situation, and the medical and moral treatment used; which book shall be +laid before the Committee, at their weekly meetings. + +The sentiments and improvements proposed in the preceding remarks, for +the consideration of the Governors, are adapted to our present situation +and circumstances; but a further and more extensive improvement has +occurred to my mind, which I conceive, would very considerably conduce +towards affecting the cure, and materially ameliorate the condition, and +add to the comfort of the insane; at the same time that it would afford +an ample opportunity [Transcriber's note: original reads 'apportunity'] +of ascertaining how far that disease may be removed by moral management +alone, which it is believed, will, in many instances, be more effectual +in controlling the maniac, than medical treatment especially, in those +cases where the disease has proceeded from causes operating directly on +the mind. + +I would propose, that a lot, not less than ten acres, should be +purchased by the Governors, conveniently situated, within a few miles of +the city, and to erect a substantial building, on a plan calculated for +the accommodation of fifty lunatic patients; the ground to be improved +in such a manner as to serve for agreeable walks, gardens, etc., for the +exercise and amusement of the patients: this establishment might be +placed under the care and superintendence of the Asylum Committee, and +be visited by them once every week: a particular description of patients +to remain at this Rural Retreat; and such others as might appear +suitable objects might be occasionally removed there from the Asylum. + +The cost and annual expense of supporting this establishment, are +matters of small consideration, when we duly consider the important +advantages it would offer to a portion of our fellow-creatures, who have +such strong claims on our sympathy and commiseration. + +But, it is a fact that can be satisfactorily demonstrated, that such an +establishment would not increase our expenses; and, moreover, would +repay us even the interest of the money that might be necessary to be +advanced, for the purchase of the ground and erecting the buildings. The +board of patients (supposing fifty) would yield two hundred dollars per +week, or ten thousand four hundred dollars per annum. + +Supposing the ground, building, etc., to cost $50,000, the interest on +this sum at 6 per cent. would be $3,000, there would yet remain $7,400, +for the maintenance and support of the establishment; a sum larger than +would be required for that purpose. + +We had lately in the Asylum, more than ninety patients; and, at that +time, had repeated applications to receive an additional number; the +Committee however, concluded, that as the building was not calculated to +accommodate more than seventy-five, it would be an act of injustice to +take in any more; they, therefore, concluded to reduce the number of +seventy-five, and strictly to refuse receiving any beyond that number. +This may serve clearly to show, that we might safely calculate, that we +should readily have applications to accommodate one hundred and +twenty-five patients. + +This succinct view of the subject may suffice, at this time, as outlines +of my plan; and which is respectfully submitted to the Governors, for +their Consideration. + +FOOTNOTES: + +[Footnote 23: "Hints for Introducing an Improved Mode of Treating the +Insane in the Asylum"; read before the Governors of the New York +Hospital on the 4th of Fourth-month, 1815. By Thomas Eddy, one of the +Asylum Committee. New York, 1815. Reprinted Bloomingdale Hospital Press, +1916.] + +[Footnote 24: The following anecdotes illustrate the observation before +made, that maniacs frequently retain the power of reasoning to a certain +extent; and that the discerning physician may oftimes successfully avail +himself of the remains of this faculty in controlling the aberrations of +his patient:--A patient in the Pennsylvania Hospital, who called his +physician his father, once lifted his hand to strike him. "What!" said +his physician, (Dr. Rush), with a plaintive tone of voice, "Strike your +father?" The madman dropped his arm, and instantly showed marks of +contrition for his conduct. The following was related to me by Samuel +Coates, President of the Pennsylvania Hospital:--maniac had made several +attempts to set fire to the Hospital: upon being remonstrated with, he +said, "I am a salamander"; "but recollect," said my friend Coates, "all +the patients in the house are not salamanders;" "That is true," said the +maniac, and never afterwards attempted to set fire to the Hospital.] + + + + +APPENDIX IV + +EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TO +ACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED APRIL, 1815 + + +_April 4, 1815._ + +A communication was received from Thos. Eddy suggesting several +improvements in the mode of treating Insane persons, which is referred +to Dr. Hugh Williamson, George Newbold, William Johnson, Peter A. Jay, +and John R. Murray--Resolved that the Treasurer have fifty copies of the +report printed for use of the Governors. + + +_July 3, 1815._ + +The Committee on the communication from Thos. Eddy, relative to the +treatment of Insane patients, report attention to the subject and that +in their opinion it is advisable to have a few acres of land purchased +in the vicinity of the City for the better accommodation of this unhappy +class of our fellow creatures--the Committee are continued. + +On motion Resolved that Thomas Eddy, John A. Murray, and John Aspinwall, +be a Committee to look out for a suitable spot of land, and to make a +purchase, if in their opinion it shall become necessary. + + +_8th Month (August) 1st, 1815._ + +The Committee on the communication from Thomas Eddy, made the following +Report, which was intended to have been laid before the last meeting of +the Board; which was now accepted, and ordered to be inserted in the +minutes. + +"The Committee appointed to consider the expediency of erecting another +Building for the accommodation of Insane Persons Report: + +That another building for the use of those unfortunate persons who have +lost the use of their reason, is not only advisable, but seems to be +absolutely necessary. + +That though there are at present more patients in the Asylum, by nearly +one third, than can with perfect Safety, and the best hopes of recovery, +be lodged there; many more insane persons, perhaps twenty within a few +months, have by their friends been soliciting a place in that +Building--In speaking of the want of safety, the Committee only mean to +express an opinion, that when two or more insane persons, from the want +of room are lodged together in one cell, the life of the weaker must be +somewhat endangered by the stronger, who in a high Paroxysm of insanity +might strangle him in his sleep, or otherwise destroy him. + +That such additional Building, from the want of room, cannot possibly be +erected near the hospital, in this city. + +That there are many reasons for believing that the recovery from a state +of insanity would be greatly promoted, by having a considerable space of +ground adjoining the Asylum or Public Building, in which many of the +patients might have the privilege of walking, or taking other kinds of +exercise. + +That considering the various kinds of insanity, your Committee, are +clearly of the opinion, that two buildings should be erected at the +distance of at least one hundred yards from each other. The sedate or +melancholy madman should not have his slumbers broken by living under +the same roof with disorderly persons, who by singing, or other noisy +proceedings, will not suffer their neighbours to sleep. + +That for the above and similar considerations, it would be advisable, +to purchase, within a few miles of this City, at least twenty acres of +land, detached from private buildings, in a healthy and pleasant +situation, where the water is good and where materials for buildings may +be obtained on easy terms: and the portage of fuel not expensive. + +Your Committee are aware that a smaller lot of ground might suffice for +all the buildings that are now required, or all this Corporation may, in +a short time, be enabled to complete. But they count it advisable to +prepare for a period that must certainly come; a period in which such a +lot will be needed, and not easily obtained, for it is evident from the +topography, and geographical position of this City, that the time must +come, when New York will be not only the greatest City in the United +States, or in America; but must rival the most distinguished City's in +the old Continent. + +Wherefore it is recommended, that a Committee be appointed, who shall +examine the sundry places, corresponding with the above description, +that may be purchased. And that they report the means of making the +purchase, and of erecting such Buildings, as seem at this time to be +required." + +The Committee to whom was referred, to purchase a suitable Lot of Land +for the erection of a House for the accommodation of maniacs, Report +that they have purchased 38 acres of Land, being part of the Estate +belonging to Gerard Depeyster at Bloomingdale, at the rate of $246. per +acre, payable 25 per cent down, 37½ per cent on 1st November and 37¾ per +cent on 1st February next, with interest. + +THOMAS EDDY, Chairman + + +August 1st, 1815 + +Whereupon Resolved that the Report of the Committee be accepted, and +they are instructed to take the Titles, after P.A. Jay shall have +examined the Records, and be satisfied that the property is free of +incumbrance. + + + + +APPENDIX V + +ADDRESS TO THE PUBLIC BY THE GOVERNORS 1821[25] + + +The Governors of the New-York Hospital have the satisfaction to announce +to the public, the completion of the Asylum for the insane; and that it +will be open for the reception of patients, from any part of the United +States, on the first day of June. + +This Asylum is situated on the Bloomingdale road, about seven miles from +the City Hall of the city of New-York, and about three hundred yards +from the Hudson River. The building is of hewn free-stone, 211 feet in +length, and sixty-feet deep, and is calculated for the accommodation of +about two hundred patients. Its site [Transcriber's note: original reads +'scite'] is elevated, commanding an extensive and delightful view of the +Hudson, the East River, and the Bay and Harbour of New-York, and the +adjacent country, and is one of the most beautiful and healthy spots on +New-York Island. Attached to the building are about seventy acres of +land, a great part of which has been laid out in walks, ornamental +grounds, and extensive gardens. + +This institution has been established by the bounty of the Legislature +of the state of New-York, on the most liberal and enlarged plan, and +with the express design to carry into effect that system of management +of the insane, happily termed _moral treatment_, the superior efficacy +of which has been demonstrated in several of the Hospitals of Europe, +and especially in that admirable establishment of the Society of +Friends, called "THE RETREAT," near York, in England. This mild and +humane mode of treatment, when contrasted with the harsh and cruel +usage, and the severe and unnecessary restraint, which have formerly +disgraced even the most celebrated lunatic asylums, may be considered as +one of the noblest triumphs of pure and enlightened benevolence. But it +is by no means the intention of the governors to rely on moral, to the +exclusion of medical treatment. It is from a judicious combination of +both, that the greatest success is to be expected in every attempt to +cure or mitigate the disease of insanity. + +In the construction of the edifice and in its interior arrangements, it +has been considered important to avoid, as far as practicable, +consistently with a due regard to the safety of the patients, whatever +might impress their minds with the idea of a prison, or a place of +punishment, and to make every thing conduce to their health and to their +ease and comfort. The self-respect and complacency which may thus be +produced in the insane, must have a salutary influence in restoring the +mind to its wonted serenity. In the disposition of the grounds attached +to the Asylum, everything has been done with reference to the amusement, +agreeable occupation, and salutary exercise of the patients. + +Agricultural, horticultural, and mechanical employments, may be resorted +to, whenever the inclination of the patient, or their probable +beneficial effects may render them desirable. To dispel gloomy images, +to break morbid associations, to lead the feelings into their proper +current, and to restore the mind to its natural poise, various +[Transcriber's note: original reads 'varius'] less active amusements +will be provided. Reading, writing, drawing, innocent sports, tending +and feeding domestic animals, &c. will be encouraged as they may be +found conducive to the recovery of the patients. A large garden has been +laid out, orchards have been planted, and yards, containing more than +two acres, have been inclosed for the daily walks of those whose +disorder will not allow more extended indulgence. The plants of the +Elgin Botanic garden, presented to this institution by the Trustees of +Columbia College, have been arranged in a handsome green-house, prepared +for their reception. + +The apartments of the house are adapted to the accommodation of the +patients, according to their sex, degree of disease, habits of life, and +the wishes of their friends. The male and female apartments are entirely +separated, so as to be completely secluded from the view of each other. + +Care has been taken to appoint a Superintendent and Matron, of good +moral and religious characters, possessing cheerful tempers, and kind +dispositions, united with firmness, vigilance and discretion. A +Physician will reside in the house, and one or more Physicians, of +established character and experience, will attend regularly, and afford +medical aid in all cases where the general health, or the particular +cause of the patient's insanity, may require it. The relations or +friends of patients will be at liberty, if they prefer it, to employ +their own physicians, who will be allowed to attend patients, subject to +the general regulations of the house. + +The institution will be regularly visited and inspected by a committee +of the Governors of the Hospital, who will, as often as they may think +it advantageous, be attended by some of the physicians of the city of +high character and respectability. + +The charges for board and the other advantages of the institution, will +be moderate, and proportioned to the different circumstances of the +patients, and the extent of the accommodations desired for them. + +Patients at the expense of the different towns of the state, will be +received at the lowest rate. + +Application for the admission of patients into the Asylum, must be made, +at the New York Hospital, in Broadway, where temporary accommodation +will be provided for such patients as may require it, previously to +their being carried to the Asylum out of town. A committee of the +Governors will, when necessary, attend at the Hospital in Broadway, for +the purpose of admitting patients into the Asylum, and to agree on the +terms and security for payment to be given. + +_By order of the board of Governors._ + +MATTHEW CLARKSON, _President._ + +THOMAS BUCKLEY, _Secretary._ + +_New-York, 10th May, 1821._ + +N.B. The friends of the patients are requested to send with them an +account of their cases, stating the probable causes of their insanity, +the commencement and peculiar character of the disorder. It is desirable +that this statement, where it is practicable, should be drawn up by a +physician. + +Applications from abroad, for information relative to the admission of +patients, may be made by letters addressed to THOMAS BUCKLEY, Secretary +of the New-York Hospital. + +FOOTNOTES: + +[Footnote 25: Address of the Governors of the New York Hospital to the +Public, Relative to the Asylum for the Insane at Bloomingdale. New York, +May 10th, 1821. Reprinted Bloomingdale Hospital Press, May 1921.] + + + + +APPENDIX VI + +BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL + +1821 AND 1921 + + +1821 + +Matthew Clarkson, President +Thomas Eddy, Vice President +Thomas Franklin +Jonathan Little +Thomas Buckley +William Johnson +Andrew Morris +John R. Murray +John B. Lawrence +George Newbold +Ebenezer Stevens +Peter A. Jay +Najah Taylor +Cadwallader D. Colden +Robert H. Bowne +Robert I. Murray +Thomas C. Taylor +John Adams, Treasurer +John McComb +Benjamin W. Rogers, Assistant Treasurer +William Bayard +Nathan Comstock +Duncan P. Campbell +Rev. F.C. Schaeffer +John Clark, Jr. +William Edgar, Jr. + + +1921 + +Hermann H. Cammann +Henry W. deForest +Richard Trimble +Howard Townsend +George F. Baker +Augustine J. Smith +Charles S. Brown +Edward W. Sheldon, President +Bronson Winthrop +Frank K. Sturgis +David B. Ogden +Joseph H. Choate, Jr. +Henry G. Barbey +Cornelius B. Bliss, Jr. +Paul Tuckerman, Treasurer +William Woodward +Arthur Iselin +Payne Whitney, Vice President +G. Beekman Hoppin +Lewis Cass Ledyard, Jr. +Henry R. Taylor +R. Horace Gallatin +Walter Jennings + + +BLOOMINGDALE COMMITTEE + +1821 + +Thomas Eddy +Cadwallader D. Colden +Thomas C. Taylor +John Adams +Thomas Buckley +John B. Lawrence + + +1921 + +Frank K. Sturgis +Augustine J. Smith +Henry R. Taylor +Henry G. Barbey +Walter Jennings +Howard Townsend + + + + +APPENDIX VII + +ORGANIZATION OF BLOOMINGDALE HOSPITAL + +1821 AND 1921 + + +1821 + +Superintendent or Warden 1 +Housekeeper 1 +Keepers, Men 3 +Keepers, Women 2 +Chambermaids 1 +Cooks 3 +Baker 1 +Assistant Baker 1 +Dairymaid 1 +Washerwoman 1 +Assistant washerwoman 1 +Yard Keeper 1 +Waitresses 2 +Gardener 1 +Farmer 1 +Assistant farmer 1 + + Total 22 + +Number of patients 75 + + +1921 + +Officers and employees: + +Men 217 +Women 195 + --- +Total 412 + +Patients: + +Men 132 +Women 156 + --- +Total 288 + +_General Administration_: + Medical Superintendent 1 + Steward 1-2 + +_Clinical and Laboratory Service:_ + Physicians: + Resident 9 + Consultants 3 + Dentist 1 + Assistant 1 + Apothecary 1 + Technicians 2 + Stenographers 5-22 + +_Nursing Service_: + Director, Assistant, and Instructor 3 + Nurses, attendants, and pupils 135 + Maids and porters 46-184 + +_Occupational Therapy_ 13 +_Physical Training_ 7 +_Hydrotherapy and Massage_ 5 +_Dietary Department_ 25 +_Housekeeping and Laundry Departments_ 60 +_Financial, Purchasing, and Supplies_ 10 +_Engineering Department_ 18 +_Building Department_ 20 +_Industrial Department_ 5 +_Farm and Grounds_ 38 +_Miscellaneous_ 8 +Chaplain, Librarian, Watchmen, Telephonists, Postal Clerk, Barber. + + +STATISTICS: 1821-1921 + +Number of cases admitted 1821 to 1921 13,411 +Number discharged recovered 1821 to 1921 4,651 +Number discharged improved 1821 to 1921 3,873 + + + + + + + + + + + + +End of the Project Gutenberg EBook of A Psychiatric Milestone, edited by +Howard Townsend, Bronson Winthrop and R. 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Horace Gallatin + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: A Psychiatric Milestone + Bloomingdale Hospital Centenary, 1821-1921 + +Author: Various + +Editor: Howard Townsend + Bronson Winthrop + R. Horace Gallatin + +Release Date: March 14, 2005 [EBook #15365] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK A PSYCHIATRIC MILESTONE *** + + + + +Produced by Suzanne Lybarger, Kathryn Lybarger and the +Online Distributed Proofreading Team. + + + + + + +</pre> + + + <div class="figcenter" + style="width:100%;"> + + <a name="illus001"></a> + <a href="images/illus001.jpg"><img width="100%" + src="images/illus001_th.jpg" + alt="New York Hospital and Lunatic Asylum, 1808" /> + </a><br /> +THE NEW YORK HOSPITAL, DUANE STREET AND BROADWAY<br /> + +The building to the left was erected in 1808 for the exclusive use of +patients suffering from mental disorders. + </div> + + +<h1>A PSYCHIATRIC MILESTONE</h1> + +<h2>BLOOMINGDALE HOSPITAL CENTENARY</h2> + +<h2>1821-1921</h2> + +<center><img src="images/logo.png" alt="logo" /></center> + +<div align="center"> +<span style='margin-left: 14em;'>"Cum corpore ut una</span><br /> +Crescere sentimus, pariterque senescere mentem."<br /> +<span style='margin-left: 16em;' class="smcap">—Lucretius</span><br /> +</div> + +<h6>PRIVATELY PRINTED<br /> +BY THE SOCIETY OF THE NEW YORK HOSPITAL</h6> + +<h4>1921</h4> + +<hr style='width: 65%;' /> + +<h2>ANNIVERSARY COMMITTEE</h2> + +<h3> +HOWARD TOWNSEND<br /> +BRONSON WINTHROP<br /> +R. HORACE GALLATIN</h3> + + + +<hr style='width: 65%;' /> +<a name='PREFACE'></a><h2>PREFACE</h2> +<br /> + +<p>The opening of Bloomingdale Asylum on June 1, 1821, was an important +event in the treatment of mental disorders and in the progress of +humanitarian and scientific work in America. Hospital treatment for +persons suffering from mental disorders had been furnished by the New +York Hospital since its opening in 1792, and the Governors had given +much thought and effort to securing the facilities needed. The treatment +consisted, however, principally in the administration of drugs and the +employment of such other physical measures as were in vogue at that +time. Little attempt was made to study the minds of the patients or to +treat them by measures directed specifically to influencing their +thoughts, feelings, and behavior, and what treatment of this character +there was had for its object little more than the repression of +excitement and disordered activity. The value and importance of +treatment directed to the mind had, indeed, been long recognized, but in +practice it had been subordinated to treatment of the actual and assumed +physical disorders to which the mental state of the patient was +attributed, and, in the few hospitals where persons suffering from +mental disorders were received, means for its application were almost or +quite entirely lacking. The establishment of Bloomingdale Asylum for the +purpose of ascertaining to what extent the recovery of the patients +might be accomplished by moral as well as by purely medical treatment +marked, therefore, the very earliest stages of the development in +America of the system of study and treatment of mental disorders which +with increasing amplification and precision is now universally employed.</p> + +<p>A hundred years of growth and activity in the work thus established have +now been accomplished, and it seemed fitting to the Governors of the +Hospital that the event should be commemorated in a way that would be +appropriate to its significance and importance. It was decided that the +principal place in the celebration should be given to the purely medical +and scientific aspects of the work, with special reference to the +progress which had been made in the direction of the practical +usefulness of psychiatry in the treatment of illness generally, and in +the management of problems of human behavior and welfare. Arrangements +were made for four addresses by physicians of conspicuous eminence in +their particular fields, and invitations to attend the exercises were +sent to the leading psychiatrists, psychologists, and neurologists of +America, and to others who were known to be specially interested in the +field of study and practice in which the Hospital is engaged. It was +felt that, in view of the place which France and England had held in the +movement in which Bloomingdale Asylum had its origin, it would add +greatly to the interest and value of the celebration if representatives +of these countries were present and made addresses. How fortunate it +was, then, that it became possible to welcome from France Dr. Pierre +Janet, who stands pre-eminent in the field of psychopathology, and from +England Dr. Richard G. Rows, whose contributions to the study and +treatment of the war neuroses and to the relation between psychic and +physical reactions marked him as especially qualified to present the +more advanced view-point of British psychiatry. The other two principal +addresses were made by Dr. Adolf Meyer, who, by reason of his scientific +contributions and his wonderfully productive practical work in clinical +and organized psychiatry and in mental hygiene, is the acknowledged +leader of psychiatry in America, and by Dr. Lewellys F. Barker, who, +because of his eminence as an internist and of the extent to which he +has advocated and employed psychiatric knowledge and methods in his +practice, has contributed greatly to interesting and informing +physicians concerning the value and importance of psychiatry in general +medical practice. The addresses given by these distinguished physicians, +representing advanced views in psychiatry held in Europe and America, +were peculiarly appropriate to the occasion and to the object of the +celebration. They were supplemented by an historical review of the +origin and development of the Hospital and of its work by Mr. Edward W. +Sheldon, President of the Society of the New York Hospital, and by a +statement concerning the medical development, made by Dr. William L. +Russell, the Medical Superintendent. The greetings of the New York +Academy of Medicine were presented in an interesting address by Dr. +George D. Stewart, President of the Academy.</p> + +<p>Of scarcely less significance and interest than the addresses was the +pageant presented on the lawn during the intermission between the +sessions, depicting scenes and incidents illustrating the origin and +development of the Hospital, and of psychiatry and mental hygiene. The +text and the scenes displayed were prepared by Dr. Charles I. Lambert, +First Assistant Physician of the Hospital, and by Mrs. Adelyn Wesley, +who directed the performance and acted as narrator. The performers were +persons who were connected with the Hospital, twenty-two of whom were +patients.</p> + +<p>The celebration was held on May 26, 1921. The weather was exceptionally +clear, with bright sunshine and moderate temperature. The grounds, in +their Spring dress of fresh leaves and flowers, were especially +beautiful. This added much to the attractiveness of the occasion and the +pleasure of those who attended. Luncheon was served on the lawn in front +of the Brown Villa and the pageant was presented on the adjoining +recreation grounds. The beauty of the day and the surroundings, the +character of the addresses and of the speakers, the remarkable felicity +and grace with which they were introduced by the President, the dignity +and noble idealism of his closing words, and the distinguished character +of the audience, all contributed to make the celebration one of +exceptional interest and value to those who were present, and a notable +event in the history of the Hospital.</p> + +<p>For the purpose of preserving, and of perhaps extending to some who were +not present, the spirit of the occasion, and of placing in permanent +form an account of the proceedings and the addresses which were made, +this volume has been published by the Society of the New York Hospital.</p> + +<p class="right2"><span class="smcap">William L. Russell.</span></p> + + + +<hr style='width: 65%;' /> +<h2>CONTENTS</h2> + +<div class="content1"><a href="#PREFACE">Preface</a></div> + +<div class="content1"><a href="#INVOCATION">Invocation</a></div> +<div class="content2"><a href="#REV_SIMMONDS">REV. FRANK H. SIMMONDS</a></div> + +<div class="content1"><a href="#HISTORICAL_REVIEW">Historical Review</a></div> +<div class="content2"><a href="#MR_SHELDON">EDWARD W. SHELDON, ESQ.</a></div> +<div class="content3">President of the Society of the New York Hospital</div> + +<div class="content1"><a href="#CONTRIBUTIONS">"The Contributions of Psychiatry to +the Understanding of Life Problems"</a></div> +<div class="content2"><a href="#DR_MEYER">ADOLF MEYER, M.D.</a></div> +<div class="content3">Director of the Henry Phipps Psychiatric Clinic, Johns Hopkins +Hospital, and Professor of Psychiatry, Johns Hopkins University, +Baltimore, Maryland</div> + +<div class="content1"> +<a href="#IMPORTANCE">"The Importance of Psychiatry in General Medical Practice"</a></div> +<div class="content2"><a href="#DR_BARKER">LEWELLYS F. BARKER, M.D.</a></div> +<div class="content3">Professor of Clinical Medicine, Johns Hopkins Medical School, +Baltimore, Maryland</div> + +<div class="content1"> +<a href="#GREETINGS">Greetings from the New York Academy of Medicine</a></div> +<div class="content2"><a href="#DR_STEWART">GEORGE D. STEWART, M.D.</a></div> +<div class="content3">President of the Academy</div> + +<div class="content1"> +<a href="#BIOLOGICAL">"The Biological Significance of Mental Illness"</a></div> +<div class="content2"><a href="#DR_ROWS">RICHARD G. ROWS, M.D.</a></div> +<div class="content3">Director of the Section on Mental Illnesses of the Special +Neurological Hospital, Tooting, London, England</div> + +<div class="content1"> +<a href="#RELATION">"The Relation of the Neuroses to the Psychoses"</a></div> +<div class="content2"><a href="#DR_JANET">PIERRE JANET, M.D.</a></div> +<div class="content3">Professor of Psychology, College de France</div> + +<div class="content1"> +<a href="#MEDICAL">"The Medical Development of Bloomingdale Hospital"</a></div> +<div class="content2"><a href="#DR_RUSSELL">WILLIAM L. RUSSELL, M.D.</a></div> +<div class="content3">Medical Superintendent</div> + +<div class="content1"><a href="#TABLEAU">The Tableau-Pageant</a></div> + +<div class="content1"><a href="#NAMES">Names of Those Who Attended the Exercises</a></div> + +<div class="content1"><a href="#APPENDIX_I">Appendix I</a></div> +<div class="content2"><a href="#COMMUNICATIONS">COMMUNICATIONS FROM DR. BEDFORD PIERCE</a></div> +<div class="content3">Medical Superintendent of The Retreat, York, England</div> +<div class="content2"><a href="#EXTRACT">EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE RETREAT, +APRIL 30, 1921.</a></div> +<div class="content2"><a href="#TRANSCRIPT">TRANSCRIPT FROM THE VISITORS BOOK OF THE RETREAT, 1803-17.</a></div> + +<div class="content1"><a href="#APPENDIX_II">Appendix II</a></div> +<div class="content2">A LETTER ON PAUPER LUNATIC ASYLUMS FROM SAMUEL TUKE TO +THOMAS EDDY, 1815.</div> + +<div class="content1"><a href="#APPENDIX_III">Appendix III</a></div> +<div class="content2">THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815.</div> + +<div class="content1"><a href="#APPENDIX_IV">Appendix IV</a></div> +<div class="content2">EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TO +ACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED +APRIL, 1815.</div> + +<div class="content1"><a href="#APPENDIX_V">Appendix V</a></div> +<div class="content2">ADDRESS TO THE PUBLIC BY THE GOVERNORS, 1821.</div> + +<div class="content1"><a href="#APPENDIX_VI">Appendix VI</a></div> +<div class="content2">BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL, 1821 +AND 1921.</div> + +<div class="content1"><a href="#APPENDIX_VII">Appendix VII</a></div> +<div class="content2">ORGANIZATION OF BLOOMINGDALE HOSPITAL, 1821 AND 1921.</div> + + + +<hr style='width: 65%;' /> +<h2>ILLUSTRATIONS</h2> +<center> +<a href="#illus001">New York Hospital and Lunatic Asylum, 1808</a><br /> +<a href="#illus002">Bloomingdale Asylum, 1821</a><br /> +<a href="#illus080">Bloomingdale Asylum, 1894</a><br /> +<a href="#illus148">Bloomingdale Hospital, 1921</a><br /> +<a href="#illus172">The Tableau-Pageant</a><br /> +<a href="#illus195">Thomas Eddy</a> +</center> + +<hr style='width: 65%;' /> + + <div class="figcenter" + style="width:100%;"> + + <a name="illus002"></a> + <a href="images/illus002.jpg"><img width="100%" + src="images/illus002_th.jpg" + alt="Bloomingdale Asylum, 1821" /> + </a><br /> +BLOOMINGDALE ASYLUM<br /> + +As it appeared when it was opened in 1821. It was located near the seven +mile stone on the Bloomingdale Road, now 116th Street and Broadway. +</div> + + + +<hr style='width: 65%;' /> +<a name="INVOCATION"></a> +<h2>BLOOMINGDALE HOSPITAL CENTENARY</h2> +<br /> + +<p>The One Hundredth Anniversary of the establishment of Bloomingdale +Hospital as a separate department for mental diseases of The Society of +the New York Hospital was celebrated at the Hospital at White Plains on +Thursday, May 26, 1921. The addresses were given in the Assembly Hall.</p> + +<p>Mr. Edward W. Sheldon, the President of the Society, acted as Chairman.</p> +<br /> + +<h3>MORNING SESSION</h3> + +<p> +<a name="REV_SIMMONDS"></a> +The exercises opened with an invocation by the Reverend Frank H. +Simmonds, rector of Grace Episcopal Church at White Plains:</p> + +<p>Oh, most mighty and all-merciful God, whose power is over all Thy works, +who willest that all men shall glorify Thee in the constant bringing to +perfection those powers of Thine which shall more and more make perfect +the beings of Thy creation, we glorify Thee in the gift of Thy Divine +Son Jesus Christ, the Great Physician of our souls, the Sun of +Righteousness arising with healing in His wings, who disposeth every +great and little incident to the glory of God the Father, and to the +comfort of them that love and serve him, we render thanks to Thee and +glorify Thy Name, this day, which brings to completion the hundredth +anniversary of this noble institution's birthday. Oh, Thou, who didst +put it into the hearts and minds of men to dedicate their lives and +fortunes to the advancement of science and medicine for the sick and +afflicted, we render Thee most high praise and hearty thanks for the +grace and virtue of the founders of this institution—men whose names +are written in the Golden Book of life as those who loved their fellow +men.</p> + +<p>We praise Thee for such men as Thomas Eddy, James Macdonald, Pliny +Earle, and these endless others, who from age to age have held high the +torch of knowledge and have kept before them the golden rule of service. +Inasmuch as ye have done it unto one of the least of these my brethren, +ye have done it unto me.</p> + +<p>Be pleased, oh merciful Father, to bless this day and gathering. Lift up +and enlighten our hearts and minds to a higher perception of all that is +noble, all that is true, all that is merciful. Awaken our dull senses to +the full knowledge of light in Thee, and may all that is said and done +be with the guiding of Thy Holy Spirit.</p> + +<p>We pray for the continued blessing of this institution and hospital, and +on all those who are striving to bring out of darkness those unhappy +souls, into the pure light of understanding.</p> + +<p>Bless the Governors, physicians, and nurses, direct their judgments, +prosper their undertakings, and dispose their ministry that the world +may feel the blessing and comfort of life in the prevention of disease +and the preservation of health. And may we all be gathered in this +nation to a more perfect unity of life and purpose in the desire to +spend and be spent in the service of our fellow men.</p> + +<p>We ask it all in the name and through the mediation of Thy Son Jesus +Christ, our Lord. Amen.</p> + + + +<hr style='width: 65%;' /> +<a name='HISTORICAL_REVIEW'></a> +<h2>ADDRESS BY<br /> +MR. EDWARD W. SHELDON</h2> + +<br /> +<a name='MR_SHELDON'></a> +<h3>MR. SHELDON</h3> + +<p>It is with profound gratification that the Governors welcome your +generous presence to-day on an occasion which means so much to us and +which has perhaps some general significance. For we are met in honor of +what is almost a unique event in our national history, the centennial +anniversary celebration of an exclusively psychopathic hospital. A +summary of its origin and development may be appropriate.</p> + +<p>A hundred and fifty years ago the only institutions on this side of the +Atlantic which cared for mental diseases were the Pennsylvania Hospital, +chartered in 1751, a private general hospital which had accommodations +for a few mental cases, and the Eastern State Hospital for the insane, +at Williamsburg, Virginia, a public institution incorporated in 1768. No +other one of the thirteen Colonies had a hospital of any kind, general +or special. With a view of remedying this deplorable lack in New York, +steps were taken in 1769 to establish an adequate general hospital in +the City of New York. This resulted in the grant, on June 11, 1771, of +the Royal Charter of The Society of the New York Hospital. Soon +afterward the construction of the Hospital buildings began on a spacious +tract on lower Broadway opposite Pearl Street, in which provision was +also to be made for mental cases; but before any patients could be +admitted, an accidental fire, in February, 1775, consumed the interior +of the buildings. Reconstruction was immediately undertaken and +completed early in the spring of 1776. But by that time the +Revolutionary War was in full course, and the buildings were taken over +by the Continental authorities as barracks for troops, and were +surrounded by fortifications. When the British captured the city in +September, 1776, they made the same use of the buildings for their own +troops, who remained there until 1783. A long period of readjustment +then ensued, and it was not until January, 1791, that the Hospital was +at last opened to patients. In September, 1792, the Governors directed +the admission of the first mental case, and for the hundred and +twenty-nine years since that time the Society has continuously devoted a +part of its effort to the care of the mentally diseased. After a few +years a separate building for them was deemed desirable, and was +constructed. The State assisted this expansion of the Hospital by +appropriating to the Society $12,500 a year for fifty years. This new +building housed comfortably seventy-five patients, but ten years later +even this proved inadequate in size and undesirable in surroundings. In +the meanwhile a wave of reform in the care of the insane was rising in +Europe under the influence of such benefactors as Philippe Pinel in +France, and William and Samuel Tuke in England. Thomas Eddy, a +philanthropic Quaker Governor of the Society, who was then its Treasurer +and afterward in succession its Vice-President and President, becoming +aware of this movement, and having made a special study of the care and +cure of mental affections, presented a communication to the Governors in +which he advocated a change in the medical treatment, and in particular +the adoption of the so-called moral management similar to that pursued +by the Tukes at The Retreat, in Yorkshire, England. This memorable +communication was printed by the Governors, and constitutes one of the +first of the systematic attempts made in the United States to put this +important medical subject on a humane and scientific basis. To carry out +his plan, Mr. Eddy urged the purchase of a large tract of land near the +city and the erection of suitable buildings. He ventured the moderate +estimate that the population of the city, then about 110,000, might be +doubled by 1836, and quadrupled by 1856. In fact, it was more than +doubled in those first twenty years, and sextupled in the second +twenty. He was justified, therefore, in believing that the hospital +site on lower Broadway would soon be surrounded by a dense population, +and quite unsuited for the efficient care of mental diseases. The +Governors gave these recommendations immediate and favorable +consideration. Various tracts of land, containing in all about +seventy-seven acres, and lying on the historic Harlem Heights between +what are now Riverside Drive and Columbus Avenue, and 107th and 120th +Streets, were subsequently bought by the Society for about $31,000. To +aid in the construction and maintenance of the necessary hospital +buildings, the Legislature, by an act reciting that there was no other +institution in the State where insane patients could be accommodated, +and that humanity and the interest of the State required that provision +should be made for their care and cure, granted an additional annual +appropriation of $10,000 to the Society from 1816 until 1857. The main +Hospital, built of brownstone, stood where the massive library of +Columbia University now is, and the brick building still standing at the +northeast corner of Broadway and 116th Street was the residence of the +Medical Superintendent. The only access to this site by land was over +what was known as the Bloomingdale Road, running from Broadway and 23d +Street through the Bloomingdale district on the North River to 116th +Street, and from that fact our institution assumed the name of +Bloomingdale Asylum, or, as it is now called, Bloomingdale Hospital. +This beautiful elevated site overlooking the Hudson River and the Harlem +River was admirably fitted for its purpose. The spacious tract of land, +laid out in walks and gardens, an extensive grove of trees, generous +playgrounds and ample greenhouses, combined to give the spot unusual +beauty and efficiency. This notable work finished, the Governors of the +Society issued on May 10, 1821, an "Address to the Public"<a name='FNanchor_1_1'></a><a href='#Footnote_1_1'><sup>[1]</sup></a> which +marks so great an advance in psychiatry in our country that it deserves +study. The national character of the institution was indicated in the +opening paragraph, where it announced that the Asylum would be open for +the reception of patients from any part of the United States on the +first of the following June. Accommodation for 200 patients was +provided, and to these new surroundings were removed on that day all the +mental cases then under treatment at the New York Hospital on lower +Broadway.</p> + +<p>In this retired and ideal spot the work of Bloomingdale Hospital was +successfully prosecuted for three-quarters of a century. But the seven +miles that separated it from the old hospital was steadily built over, +and before fifty years had gone the growth of the city had passed the +asylum grounds. Foreseeing that they could not maintain that verdant +oasis intact for many years longer, the Governors, in 1868, bought this +300-acre tract on the outskirts of the Village of White Plains. After +prolonged consideration of the time and method of development of the +property, final plans were adopted in December, 1891, construction was +begun May 1, 1892, and two years later, under the direction of our +Medical Superintendent, Dr. Samuel B. Lyon, all the patients were moved +from the old to this new Bloomingdale. The cost of the new buildings was +about $1,500,000. From time to time the original Bloomingdale site was +sold and now supplies room, among other structures, for Columbia +University, Barnard College, the Cathedral of St. John the Divine, St. +Luke's Hospital, the Woman's Hospital, and the National Academy of +Design. With the proceeds of those sales of the old Bloomingdale, not +only was the cost of the new Bloomingdale met, but the permanent +endowment of the Society was substantially increased, and Thomas Eddy +was proved to have been both a wise humanitarian and a far-sighted +steward of charitable funds.</p> + +<p>In their "Address to the Public" to which I have referred, issued when +Bloomingdale Hospital was opened in 1821, the Governors of the Society +spoke of the new conception of moral treatment of the mentally afflicted +which had been established in several European hospitals and which was +supplanting the harsh and cruel usage of former days, as "one of the +noblest triumphs of pure and enlightened benevolence." In that same +spirit those founders dedicated themselves to the conduct of this +institution. Their devotion to the work was impressive. Looking back on +those early days we see a constant personal attention to the details of +institutional life that commands admiration. The standards then set have +become a tradition that has been preserved unbroken for a hundred years. +Humane methods of care, the progressively best that medical science can +devise, the utilization of a growingly productive pursuit of research, +have consistently marked the administration of this great trust. The +Governors of to-day are as determined as any of their predecessors to +maintain that ideal of "pure and enlightened benevolence." New paths are +opening and larger resources are becoming available. Under the guidance +of our distinguished Medical Superintendent, with his able and devoted +staff of physicians, a broader and more intensive development is +already under way. Animated by that resolve and cheered by that +prospect, we may thus confidently hope, as we begin the second century +of Bloomingdale's career, for results not less fruitful and gratifying +than those which we celebrate to-day.</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_1_1'></a><a href='#FNanchor_1_1'>[1]</a><div class='note'><p> Address of the Governors of the New York Hospital, to the +Public, relative to the Asylum for the Insane at Bloomingdale, New York, +May 10th, 1821. Reprinted by Bloomingdale Hospital Press, White Plains, +May 26, 1921. See <a href="#APPENDIX_V">Appendix V</a>, p. 212.</p></div> + + + +<hr style='width: 65%;' /> +<a name='CONTRIBUTIONS'></a> +<h2>ADDRESS BY<br /> +DR. ADOLF MEYER</h2> +<br /> + +<p><i>The Chairman</i>: In celebrating our centenary we are naturally dealing +also with the larger subject of general psychiatry. Our success in this +discussion should be materially promoted by the presence with us of Dr. +Adolf Meyer, Professor of Psychiatry in the Medical School of Johns +Hopkins University, and Director of the Phipps Psychiatric Clinic, of +Baltimore. Before taking up this important work in that famous medical +centre, Dr. Meyer was actively engaged for several years in psychopathic +work in New York. He will speak to us on +<span class="smcap"> +"The Contributions of +Psychiatry to the Understanding of Life Problems." +</span> +</p> + +<br /> +<a name='DR_MEYER'></a> +<h3>DR. MEYER</h3> + +<p>When Dr. Russell honored me with the invitation to speak at this +centenary celebration of the renowned Bloomingdale Hospital, my +immediate impulse was to choose as my topic a phase of psychiatric +development to which this Hospital has especially contributed through +our greatly missed August Hoch and his deeply appreciated coworker +Amsden. I have in mind the great gain in concreteness of the physician's +work with mind and the resulting contribution of psychiatry to a better +knowledge of human life and its problems. The great gain this passing +century is able to hand on to its successor is the clearer recognition +of just what the psychiatrist actually works with and works on.</p> + +<p>Of all the divisions of medicine, psychiatry has suffered longest from +man's groping for a conception of his own nature. Psychiatry means, +literally, the healing of souls. What then do we actually mean by soul +or by psyche? This question has too long been treated as a disturbing +puzzle.</p> + +<p>To-day we feel that modern psychiatry has found itself—through the +discovery that, after all, the uncritical common-sense view of mind and +soul is not so far remote from a critical common-sense view of the +individual and its life activity, freed from the forbidding and +confusing assumptions through which the concept of mind and soul has +been held in bewildering awe.</p> + +<p>Strange to say, good old Aristotle was nearer an understanding than most +of the wise men and women that have succeeded him for these more than +two thousand years. He saw in the psyche what he called the form and +realization or fulfilment of the human organism; he would probably now +say with us, the activity and function as an individual or person.</p> + +<p>Through the disharmonies and inevitable disruption of a +self-disorganizing civilization, the Greek and Roman world was plunged +into the dark centuries during which the perils of the soul and the +sacrificial attainment of salvation by monastic life and crusades +threatened to overshadow all other concern. This had some inevitable +results: it favored all those views through which the soul became like a +special thing or substance, in contrast to and yet a counterpart of the +physical body. As long as there was no objective experimental science, +the culminating solution of life problems had to be intrusted to that +remarkable development of religious philosophy which arose from the +blending of Hebrew religion and tradition and the loftiest products of +the Greek mind, in the form which St. Paul and the early Church fathers +gave to the teachings of Christ. From being the form and activation, or +function, of the organism in life, the soul feature of man was given an +appearance in which it could neither be grasped nor understood, nor +shaped, nor guided by man when it got into trouble. From the Middle Ages +there arose an artificial soul and an artificial world of souls +presented as being in eternal conflict with the evil of the flesh—<i>and +thus the house of human nature was divided against itself</i>.</p> + +<p>Science of the nineteenth century came nearer bringing mind and body +together again. The new astronomical conception of the world and the +growing objective experimental science gradually began to command +confidence, and from being a destroyer of excessively dogmatic notions, +science began to rise to its modern constructive and creative position. +But the problem of <i>mind</i> remained on a wrong basis and still does so +even with most scientists. Too much had been claimed for the psyche, and +because of the singling out of a great world of spirit, the world of +fact had been compromised and left cold and dry and unattractive and +unpromising. No doubt it was necessary that the scientist should become +hardened and weaned from all misleading expectation, and shy of all the +spurious claims of sordid superstition and of childish fancy. He may +have been unduly radical in cutting out everything that in any way +recalled the misleading notions. In the end, we had to go through a +stage of psychology without a "soul," and lately even a psychology +without "consciousness," so that we might be safe from unscientific +pretensions. All the gyrations no doubt tended to retard the wholesome +practical attack upon the problems in the form in which we find them in +our common-sense life.</p> + +<p>The first effort at a fresh start tried to explain everything rather +one-sidedly out of the meagre knowledge of the body. Spinoza had said in +his remarkable Ethics (III, Prop. II, Schol.): "Nobody has thus far +determined what the body can do, <i>i.e.</i>, nobody has as yet shown by +experience and trial what the body can do by the laws of nature alone in +so far as nature is considered merely as corporeal and extended, and +what it cannot do save when determined by mind."</p> + +<p>This challenge of Spinoza's had to be met. With some investigators this +seemed very literally all there was to be done about the study of +man—to show how far the body could explain the activity we call "the +mind." The unfortunate feature was that they thought they had to start +with a body not only with mind and soul left out but also with +practical disregard of the whole natural setting. They studied little +more than corpses and experimental animals, and many a critic wondered +how such a corpse or a frog could ever show any mind, normal or +abnormal. To get things balanced again, the vision of man had to expand +to take a sane and practical view of all of human life—not only of its +machinery.</p> + +<p>The human organism can never exist without its setting in the world. All +we are and do is of the world and in the world. The great mistake of an +overambitious science has been the desire to study man altogether as a +mere sum of parts, if possible of atoms, or now of electrons, and as a +machine, detached, by itself, because at least some points in the +simpler sciences could be studied to the best advantage with this method +of the so-called elementalist. It was a long time before willingness to +see the large groups of facts, in their broad relations as well as in +their inner structure, finally gave us the concept and vision of +integration which now fits man as a live unit and transformer of energy +into the world of fact and makes him frankly a consciously integrated +psychobiological individual and member of a social group.</p> + +<p>It is natural enough that man should want to travel on the road he knows +and likes best. The philosopher uses his logic and analysis and +synthesis. The introspectionist wants to get at the riddle of the +universe by crawling into the innermost depth of his own self-scrutiny, +even at the risk—to use a homely phrase—of drawing the hole in after +him and losing all connection with the objective world. The physicist +follows the reverse course. He gives us the appreciation of the +objective world around and in us. The chemist follows out the analytic +and synthetic possibilities of his atoms and elements, and the biologist +the growth and reproduction and multiplication of cells. Each sees an +open world of possibilities and is ready to follow as far as facts will +carry and as far as the imagination will soar. Each branch has created +its rules of the game culminating in the concept of objective science, +and the last set of facts to bring itself under the rules of objective +science, and to be accepted, has been man as a unit and personality.</p> + +<p>The mind and soul of man have indeed had a hard time. To this day, +investigators have suffered under the dogma that mind must be treated as +purely subjective entity, something that can be studied only by +introspection, or at least only with ultra-accurate instruments—always +with the idea that common sense is all wrong in its psychology. +Undoubtedly it was, so long as it spoke of a mind and soul as if what +was called so had to be, even during life, mysterious and inaccessible, +something quite different from any other fact of natural-history study.</p> + +<p>The great step was taken when all of life was seen again in its broad +relations, without any special theory but frankly as common sense finds +it, viz., as the activities and behavior of definite individuals—very +much as Aristotle had put it—"living organisms in their 'form' or +activity and behavior." Psychology had to wake up to studying other +minds as well as one's own. Common sense has always been willing to +study other persons besides our own selves, and that exactly as we study +single organs—viz., for what they are and do and for the conditions of +success and failure. Nor do we have to start necessarily from so-called +elements. Progress cannot be made merely out of details. It will not do +merely to pile up fragments and to expect the aggregates to form +themselves. It also takes a friend of facts with the capacity for +mustering and unifying them, as the general musters his army. Biology +had to have evolutionists and its Darwin to get on a broad basis to +start with, and human biology, the life of man, similarly had to be +conceived in a new spirit, with a clear recognition of the opportunities +for the study of detail about the brain and about the conditions for +its working and its proper support, but also with a clear vision of the +whole man and all that his happiness and efficiency depend upon.</p> + +<p>All this evolution is strongly reflected in the actual work of +psychiatry and medicine. For a time, it looked to the physician as if +the physiology and pathology of the body had to make it their ambition +to make wholly unnecessary what traditional psychology had accumulated, +by turning it all into brain physiology. The "psychological" facts +involved were undoubtedly more difficult to control, so much so that one +tried to cut them out altogether. As if foreshadowing the later academic +"psychology without soul and consciousness," the venerable +Superintendent of Utica, Dr. Gray, was very proud when in 1870 he had +eliminated the "mental and moral causes" from his statistics of the +Utica State Hospital, hiding behind the dogma that "mind cannot become +diseased, but only the body." To-day "mental and moral causes" are +recognized again in truer form—no longer as mere ideas and +uninvestigated suppositions taken from uncritical histories, but as +concrete and critically studied life situations and life factors and +life problems. Our patients are not sick merely in an abstract mind, but +by actually living in ways which put their mind and the entire organism +and its activity in jeopardy, and we are now free to see how this +happens—since we study the biography and life history, the resources of +adaptation and of shaping the life to success or to failure.</p> + +<p>The study of life problems always concerns itself with the interaction +of an individual organism with life situations. The first result of a +recognition of this fact was a more whole-hearted and practical concept +of personality.</p> + +<p>In 1903 I put together for the first time my analysis of the neurotic +personality, which was soon followed by a series of studies on the +influences of the mental factors, and in 1908 a paper on "What Do +Histories of Cases of Insanity Teach Us Concerning Preventive Mental +Hygiene During the Years of School Life?" All this was using for +psychiatry the growing appreciation of a broad biological view-point in +its concrete application. It was a reaction against the peculiar fear of +studying the facts of life simply and directly as we find and experience +them—scoffed at because it looked as if one was not dealing with +dependable and effective data. Many of the factors mentioned as causes +do not have the claimed effects with sufficient regularity. It is quite +true that not everybody is liable to any serious upset by several of the +handicaps sometimes found to be disastrous during the years of +development; but we have learned to see more clearly why the one person +does and the other does not suffer. Evidently, not everybody who is +reserved and retiring need be in danger of mental disorder, yet there +are persons of just this type of make-up that are less able than others +to stand the strains of isolation, of inferiority feeling, of exalted +ambitions and one-sided longings, intolerable desires, etc. The same +individual difference of susceptibility holds even for alcohol. With +this recognition we came to lay stress again on the specific factors +which make for the deterioration of habits, for tantrums with +imaginations, and for drifting into abnormal behavior, and conditions +incompatible with health.</p> + +<p>It was at this point that our great indebtedness to the Bloomingdale +Hospital began. Dr. August Hoch, then First Assistant of the +Bloomingdale Hospital, began to swing more and more toward the +psychobiological trend of views, and with his devoted and very able +friend Amsden he compiled that remarkable outline,<a name='FNanchor_2_2'></a><a href='#Footnote_2_2'><sup>[2]</sup></a> which was the +first attempt to reduce the new ideals of psychobiology to a practical +scheme of personality study—that clear and plain questionnaire going +directly at human traits and reactions such as we all know and can see +at work without any special theories or instruments.</p> + +<p>After studying in each patient all the non-mental disorders such as +infections, intoxications, and the like, we can now also attack the +problems of life which can be understood only in terms of plain and +intelligible human relations and activities, and thus we have learned to +meet on concrete ground the real essence of mind and soul—the plain and +intelligible human activities and relations to self and others. There +are in the life records of our patients certain ever-returning +tendencies and situations which a psychiatry of exclusive brain +speculation, auto-intoxications, focal infections, and internal +secretions could never have discovered.</p> + +<p>Much is gained by the frank recognition that man is fundamentally a +social being. There are reactions in us which only contacts and +relations with other human beings can bring out. We must study men as +mutual reagents in personal affections and aversions and their +conflicts; in the desires and satisfactions of the simpler appetites for +food and personal necessities; in the natural interplay of anticipation +and fulfilment of desires and their occasional frustration; in the +selection of companionship which works helpfully or otherwise—for the +moment or more lastingly throughout the many vicissitudes of life. All +through we find situations which create a more or less personal bias and +chances for success or failure, such as simpler types of existence do +not produce. They create new problems, and produce some individuals of +great sensitiveness and others with immunity—and in this great field +nothing will replace a simple study of the life factors and the social +and personal life problems and their working—the study of the real mind +and the real soul—<i>i.e.</i>, human life itself. Looking back then this +practical turn has changed greatly the general view as to what should be +the chief concern of psychology. One only need take up a book on +psychology to see what a strong desire there always was to contrast a +pure psychology and an applied psychology, and to base a new science +directly on the new acquisitions of the primary sciences such as anatomy +and histology of the nervous system. There was a quest for the elements +of mind and their immediate correlation with the latest discoveries in +the structure of the brain. The centre theory and the cell and neurone +theory seemed obligatory starting-points. To-day we have become shy of +such postulates of one-sided not sufficiently functional materialism. We +now call for an interest in psychobiological facts in terms of critical +common sense and in their own right—largely a product of psychiatry. +There always is a place for elements, but there certainly is also a +place for the large momentous facts of human life just as we find and +live it.</p> + +<p>Thus psychiatry has opened to us new conceptions and understandings of +the relation of child and mother, child and father, the child as a +reagent to the relations between mother and father, brothers and +sisters, companions and community—in the competitions of real concrete +life. It has furnished a concrete setting for the interplay of emotions +and their effects.</p> + +<p>It has led us from a cold dogma of blind heredity and a wholesale +fatalistic asylum scheme, to an understanding of individual, familiar, +and social adjustments, and a grasp on the factors which we can consider +individually and socially modifiable. We have passed from giving mere +wholesale advice to a conscientious study of the problems of each unit, +and at the same time we have developed a new and sensible approach to +mental hygiene and prevention, as expressed in the comprehensive surveys +of State and community work and even more clearly in the development of +helps to individuals in finding themselves, and in the work in schools +to reach those who need a special adaptation of aims and means. To the +terrible emergency of the war it was possible to bring experienced men +and women as physicians and nurses, and how much was done, only those +can appreciate who have seen the liberality with which all the +hospitals, and Bloomingdale among the first, contributed more than their +quota of help, and all the assistance that could possibly be offered to +returning victims for their readjustment.</p> + +<p>It is natural enough that psychiatry should have erred in some respects. +We had forced upon us the herding together of larger numbers of patients +than can possibly be handled by one human working unit or working group. +The consequence was that there arose a narrowing routine and wholesale +classifications and a loss of contact with the concrete needs of the +individual case; that very often progress had to come from one-sided +enthusiasts or even outsiders, who lost the sense of proportion and +magnified points of relative importance until they were supposed to +explain everything and to be cure-alls. We are all inclined to sacrifice +at the altar of excessive simplicity, especially when it suits us; we +become "single-taxers" and favor wholesale legislation and exclusive +State care when our sense for democratic methods has gone astray. Human +society has dealt with the great needs of psychiatry about as it has +dealt with the objects of charity, only in some ways more stingily, with +a shrewd system and unfortunately often with a certain dread of the +workers themselves and of their enthusiasm and demands. Law and +prejudice surrounded a great share of the work with notions of stigma +and hopelessness and weirdness—while to those who see the facts in +terms of life problems there can be but few more inspiring tasks than +watching the unfolding of the problematic personality, seeking and +finding its proper settings, and preventing the clashes and gropings in +maladjustments and flounderings of fancy and the faulty use and +nutrition of the brain and of the entire organism.</p> + +<p>What a difference between the history of a patient reported and studied +and advised by the well-trained psychiatrist of to-day and the account +drawn up by the statistically minded researcher or the physician who +wants to see nothing but infections or chemistry and hypotheses of +internal secretion. What a different chance for the patient in his +treatment, in contrast to what the venerable Galt of Virginia reports as +the conception of treatment recommended by a great leader of a hundred +years ago: "Mania in the first stage, if caused by study, requires +separation from books. Low diet and a few gentle doses of purging +physic; if pulse tense, ten or twelve ounces of blood [not to be given +but to be taken!]. In the high grade, catch the patient's eye and look +him out of countenance. Be always dignified. Never laugh at or with +them. Be truthful. Meet them with respect. Act kindly toward them in +their presence. If these measures fail, coercion if necessary. +Tranquillizing chair. Strait waistcoat. Pour cold water down their +sleeves. The shower bath for fifteen or twenty minutes. Threaten them +with death. Chains seldom and the whip never required. Twenty to forty +ounces of blood, unless fainting occurs previously; ... etc."</p> + +<p>To-day an understanding of the life history, of the patient's somatic +and functional assets and problems, likes and dislikes, the problem +presented by the family, etc.!</p> + +<p>So much for the change within and for psychiatry. How about psychiatry's +contribution beyond its own narrower sphere? It has led us on in +philosophy, it has brought about changes in our attitude to ethics, to +social study, to religion, to law, and to life in general. Psychiatric +work has undoubtedly intensified the hunger for a more objective and yet +melioristic and really idealistic philosophical conception of reality, +such as has been formulated in the modern concept of integration.</p> + +<p>Philosophical tradition, logic, and epistemology alike had all conspired +to make as great a puzzle as possible of the nature of mental life, of +life itself, and of all the fundamental principles, so much so that as +a result anything resembling or suggesting philosophy going beyond the +ordinary traditions has got into poor repute in our colleges and +universities and among those of practical intelligence. The consequence +is that the student and the physician are apt to be hopeless and +indifferent concerning any effort at orderly thinking on these +problems.<a name='FNanchor_3_3'></a><a href='#Footnote_3_3'><sup>[3]</sup></a></p> + +<p>Most of us grew up with the attitude of a fatalistic intellectual +hopelessness. How could we ever be clear on the relation of mind and +body? How could mind and soul ever arise out of matter? How can we +harmonize strict science with what we try to do in our treatment of +patients? How can we, with our mechanistic science, speak of effort, and +of will to do better? How can we meet the invectives against the facts +of matter on the part of the opposing idealistic philosophies and their +uncritical exploitations in "New Thought"—<i>i.e.</i>, really the revival of +archaic thought? It is not merely medical usefulness that forced these +broad issues on many a thinking physician, but having to face the facts +all the time in dealing with a living human world. The psychopathologist +had to learn to do more than the so-called "elementalist" who always +goes back to the elements and smallest units and then is apt to shirk +the responsibility of making an attempt to solve the concrete problems +of greater complexity. The psychiatrist has to study individuals and +groups as wholes, as complex units, as the "you" or "he" or "she" or +"they" we have to work with. We recognize that throughout nature we have +to face the general principle of unit-formation, and the fact that the +new units need not be like a mere sum of the component parts but can be +an actually new entity not wholly predictable from the component parts +and known only through actual experience with the specific product. +Hydrogen and oxygen, it is true, can form simple mixtures, but when they +make an actual chemical integration we get a new specific type of +substance, water, behaving and dividing according to its own laws and +properties in a way not wholly predictable from just what we know of +hydrogen and oxygen as such. Analogy prompts us to see in plants and +animals products of physics and chemistry and organization, although the +peculiarity of the product makes us recognize certain specificities of +life not contained in the theory of mere physics and chemistry. All the +facts of experience prompt us to see in mentation a biological function, +and we are no longer surprised to find this product of integration so +different from the nature and functions of all the component parts. All +the apparent discontinuities in the intrinsic harmony of facts, on the +one hand, and the apparent impossibility of accounting for new features +and peculiarities of the new units, are shown to be a general feature of +nature and of facts: integration is not mere summation, but a creation +of ever-new types and units, with superficial discontinuities and with +their own new denominators of special peculiarities; hence there is no +reason to think of an insurmountable and unique feature in the origin of +life, nor even of mentally integrated life; no need of special mystical +sparks of life, of a mysterious spirit, etc.; but—and this is the +important point—also no need of denying the existence of all the +evidence there may be of facts which we imply when we use the deeply +felt concepts of mind and soul. In other words, we do not have to be +mind-shy nor body-shy any longer.</p> + +<p>The inevitable problem of having to study other persons as well as +ourselves necessarily leads us on to efforts at solution of other +philosophical problems, the problem of integrating materialism and +idealism, mechanism and relative biological determinism and purpose, +etc. Man has to live with the laws of physics and chemistry unbroken and +in harmony with all that is implied in the laws of heredity and growth +and function of a biological organism. Yet what might look like a +limitation is really his strength and safe foundation and stability. On +this ground, man's biological make-up has a legitimate sphere of growth +and expansion shared by no other type of being. We pass into every new +moment of time with a preparedness shown in adaptive and constructive +activity as well as structure, most plastic and far-reaching in the +greatest feat of man, that of imagination. Imagination is not a mere +duplication of reality in consciousness and subjectivity; it is a +substitute in a way, but actually an amplification, and often a real +addition to what we might otherwise call the "crude world," integrated +in the real activities of life, a new creation, an ever-new growth, seen +in its most characteristic form in choice and in any new volition. Hence +the liberating light which integration and the concepts of growth and +time throw on the time-honored problem of absolute and relative +determinism and on the relation of an ultra-strict "science" with common +sense.</p> + +<p>In logic, too, we are led to special assertions. We are forced to +formulate "open definitions," <i>i.e.</i>, we have to insist on the open +formulation of tendencies rather than "closed definitions." We deal with +rich potentialities, never completely predictable.</p> + +<p>This background and the demands of work in guiding ourselves and others +thus come to lead us also into practical ethics, with a new conception +of the relation of actual and experimental determinism and of what "free +will" we may want to speak of, with a new emphasis on the meaning of +choice, of effort, and of new creation out of new possibilities +presented by the ever-newly-created opportunities of ever-new time. We +get a right to the type of voluntaristic conception of man which most of +us live by—with a reasonable harmony between our science and our +pragmatic needs and critical common sense.</p> + +<p>The extent to which we can be true to the material foundations and yet +true to a spiritual goal, ultimately measures our health and natural +normality and the value of our morality. <i>Nature shapes her aims +according to her means.</i> Would that every man might realize this simple +lesson and maxim—there would be less call for a rank and wanton +hankering for relapses into archaic but evidently not wholly outgrown +tendencies to the assumption of "omnipotence of thought," revived again +from time to time as "New Thought." Psychiatry restores to science and +to the practical mind the right to reinclude rationally and +constructively what a narrower view of science has, for a time at least, +handed over unconditionally to uncritical fancy. But the only way to +make unnecessary astrology and phrenology and playing with mysticism and +with Oliver Lodge's fancies of the revelation of his son Raymond, is to +recognize the true needs and yearnings of man and to show nature's real +ways of granting appetites and satisfactions that are wholesome.</p> + +<p>Hereby we have indeed a contribution to biologically sound idealism: a +clearer understanding of how to blend fact and ambition, nature and +ideal—an ability to think scientifically and practically and yet +idealistically of matters of real life.</p> + +<p>To come back to more concrete problems again, a wider grasp of what +psychiatry may well furnish us helps toward a new ethical goal in our +social conscience. The nineteenth century brought us the boon and the +bane of industrialism. More and more of the pleasures and satisfactions +of creation and production and of the natural rewards of the daily labor +drifted away from the sight and control of the worker, who now rarely +sees the completed result of his work as the farmer or the artisan used +to do. Few workers have the experience of getting satisfaction from +direct pride in the end result; as soon as the product is available, a +set of traders carries it to the markets and a set of financiers +determines, in fact may already have determined, the reward—just as the +reward of the farmer is often settled for him by astounding +speculations long before the crop is at hand. There is a field for a new +conscience heeding the needs of fundamental satisfactions of man so well +depicted by Carlton Parker, and psychiatric study furnishes much +concrete material for this new conscience in industrial relations—with +a better knowledge of the human needs of all the participants in the +great game of economic life.</p> + +<p>Psychiatry gives us also a new appreciation of the religious life and +needs of our race. Man's religion shows in his capacity to feel and +grasp his relations and responsibility toward the largest unit or force +he can conceive, and his capacity for faith and hope in a deeper and +more lasting interdependence of individual and race with the Ruler or +rules of the Universe. Whatever form it may take expresses his capacity +to feel himself in humility and faith, and yet with determination, a +more or less responsible part of the greatest unit he can grasp. The +form this takes is bound to vary individually. As physicians we learn to +respect the religious views of our fellow beings, whatever they may be; +because we are sure that we have the essentials in common; and with this +emphasis on what we have in common, we can help in attaining the +individually highest attainable truth without having to be destructive. +We all recognize relations that go beyond individual existence, lasting +and "more than biological" relations, and it is the realization of these +conceptions intellectually and emotionally true to our individual and +group nature that constitutes our various religions and faiths. +Emphasizing what we have in common, we become tolerant of the idea that +probably the points on which we differ are, after all, another's best +way of expressing truths which our own nature may picture differently +but would not want to miss in, or deny to, the other. One of the +evidences of the great progress of psychiatry is that we have learned to +be more eager to see what is sane and strong and constructively valuable +even in the strange notions of our patients, and less eager to call them +queer and foolish. A delusion may contain another person's attempt at +stating truth. The goal of psychiatry and of sound common sense is truth +free of distortion. Many a strange religious custom and fancy has been +brought nearer our understanding and appreciation since we have learned +to respect the essential truth and individual and group value of fancy +and feeling even in the myths and in the religious conceptions of all +races.</p> + +<p>Among the most interesting formulations and potential contributions of +psychiatry are those reaching out toward jurisprudence. Psychiatry deals +pre-eminently with the variety and differences of human personalities. +To correct or supplement a human system apparently enslaved by concern +about precedent and baffling rules of evidence inherited from the days +of cruel and arbitrary kings, the demand for justice has called for +certain remedies. Psychiatry still plays a disgraceful rôle in the +so-called expert testimony, largely a prostitution of medical authority +in the service of legal methods. Yet, out of it all there has arisen the +great usefulness of the psychiatrist in the juvenile and other courts. +There it is shown that if psychiatry is to help, it should be taken for +granted that the person indicted on a charge should thereby become +subject to a complete and unreserved study of all the facts, subject to +cross-examination, to be sure, but before all accessible to complete and +unreserved study. This would mean a substantial participation of law in +the promotion of knowledge of facts and constructive activity, and a +conception of indeterminate sentence not merely in the service of +leniency but in the service of the best protection of the public, and, +if necessary, lasting detention of those who cannot be reformed, before +they have had to do their worst. Whoever is clearly indicted for +breaking the laws of social compatibility should not merely invite a +spirit of revenge, but should, through the indictment, surrender +automatically to legalized authority endowed with the right and duty of +an unlimited investigation of the facts as they are.</p> + +<p>Looking back then, you can see how the history of the human thought +about what we call mind and psyche displayed some strange reactions of +the practical man, the scientist, the philosopher, and theologian toward +one of the most important and practical problems. It is difficult to +realize what it means to arrive at ever-more-workable formulations and +methods of approach. We do not have to be mind-shy <i>or</i> body-shy any +longer. To-day we can attack the facts as we find them, without that +disturbing obsession of having to translate them first into something +artificial before we can really study them and work with them. Since we +have reached a sane pluralism with a justifiable conviction of the +fundamental consistency of it all, a satisfaction with what we modestly +call formulation rather than definition and with an appreciation of +relativity, we have at last an orderly and natural field and method from +which nobody need shy.</p> + +<p>The century that has passed since the inspiration of a few men of the +Society of the New York Hospital to provide for the mentally sick has +cleared the atmosphere a great deal. We can start the second century +freer and unhampered in many ways. Much has been added, and more than +ever do we appreciate the position of just such a hospital as that of +Bloomingdale as a centre of healing and as a leader of public opinion +and as a contributor to progress.</p> + +<p>The Bloomingdale Hospital has a remarkable function. It is a more or +less privileged forerunner in standards and policies. Without having to +carry the burdens of the whole State with its sweeping and sometimes +distant power and its forced economy, a semiprivate hospital like +Bloomingdale aims to minister to a slightly select group, especially +those who are in the difficult position of greater sensitiveness but +moderate means in days of sickness. It serves the part of our community +which more than any other sets the pace of the civilization about +us—the intelligent aspiring workers who may not have reached the goal +of absolute financial independence. It creates the standard of which we +may dream that it might become the standard of the whole State.</p> + +<p>When we review the roster of Superintendents—from John Neilson to Pliny +Earle and from Charles Nichols, Tilden Brown, and Samuel Lyon down to +the present head, our highly esteemed friend and coworker William L. +Russell—and the names of the members of the staff, many of whom have +reached the highest places in the profession, and last, but not least, +the names of the Governors of The Society of the New York Hospital, we +cannot help being impressed by the forceful representation of both the +profession and the public, and we recognize the wide range of influence.</p> + +<p>Instead of depending on frequently changing policies regulated from the +outside under the influence of the greater and lesser lights and +exigencies of State and municipal organization, the New York Hospital +has its self-perpetuating body of Governors chosen from the most +public-spirited and thoughtful representatives of our people. +Bloomingdale thus has always had a remarkable Board of Governors, who, +from contact with the General Hospital and with this special division, +are in an unusual position to see the practical aspects of the great +change that is now taking place. You see how the division of psychiatry +has developed from practically a detention-house to an asylum, and +finally to a hospital with all the medical equipment and laboratories of +the General Hospital. And you begin to see psychiatry, with its methods +of study and management of life problems as well as of specific brain +diseases, infections, and gastrointestinal and endocrine conditions, +become more and more helpful, even a necessity, in the wards and +dispensary of the General Hospital on 16th Street. The layman cannot, +perhaps, delve profitably into the details of such a highly and broadly +specialized type of work. But he can readily take a share in the best +appreciation of the general philosophy and policy of it all.</p> + +<p>The shaping of the policy of a semiprivate hospital is not quite as +simple as shaping that of a State Hospital with its well-defined +districts and geographically marked zones of responsibility. +Bloomingdale has its sphere of influence marked by qualitative selection +rather than by a formal consideration. It does not pose as an invidious +contrast to the State Hospital, and yet it is intended to solve in a +somewhat freer and more privileged manner the problem of providing for +the mentally sick of a more or less specific hospital constituency, the +constituency of the New York Hospital; and since it reaches the most +discriminating and thinking part of our population, it has the most +wonderful opportunity to shape public opinion. Like all psychiatrical +institutions, it has to live down the traditional notions of the +half-informed public; it has to make conspicuous the change of spirit +and the better light in which we see our field and responsibilities. +This organization can show that it is not mere insanity but the working +out of life problems that such a hospital as this is concerned with. The +conditions for which it cares are many. Some of them are all that which +tradition and law stamp as insanity. But see what a change. +Seventy-five per cent of the patients are voluntary admissions; and more +and more will be able to use the helps when they begin to feel the need, +not merely when it becomes an enforced necessity.</p> + +<p>By creating for this Hospital a liberal foundation, by completing its +equipment so as to make possible a free exchange of patients and of +workers from the Hospital in the city and this place in the country, +much has been done and more will be done to set a living example of the +very spirit of modern psychopathology and psychiatry. We know now that +from 10 to 40 per cent of the patients of the gynecologist, the +gastroenterologist, and the internist generally would be better treated +if a study of the life problems were added to that of the special organs +and functions. To meet this need it should be possible to have enough +workers in this branch of the Hospital to take their share of the +consulting and co-operation work in the wards and dispensary of the +General Hospital, and perhaps even in the schools provided for the same +type of people from which you draw your patients. The grouping of the +patients can be such that the old prejudices need not reach far into the +second century of the life of the Hospital. With a man of the vision and +practical experience of Dr. Russell, there is no need for an outsider to +conjure up a picture of special practical achievements as I have done +of the more general principles to-day.</p> + +<p>An institution is more than a human life. Many ambitions combine and +become part of a group spirit permeating the organization and reaching +their fulfilment in the succession of leaders. The life and growth and +happy self-realization of an institution is not the bricks and +mortar—it is a living and elastic entity—never too stable, never too +finished, a growing and plastic plant—to use a metaphor that has +slipped in perhaps without arousing all the implications the term plant +might carry and does carry.</p> + +<p>Some years ago my wife celebrated her birthday and told her colored cook +jocosely: "Geneva, I am a hundred years old to-day." The cook's jaw +dropped and then she suddenly remarked: "Lord! you don't look dat ole." +That is the way I feel about Bloomingdale Hospital as we see it to-day +pulsating with ever-fresh life and ever-fresh problems! How different +from a simple human being, after all! The heart and wisdom of many a man +and woman has gone into the perpetuation of what a few thoughtful men +started in 1821 and the result is that it is ever renewing its youth.</p> + +<p>Many a dream has been realized and many a dream has given way to +another. Here and there the past may make itself felt too much. But the +spirit and its growth show in recruiting ever-new lives to meet the +present day and the days to come, and this all the more so if we can +show the younger generation that every effort is likely to have its +reasonable direct support. We all want a man like Dr. William L. Russell +to have the fullest opportunity to bring to its best expression the rich +and well-tried wisdom of over twenty-five years of devoted work in the +field. This is no doubt a time of stress when many personal and general +sacrifices may be needed to bring about the fruition and culmination of +the labors of the present generation. Yet is it not a clear opportunity +and duty, so that those who are growing up in the ranks to-day may +really be encouraged to get a solid training, always animated by the +conviction that one can be sure of the practical reward for toiling +through the many years of preparation in a psychiatric career, whether +it be as a physician or as a nurse or as an administrator?</p> + +<p>I cannot help feeling as I stand here that I am in a way representing +not only my own sentiments and convictions but those of our dear old +friend Hoch. We all wish that he might be with us to express himself the +warm feelings toward the Bloomingdale Hospital and its active +representatives, from the managers to the humblest workers. Hoch in his +modesty could probably not have been brought to state fully and frankly +his own share in the achievements of this Hospital. But I know how much +he would have liked to be here to express especially the warmth of +appreciation we all entertain of what our friend William L. Russell +means to us and has meant to us all through the nearly twenty-five years +of our friendship and of working together. We delight in seeing him +bring to further fruition the admirable work he did at Willard, and +later for all the State hospitals; and that which we see him do at all +times for sanity in the progress of practical psychiatry, and now +especially in the guidance of this institution. We delight in seeing his +master mind given more and more of a master's chance for the practical +expression of his ideals and convictions concerning the duties and +opportunities of such a hospital as Bloomingdale.</p> + +<p>Our thanks and best wishes to those who invited us to stand here to-day +at the cradle of a second century of Bloomingdale Hospital! It is a +noteworthy gathering that joins here in good wishes to those who have +shaped this ever-new Bloomingdale. With a tribute to our thoughtful and +enthusiastic friend in internal medicine, Lewellys F. Barker, to our +English coworker, Richard G. Rows, to the illustrious champion of French +psychopathology, Pierre Janet, to our friend and leader in practical +psychiatry, William L. Russell, to our friends and coworkers of the +Bloomingdale staff, and especially also to the Board of Governors who +shape the policy and control the finances, and exercise the leadership +of public opinion, I herewith express my sincerest thanks and best +wishes.</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_2_2'></a><a href='#FNanchor_2_2'>[2]</a><div class='note'><p> A Guide to the Descriptive Study of the Personality, with +Special Reference to the Taking of Anamneses of Cases with Psychoses, by +Dr. August Hoch and Dr. George S. Amsden.</p></div> + +<a name='Footnote_3_3'></a><a href='#FNanchor_3_3'>[3]</a><div class='note'><p> See, for instance, Moebius, The Hopelessness of All +Psychology, reviewed in the Psychological Bulletin, vol. IV, 1907, pp. +170-179.</p></div> + + + +<hr style='width: 65%;' /> +<a name='IMPORTANCE'></a><h2>ADDRESS BY<br /> +DR. LEWELLYS F. BARKER</h2> +<br /> + +<p><i>The Chairman</i>:—The Johns Hopkins Medical School lends us also to-day +Dr. Lewellys F. Barker, its Professor of Clinical Medicine. Dr. Barker +has done so much to define and settle the contradictions of mind and +matter, and has clarified so much, and in fields so varied, as teacher, +research worker, and practitioner, that we welcome this opportunity of +listening to his discussion of +<span class="smcap"> +"The Importance of Psychiatry in General +Medical Practice." +</span> +</p> + +<br /> +<a name='DR_BARKER'></a> +<h3>DR. BARKER</h3> + +<p>We have met to-day to celebrate the hundredth anniversary of the +founding of a hospital that, in its simpler beginnings and in its +evolution to the complex and highly organized activities of the present, +has served an eminently practical purpose and has played an important +rôle in the development of the science and art of psychiatry in America. +I desire, as a representative of general medicine, and, especially, of +internal medicine, to add, on this occasion, my congratulations to those +of the spokesmen of other groups, and, at the same time to express the +hope that this institution, historically so significant for the century +just past, may maintain its relative influence and reputation in the +centuries to come.</p> + +<p>The interest taken in psychiatry by the general practitioner and by the +consulting internist has been growing rapidly of late. Some of the +reasons for this growth of interest and heightening of appreciation I +have drawn attention to on an earlier occasion.<a name='FNanchor_4_4'></a><a href='#Footnote_4_4'><sup>[4]</sup></a> Psychiatry as a whole +was for a long time as widely separated from general medicine as +penology is to-day, and for similar reasons. It was a long time before +persons that manifested extraordinary abnormalities of thought, feeling, +and behavior were regarded as deserving medical study and care, and even +when a humanitarian movement led to their transfer from +straight-jackets, chains, and prison cells to "asylums for the insane," +these institutions were, for practical reasons, so divorced from the +homes of the people and from general hospitals that psychiatry had, and +could at the time have, but little intercourse with general medicine or +with general society. Mental disorders were moral and legal problems +rather than biological, social, and medical problems. Their genesis was +wholly misunderstood, and legal, medical, social, religious, and +philosophic prejudices went far toward preventing any rational +scientific mode of approach to the questions involved or any formulation +of investigative procedures that promised to be fruitful. Even to-day +the same prejudices are all too inhibitory; but thanks to the +unprecedented development of the natural sciences during the period +since this hospital was founded, we are witnessing, in our time, a rapid +transformation of thought and opinion concerning both the normal and the +disordered mind, a transformation that is reaching all circles of human +beings, bidding fair to compel the strongholds of tradition and +prejudice to relax, and inviting the whole-hearted co-operation of +workers in all fields in a common task of overcoming some of the +greatest difficulties by which civilization and human progress are +confronted. And though the brunt of this task is borne and must be borne +by the shoulders of medical men, physicians assume the burden +cheerfully, now that they know that they can count upon the intelligent +support and the cordial sympathy of an ever-enlarging extra-medical +aggregate. No better illustration could be given, perhaps, of the change +in the status of psychiatry in this country and in the world than the +contents of the programme of our meeting to-day at which a distinguished +investigator from London tells us of the biological significance of +mental disorders, an eminent authority from Paris explains the +relationship between certain diseases of the nervous system and these +disorders, and a leading psychiatrist of this country speaks upon the +contributions of psychiatry to the understanding of the problems of +life. Psychiatry, like each of the other branches of medicine, has come +to be recognized as one of the subdivisions of the great science of +biology, free to make use of the scientific method, in duty bound to +diffuse the knowledge that it gains, and privileged to contribute +abundantly to the lessening of human suffering and the enhancement of +human joys. General practitioners of medicine and medical +specialists—at least the more enlightened of them—welcome the +developing science of psychiatry, are eager to hasten its progress, and +will gladly share in applying its discoveries to the early diagnosis, +the cure, and the prevention of disease.</p> + +<p>That the majority of medical and surgical specialists and even most of +the widely experienced general practitioners, though constantly coming +in contact with major and minor psychic disturbances, are, however, +still far from realizing the full meaning and value of the principles +and technic of modern psychology and of the newer psychiatry must, I +fear, be frankly admitted.<a name='FNanchor_5_5'></a><a href='#Footnote_5_5'><sup>[5]</sup></a> But dare we blame these practitioners for +their ignorance of, apathy regarding, and even antipathy to, the psychic +and especially the psychotic manifestations of their patients? Ought we +not rather to try to understand the reasons for this ignorance, this +apathy, and this aversion, all three of which seem astonishing to many +of our well-trained psychologists and psychopathologists? Are there not +definite conditions that explain and at least partially excuse the +defects in knowledge and interest and the errors in attitude manifested +by those whom we would be glad to see cognizant and enthusiastically +participant? Psychiatrists, who have taught us to understand and rescue +various types of "sinners" and "social offenders" will, I feel sure, +avoid any moralistic attitude when discussing the shortcomings of their +brethren in the general medical profession, and will, instead, seek to +discover and to remove their causes.</p> + +<p>As an internist who values highly the gifts that modern psychology and +psychiatry have been making to medicine, I have given some thought to +the conditions and causes that may be responsible for these professional +delinquencies that you deplore. Though this is not the time nor the +place fully to discuss them, the mere mention of some of the causes and +conditions will, perhaps, contribute to comprehension and pardon, and +may serve to stimulate us all to livelier corrective activity. Let me +enumerate some of them:</p> + +<p>(1) A social stigma still attaches, despite all our efforts to abolish +it, to mental disorders and has, to a certain extent, been transferred +to those that study and treat patients manifesting these disorders.</p> + +<p>(2) The organization of our general education is very defective since it +fails to make clear to each student man's place in the universe and any +orderly view of the world and man; it fails adequately to enlighten the +student regarding the processes of life as adaptations of organisms to +their environment, man, himself, being such an organism reacting +physically and psychically to his surroundings in ways either favorable +or unfavorable to his own preservation and that of his species; it fails +to teach the student that the human organism represents a bundle of +instincts each with its knowing, its feeling, and its striving +component, that what we call "knowledge" and what we call "character" +are gradual developments in each person, and that if we know how they +have developed in a particular person we possess clues to the way that +person will react under a given stimulus, that is to say, what he will +think, how he will feel, and how he will act; and it fails, again, +properly to instruct students regarding the interrelationships of +members of different social groups (familial, civic, economic, +occupational, ethical, national, racial, etc.); in other words, our +general educational organization is as yet far from successful in +inculcating philosophical, biological, psychological, and sociological +conceptions that are adequate symbols of reality.</p> + +<p>(3) Though our medical schools have made phenomenal advances in the +organization and equipment of their institutes and in provision for +teaching and research in a large number of preclinical and clinical +sciences, they have up to now almost wholly ignored normal psychology, +psychiatry, and mental hygiene. The majority of the professors in these +schools are so absorbed by the morphological, physical, and chemical +aspects of their subjects, that students rarely get from them any +inkling of the psychobiological aspect, any adequate knowledge of human +motives, or any satisfactory data regarding human behavior, normal or +abnormal.<a name='FNanchor_6_6'></a><a href='#Footnote_6_6'><sup>[6]</sup></a> It is only recently and only in a few schools that +psychiatric clinics have been established as parts of the teaching +hospitals, that medical students have been able to come into direct +contact over an appreciable period of time with the objects of +psychiatric study, that the psychic manifestations of patients have +received any direct and particular attention in the general medical and +surgical wards, and that there has been any free and constant reciprocal +exchange of thought and opinion between students of the somatic on the +one hand and students of the psychic on the other.</p> + +<p>(4) The language of the psychiatrist is unique and formidable. The names +he has applied to motives and impulses, to symptoms and syndromes, are +foreign to the tongue of the general practitioner who is so awed by +them that he withdraws from them and remains humbly reticent in a state +of enomatophobia; or, if he be more tough-minded, he may be amused by, +or contemptuous of, what he refers to as "psychiatric jargon" or +"pseudoscientific gibberish." There is, furthermore, a dearth of +concise, authoritative, well-written text-books on psychiatry, and the +general medical journals rarely print psychiatric papers designed to +interest the average practitioner. The most widely diffused psychiatric +reports of our time are the sensational news items of the daily press.</p> + +<p>(5) The overemphasis of psychogenetic factors to the apparent neglect of +important somatogenic factors by some psychiatrists has tended to arouse +suspicion regarding the soundness of the opinions and methods of +psychiatric workers in the minds of men thoroughly imbued with +mechanistic conceptions and impressed with the results of medical +researches based upon them. The ardor of the psychoanalysts, also, +though in part doubtless justified by experience, has, it is to be +feared, excited a certain amount of antipathy among the uninitiated.</p> + +<p>(6) The fears of insanity prevalent among the laity and the repugnance +of patients to any idea that they may be "psychotic" or "psychoneurotic" +(words that, in their opinion, refer to "imaginary symptoms," or to +symptoms that they could abolish if they would but "buck up" and exert +their "wills") undoubtedly exert a reflex influence upon practitioners +who put the "soft pedal" on the psychobiological reactions and "pull out +the stop" that amplifies the significance of any abnormal physical +findings.</p> + +<p>(7) Psychotherapy, to the mind of the average medical practitioner, is +(or has been) something mysterious or occult. He uses much psychotherapy +himself but it is nearly always applied unconsciously and indirectly +through some form of physical or chemical therapy that he believes will +cure. He is usually quite devoid of insight into the effect of his own +expressed beliefs and bodily attitudes upon the adjusting mechanisms of +his patients. Conscious and direct psychotherapy is left by the average +practitioner to New Thoughters, Christian Scientists, quacks, and +charlatans. If he were to use psychotherapy consciously and were to +receive a professional fee for it he would feel that he was being paid +for a value that the patient had not received. A highly respected +colleague once privately criticised a paper of mine (read before the +Association of American Physicians) on the importance of psychotherapy. +"What you said is true," he remarked; "we all use psychotherapy but we +are a little ashamed of it; and it is better not to talk about it." Even +he did not realize that every psychotherapy is also a physical therapy.</p> + +<p>(8) The rise of specialism, through division of labor and +intensification of interests restricted to limited fields, in practical +medicine, the necessary result and to a large extent also a cause of the +rapid growth of knowledge and technic has brought with it many +advantages, but also some special difficulties, among them (a) the +impossibility any longer of any single practitioner, unaided, to study +and treat a patient as well as he can be studied and treated by a +co-ordinated group whose special analytical studies in single domains +are adequately synthesized by a competent integrator, and (b) in the +absence of such group work, the tendency to one-sided study, partial +diagnosis, and incomplete and unsatisfactory therapy. Through the rise +of specialism, it is true, psychiatry itself has arisen and the +psychiatrist, like the skilled integrating internist, is interested in +the synthesis of the findings in all domains, for only through such +synthetic studies, such integration of the functional activities of the +whole organism, is it possible to gain a global view of the patient as a +person, to make a complete somatic, psychic, and social diagnosis, and +to plan a regimen for him that will ensure the best adjustment possible +of his internal and external relationships.<a name='FNanchor_7_7'></a><a href='#Footnote_7_7'><sup>[7]</sup></a></p> + +<p>Working in a diagnostic group myself as an integrating internist, I have +been much helped by the reports of personality studies made by skilful +psychiatrists; these are linked with the special reports on the several +bodily domains (cardiovascular, respiratory, hæmic, dental, digestive, +urogenital, locomotor, neural, metabolic, and endocrine) in order +finally to arrive at an adequately co-ordinated and (subordinated) total +diagnosis from which the clues for an appropriate therapeutic regimen +can safely be drawn. If group practice is to grow and be successful in +this country, as I think likely, groups must see to it that psychiatry, +as well as the other medical and surgical specialties, is properly +represented in their make-up.<a name='FNanchor_8_8'></a><a href='#Footnote_8_8'><sup>[8]</sup></a> From now on, too, general practitioners +should, as Southard emphasized, be urged to be at least as familiar +with the general principles and methods of the psychiatrist as they are +with those of the gynecologist, the dermatologist, and the +pædiatrist.<a name='FNanchor_9_9'></a><a href='#Footnote_9_9'><sup>[9]</sup></a> Well organized group-diagnosis and general will then help +to counteract the inhibiting influence of earlier isolated specialism +upon the appreciation of psychiatry.</p> + +<p>This enumeration of some of the causes of the ignorance and apathy +(existent hitherto) in the general profession regarding psychiatry may +perhaps suffice as explanation. These causes are, fortunately, rapidly +being removed. We are entering upon an era in which psychiatry will be +recognized as one of the most important specialties in medicine, an era +that will demand alliance and close communion among psychiatrists, +internists, and the representatives of the various medical and surgical +specialties.</p> + +<p>The internist and the psychiatrist will ever have a common interest in +the obscure problems of etiology and pathogenesis of diseases and +anomalies that are accompanied by abnormalities of thought, feeling, and +behavior. Progress in this direction is bound to be slow for the studies +are exceptionally complex and there are many impediments to be removed. +Though the problems are deep and difficult, they are doubtless soluble +by the mind of man, and they exert an uncommon fascination upon those +who visualize them. Causes may be internal or external, and are often a +combination of both. The tracing of the direct and indirect +relationships between these causes and the abnormal cerebral functioning +upon which the disturbances of psychobiological adjustment seem to +depend is the task of pathogenesis. The internist who has studied the +infantile cerebropathies with their resulting imbecilities, syphilis +followed by general paresis, typhoid fever and its toxic delirium, +chronic alcoholism with its characteristic psychoses, cerebral +thrombosis with its aphasias, agnosias, and apraxias, thalmic syndromes +due to vascular lesions with their unilateral pathological feeling-tone, +frontal-lobe tumors with joke-making, uncus tumors with hallucinations +of taste and smell, lethargic encephalitis with its disturbance of the +general consciousness and its psychoneurotic sequelæ (lesions in the +globus pallidus and their motor consequences), pulmonary tuberculosis +with its euphoria, and endocrinopathies like myxoedema and exophthalmic +goitre with their pathological mental states, is encouraged to proceed +with his clinical-pathological-etiological studies in full assurance +that they will steadily contribute to advances in psychiatry. The +eclectic psychiatrist who is examining mental symptoms and +symptom-complexes ever more critically, who is seeking for parallel +disturbances in physiological processes and who considers both +psychogenesis and somatogenesis in attempting to account for +psychobiological maladjustments will welcome, we can feel sure, any help +that internal medicine and general and special pathology can yield.</p> + +<p>These studies in pathogenesis and etiology are fundamentally necessary +for the development of a rational therapy and prophylaxis. Already much +that is of applicable value in practice has been achieved. The internist +shares with the psychiatrist the desire that knowledge of the facts +regarding care, cure, and prevention of mental disorders may become +widely disseminated among medical men and at least to some extent among +the laity. Experts in psychiatry firmly believe that at least half of +the mental disturbances now prevalent could have been prevented, if, +during the childhood and adolescence of those afflicted, the facts and +principles of existing knowledge and the practical resources now +available could have been applied.</p> + +<p>We have recently had an excellent illustration of the benefits of +applied psychiatry in the remarkable results achieved during the great +war through the activities of the head of the neuropsychiatric division +of the Surgeon General's office and his staff<a name='FNanchor_10_10'></a><a href='#Footnote_10_10'><sup>[10]</sup></a> and those of the +senior consultant in neuropsychiatry and his divisional associates in +the American Expeditionary Force. In no other body of recruits and in no +other army than the American was a comparable success arrived at, and +the credit for this is due to American applied psychiatry and its wisely +chosen official representatives.</p> + +<p>The active campaign for the preservation of the mental health of our +people and for a better understanding and care of persons presenting +abnormal mental symptoms carried on during the past decade by the +National Committee for Mental Hygiene marks a new epoch in preventive +medicine.<a name='FNanchor_11_11'></a><a href='#Footnote_11_11'><sup>[11]</sup></a></p> + +<p>The prevention of at least a large proportion of abnormal mental states +through the timely application of the principles of mental hygiene is +now recognized as a practically realizable ideal. Many important reforms +are now in process throughout the United States, no small part of them +directly attributable to the active efforts of our leading psychiatrists +and to our National +<ins class="correction" +title="Transcriber's note: original reads 'Committe's'">Committee's</ins> +work. The old "asylums" are being changed into +"hospitals." Psychiatric clinics are becoming attached to teaching +hospitals and psychiatric instruction in the medical schools is being +vastly improved. The mental symptoms of disease now receive attention in +hospitals and in private practice and at a much earlier stage than +formerly. Even the courts, the prisons, and the reformatories are +awakening to the importance of scientific psychiatry; before long +penology may be brought more into accord with our newer and juster +conceptions of the nature and origin of crime, dependency, and +delinquency. That schools of hygiene and the public health services must +soon fall into line and consider mental hygiene seriously is obvious. +The objection sometimes made that the practical problems are too vague, +not sufficiently concrete, to justify attack by public health officials +is no longer valid. In no direction, probably, could money and energy be +more profitably spent during the period just ahead than in the support +of a widely organized campaign for Mental Hygiene.<a name='FNanchor_12_12'></a><a href='#Footnote_12_12'><sup>[12]</sup></a> Psychiatrists +can count upon internists and general practitioners to aid them in +educating the public regarding the nature and desirability of this +campaign.</p> + +<p>Man is now consciously participating in the direction of his own +evolution. To cite England's poet laureate, who, you will recall, is a +physician: "The proper work of his (man's) mind is to interpret the +world according to his higher nature, and to conquer the material +aspects of the world so as to bring them into subjection to the spirit."</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_4_4'></a><a href='#FNanchor_4_4'>[4]</a><div class='note'><p> In an address at the seventieth annual meeting of the +American Medico-Psychological Association, 1914, entitled "The Relations +of Internal Medicine to Psychiatry."</p></div> + +<a name='Footnote_5_5'></a><a href='#FNanchor_5_5'>[5]</a><div class='note'><p> <i>Cf.</i> Polon (A.) "The Relation of the General Practitioner +to the Neurotic Patient," Mental Hygiene, New York, 1920, IV, 670-678.</p></div> + +<a name='Footnote_6_6'></a><a href='#FNanchor_6_6'>[6]</a><div class='note'><p> <i>Cf.</i> Paton (S.) Human Behavior in Relation to the Study of +Educational, Social, and Ethical Problems. New York, 1921. Charles +Scribner's Sons, p. 465.</p></div> + +<a name='Footnote_7_7'></a><a href='#FNanchor_7_7'>[7]</a><div class='note'><p> <i>Cf.</i> Meyer (A.), "Progress in Teaching Psychiatry," +Journal A.M.A., Chicago, 1917, LXIX, 861-863; see also his, "Objective +Psychobiology, or Psychobiology with Subordination of the Medically +Useless Contrast of Medical and Physical," Journal A.M.A., Chicago, +1915, LXV, 860-863; and, "Aims and Meanings of Psychiatric Diagnosis," +Am. Journal of Insanity, Baltimore, 1917, LXXIV, 163-168.</p></div> + +<a name='Footnote_8_8'></a><a href='#FNanchor_8_8'>[8]</a><div class='note'><p> <i>Cf.</i> "The General Diagnostic Survey Made by the Internist +Cooperating with Groups of Medical and Surgical Specialists," New York +Medical Journal, 1918, 489,538,577; also, "The Rationale of Clinical +Diagnosis," Oxford Medicine, 1920, vol. I, 619-684; also, "Group +Diagnosis and Group Therapy," Journal Iowa State Medical Society, +113-121, Des Moines, 1921.</p></div> + +<a name='Footnote_9_9'></a><a href='#FNanchor_9_9'>[9]</a><div class='note'><p> <i>Cf.</i> Southard (E.E.), "Insanity Versus Mental Disease"; +the Duty of the General Practitioner in Psychiatric Diagnosis, Journal +American Medical Association, LXXI, 1259-1261, Chicago, 1918.</p></div> + +<a name='Footnote_10_10'></a><a href='#FNanchor_10_10'>[10]</a><div class='note'><p> <i>Cf.</i> Bailey (P.), "The Applicability of Findings of +Neuro-psychiatric Examinations in the Army to Civil Problems," Mental +Hygiene, New York, 1920, IV, 301; also "War and Mental Diseases," Am. J. +Pub. Health, IX, 1, Boston, 1919.</p></div> + +<a name='Footnote_11_11'></a><a href='#FNanchor_11_11'>[11]</a><div class='note'><p> <i>Cf.</i> Salmon (T.W.), "War Neuroses and Their Lesson," New +York Medical Journal, CIX, 993, 1919; also, "The Future of Psychiatry in +the Army," Mil. Surgeon, XLVII, 200, Washington, 1920. +</p><p> +<i>Cf.</i> "Origin, Objects, and Plans of the National Committee for Mental +Hygiene" (Publication No. 1, of the National Committee, New York City); +and, "Some Phases of the Mental Hygiene Movement and the Scope of the +Work of the National Committee for Mental Hygiene," in Trans., XV, +Internal. Congr. for Hygiene and Demography, III, 468-476, (1912), +Washington 1913.</p></div> + +<a name='Footnote_12_12'></a><a href='#FNanchor_12_12'>[12]</a><div class='note'><p> <i>Cf.</i> Russell (W.L.) "Community Responsibilities in the +Treatment of Mental Disorders." Canad. J. Ment. Hygiene, 1919, I 155—. +</p><p> +Hincks (C.M.), "Mental Hygiene and Departments of Health," Am. J. Pub. +Health, Boston, IX, 352, 1919; Haines (T.H.), "The Mental Hygiene +Requirements of a Community: Suggestions Based upon a Personal Survey," +Mental Hygiene, IV, 920-931, New York, 1920. +</p><p> +Beers (C.W.), "Organized Work in Mental Hygiene," Mental Hygiene, 567, +New York, 1917, also, Williams (F.E.), "Progress in Mental Hygiene," +Modern Hospital, XIV, 197, Chicago, 1920.</p></div> + + + +<hr style='width: 65%;' /> +<p><i>The Chairman</i>: We had hoped to receive to-day the greetings of our +sole elder sister among American institutions, the Pennsylvania +Hospital, of Philadelphia, which since its foundation in 1751 has +pursued a career much like our own, treating mental cases in the general +hospital from the very beginning, and since 1841 maintaining a separate +department for mental diseases in West Philadelphia. Dr. Owen Copp, the +masterly physician-in-chief and administrator of that department, was to +have been here, but unfortunately has been detained. Our morning +exercises having come to an end, Dr. Russell asks me to say that your +inspection of the occupational buildings and other departments of the +Hospital is cordially invited; a pageant illustrative of the origin and +aspirations of the Hospital will be given on the adjoining lawn; and +that after the pageant our guests are desired to return to the Assembly +Hall, where we shall have the privilege of listening to addresses by Dr. +Richard G. Rows, of London, and Dr. Pierre Janet, of Paris, who have +come across the Atlantic especially to take part in this anniversary +celebration.</p> + + + + +<hr style='width: 65%;' /> +<a name='GREETINGS'></a> +<h2>ADDRESS BY<br /> +DR. GEORGE D. STEWART</h2> + + <div class="figcenter" + style="width:100%;"> + + <a name="illus080"></a> + <a href="images/illus080.jpg"><img width="100%" + src="images/illus080_th.jpg" + alt="Bloomingdale Asylum, 1894" /> + </a><br /> + +BLOOMINGDALE ASYLUM<br /> + +As it appeared in 1894 when it was discontinued and replaced by +Bloomingdale Hospital at White Plains, New York. +</div> + + +<h3>AFTERNOON SESSION</h3> + +<p><i>The Chairman</i>: For the first seventy-five years of its existence the +New York Hospital was the nearest approach to an academy of medicine +that the city possessed. When the now famous New York Academy of +Medicine was established in 1847, a friendly and cordial co-operation +between the two institutions arose, and while the activity of this +co-operation is not as pronounced as it was, we still cherish in our +hearts a warm regard for that ancient ally in the cause of humanity. Its +President, Dr. George D. Stewart, the distinguished surgeon, has come to +extend the greetings of the medical profession of New York City.</p> + +<br /> +<a name='DR_STEWART'></a><h3>DR. STEWART</h3> + +<p>The emotions that attend the birthday celebrations of an individual are +often a mixture of joy and sadness, of laughter and of tears. In warm +and imaginative youth there is no sadness and there are no tears, +because that cognizance of the common end which is woven into the very +warp and woof of existence is then buried deep in our subconscious +natures, or if it impresses itself at all, is too volatile and fleeting +to be remembered. But as the years fall away and there is one less +spring to flower and green, the serious man "tangled for the present in +some parcels of fibrin, albumin, and phosphates" looks forward and +backward and takes in both this world and the next. In the case of +institutions, however, the sadness and the tears do not obtain—for a +century of anniversaries may merely mean dignified maturity, as in the +case of Bloomingdale, with no hint of the senility and decay that must +come to the individual who has lived so long. This institution was +founded one hundred years ago to-day; the parent, the New York Hospital, +has a longer history. Bloomingdale, as a separate and independent +concern, had its birthday a century ago.</p> + +<p>It is curious to let the mind travel back, and consider what was +happening about that time. Just two years before the news had flashed on +the philosophical and scientific world that Oersted, a Danish +philosopher, had caused a deflection of the magnetic needle by the +passage near it of an electric current. The relation between the two +forces was then and there confirmed by separate observations all over +the civilized world. This discovery probably created more interest at +that time than Professor Einstein's recent announcement which, if +accepted, may be so disturbing to the principia of Newton and to our +ideas of time and space. There can be no doubt that the practical +significance of Oersted's experiment was much more widely appreciated +than the theory of Einstein, for an understanding of the latter is +confined, we are told, to not many more men than was necessary to save +Sodom and Gomorrah. Its immense practical significance, however, could +have been foreseen by no man, no matter with what vision endowed. Just +two years prior to the founding of this institution the first steamboat +had crossed the Atlantic and in the same year that great conqueror, who +had so disturbed the peace of the world which was even then as now +slowly recovering from the ravages of war, breathed his last in Saint +Helena, yielding to death as utterly as the poorest hind.</p> + +<p>In 1815, Bedlam Hospital in South London was converted into an asylum +for the insane who were at the time called "lunatics." The name Bedlam +is a corruption of the Hebrew "Bethlehem"—meaning the House of +Bread—and while the name popularly came to signify a noisy place it was +the beginning of really scientific treatment for the tragically +afflicted insane. While the treatment of the insane in Europe was being +steadily raised to a higher plane of efficiency, America has also reason +to be proud of her record in this respect. During all the years that +have followed, Bloomingdale has been an important factor in the medical +world of New York.</p> + +<p>There are two phases of its existence which might be emphasized—first, +it was founded by physicians; even then and, of course, long before +doctors had proven that they were in the forefront in the promotion of +humanitarian activities. Medicine has always carried on its banners an +inscription to the Brotherhood of Man. It is worthy of note that when +Pinel and Tuke had begun to regard mental aberration as a disease and to +provide scientific hospital treatment therefor, American physicians, +prepared by study and experimentation, were ready to accept and apply +the new teachings.</p> + +<p>A second phase of great importance is that institutions like +Bloomingdale have promoted the study of psychology far more than any +other factor, particularly because in them the personality stripped of +some of its intricacies, the diseased personality, permits analysis, +which the normal complex has so long defied. That it is high time that +mankind was undertaking this knowledge of himself is particularly +emphasized by the unrest and aberrance of human behavior now startling +and disturbing the whole world. If mankind does not take up this self +study as Trotter has said, Nature may tire of her experiment man, that +complex multicellular gregarious animal who is unable to protect himself +even from a simple unicellular organism, and may sweep him from her +work-table to make room for one more effort of her tireless and patient +curiosity. Psychology should be taught to every doctor and to every +lettered man.</p> + +<p>Digressing for a moment, to every one capable of understanding it, there +should be imparted a knowledge of that simple economic law announced +from the Garden of Eden after the grounds had been cleared and the gates +closed: "By the sweat of thy brow thou shalt earn thy bread." The +economic phase indeed constitutes a highly important aspect of modern +psychology, for abnormal elements are antisocial, and from pickpockets +to anarchists flourish on the soil of pauperism. The key-note of the +future is responsibility. To the educated and enlightened man who still +asks, "Am I my brother's keeper?" Cain has bequeathed a drop of his +fratricidal blood; and he who spurns to do his share of the world's +work, electing instead to fall a burden upon the community, deserves the +fate of the barren fig-tree.</p> + +<p>However, amidst the social unrest, buffeted and perplexed by the cross +currents of our time, we should not be pessimistic but should look +forward with courage, parting reluctantly with whatever of good the past +contained and living hopefully in the present. As Ellis says: "The +present is in every age merely the shifting point at which past and +future meet, and we can have no quarrel with either. There can be no +world without traditions; neither can there be any life without +movement. As Heraclitus knew at the outset of modern philosophy, we +cannot bathe twice in the same stream, though as we know to-day, the +stream still flows in an unending circle. There is never a moment when +the new dawn is not breaking over the earth, and never a moment when the +sunset ceases to die. It is well to greet serenely even the first +glimmer of the dawn when we see it, not hastening toward it with undue +speed, nor leaving the sunset without gratitude for the dying light +that once was dawn."</p> + +<p>So to-day I bring to you from the New York Academy of Medicine +felicitations on your one hundredth anniversary and greetings to your +guests who have come from all over the world to join in your birthday +celebration.</p> + + + +<hr style='width: 65%;' /> +<a name='BIOLOGICAL'></a> +<h2>ADDRESS BY<br /> +DR. RICHARD G. ROWS</h2> +<br /> + +<p><i>The Chairman</i>: Besides the Royal Charter, the New York Hospital is +indebted to Great Britain for invaluable encouragement and financial aid +in our natal struggle in Colonial days. Dr. Rows has added charmingly to +that debt by journeying from London to take part in these exercises. His +subject will be, +<span class="smcap"> +"The Biological Significance of Mental Illness." +</span> +</p> + +<p>As Director of the British Neurological Hospital for Disabled Soldiers +and Sailors, at Tooting, he is giving the community and the medical +world the benefit of his rich professional experience in the trying +years of war as well as in peace, and gaining fresh laurels as he +marches, like Wordsworth's warrior, "from well to better, daily +self-surpast."</p> + +<br /> +<a name='DR_ROWS'></a><h3>DR. ROWS</h3> + +<p>I must first express to you my keen appreciation of the high honor you +have conferred on me by inviting me to come from England to address you +on the occasion of the centenary celebration of the opening of this +Hospital.</p> + +<p>It is perhaps difficult for us to realize what resistances lay in the +way of reform at that time, resistances in the form of long-established +but somewhat limited views as to the nature of mental illnesses, as to +whether the sufferer was not reaping what he had sown in angering the +supreme powers and in making himself a fit habitation for demons to +dwell in; in the form of a lack of appreciation of the need of sympathy +for those who, while in a disturbed state, offended against the social +organism or in the form of an exaggerated fear which compelled the +adoption of vigorous methods of protecting the social organism against +those who exhibited such anti-social tendencies. The men and women of +the different countries of the world who recognized this and made it the +chief of their life's duties to spread a wider view of such conditions +and to insist that the unfortunate people should be regarded and +treated as fellow human beings will ever command our admiration.</p> + +<p>By the courtesy of Dr. Russell I have had an opportunity of seeing the +pamphlet in which are recorded the efforts of Mr. Thomas Eddy in the +year 1815 to move his colleagues to consider this matter.<a name='FNanchor_13_13'></a><a href='#Footnote_13_13'><sup>[13]</sup></a> The result +of those efforts was the establishment of an institution on Bloomingdale +Road.</p> + +<p>Various changes followed until we arrived at the Bloomingdale Hospital +of to-day with its large and trained staff of medical officers, who, +while still recognizing the difficulties of the task, are imbued with a +hope of success which has arisen on a basis of wider knowledge, but +which was unknown to many of their predecessors. To have the opportunity +of joining with you in celebrating the big advance made a hundred years +ago, of exchanging ideas with you with regard to the difficulties which +still confront us, whether in America or in England, and which demand a +united effort on the part of all who are interested in the scientific +investigation of the subject, cannot fail to afford one the liveliest +satisfaction.</p> + +<p>In the brief history of the Hospital prepared by Dr. Russell we find the +recommendations of another reformer, Dr. Earle, who in 1848 was +evidently still not satisfied with the treatment provided for the +sufferers from mental illness.</p> + +<p>Both Mr. Eddy and Dr. Earle were influenced by their observation that +even in those suffering from mania much of their behavior could not be +described as irrational. If you will allow me I will quote a sentence of +two from each.</p> + +<p>Mr. Eddy said: "It is to be observed that in most cases of insanity, +from whatever cause it may have arisen or to whatever it may have +proceeded, the patient possesses small remains of ratiocination and +self-command; and although they cannot be made sensible of the +irrationality of their conduct or opinions, yet they are generally aware +of those particulars for which the world considers them proper objects +of confinement." With reference to treatment Dr. Earle said: "The +primary object is to treat patients, so far as their condition will +possibly permit, as if they were still in the enjoyment of the healthy +exercise of their mental faculties."</p> + +<p>To superficial observation these suggestions might well have appeared as +the phantasies of dreamers and perhaps at the present day their +importance is not always fully appreciated. Recent advances in +knowledge, however, have led us beyond the moral treatment recommended a +hundred years ago and have enabled us to see that a more important +truth underlay these suggestions.</p> + +<p>We are all familiar with the frequent difficulty we encounter in our +efforts to discover the actual mental disturbance which is supposed to +exist in our patients. It is often a question of wit against wit as +between patient and doctor, and not infrequently a rational and +intelligent conversation may be maintained on an indifferent subject. +The fact too that the disturbance is so frequently only temporary +suggests that the loss of rational control is a less serious phenomenon +than was generally supposed and we know that the control can be +frequently restored by a period of rest or by a helpful stimulus. Quite +recently a patient who in hospital had been confused, undisciplined, +abusive, and threatening, was removed to a house of detention. The shock +of finding himself, as he said, amongst a lot of lunatics, led him to +face reality from a fresh point of view. He admitted that it had taught +him a lesson and when he revisited the hospital, if not entirely +grateful to us for the experience, he evidently bore no ill will.</p> + +<p>But not only is it necessary to recognize what rational powers remain to +the patient, we must also inquire how much in their disturbed mental +activity can be considered a rational reaction to the stimuli which +have operated, and still may be operating, on them.</p> + +<p>In connection with this I would suggest that there are two aspects to be +considered. First, what is the standard according to which we are to +judge them? Secondly, to what extent are the reactions of the patient +abnormal in kind to the driving stimulus? They may perhaps be reckoned +abnormal in degree, but, to what extent, if at all, are they abnormal in +kind?</p> + +<p>It may be readily admitted that the behavior of those suffering from +mental illness offends against conventional usages and is anti-social. +It must also be recognized that amongst human beings living in +aggregates some conventional usages must be evolved and insisted on in +order to insure the greatest good of the greatest number. These usages +are regarded not merely as protective measures for the body corporate, +but they are also supposed to indicate a beneficial standard for the +individual. But such a standard being adopted, observation is liable to +be limited so much to results without sufficient attention being given +to the causes which had led to those results.</p> + +<p>By the recent advances in scientific knowledge and in methods of +investigation we have been led to see that the conditions under +consideration cannot be understood without a study of the mechanisms on +which mental activity depends and without discovering the psychic and +physical causes, arising from without and from within, which have +disturbed the function of these mechanisms. We have learned that these +illnesses do not arise from one cause alone and that they are the result +of influences to which we all may be subject to some degree.</p> + +<p>The originator of these modern methods, Prof. Freud, has stimulated us +to regard the ordinary symptoms of mental illnesses as directing posts +indicating lines to be investigated, and he and others have suggested +various methods which may usefully be employed.</p> + +<p>It is essential that we carefully distinguish what are primary from what +are secondary symptoms. Two thousand years ago a +<ins class="correction" +title="Transcriber's note: original reads 'physican'">physician</ins>, +Areteus, pointed out +that mania frequently commenced as melancholia, and he drew attention to +the extreme frequency of an initial depression in cases of mental +illnesses. But he did not offer any explanation of this initial state.</p> + +<p>Such an initial state may perhaps be, to a certain extent, understood if +we assume that the first evidences of mental disturbance consist in some +difficulty in carrying out ordinary mental processes, some difficulty in +exercise of the function of perceiving, thinking, feeling, judging, and +acting, and that any disturbance of the harmonious activity of these +functions must give rise to an emotional condition of anxiety and +depression. Some such disharmony will, by adequate investigation, be +found in a large number of cases to exist in the early states of the +illness and will be appreciated by the patient before there occur any +obvious signs, any outward manifestations of disability.</p> + +<p>But in any disharmony which may occur it must be recognized that the +mental mechanisms affected are those with which the patient was +originally endowed, which he has gradually trained throughout his past +experience and which he has employed more or less successfully up to the +time the illness commenced. There is no new mechanism introduced to +produce a mental illness, but a putting out of gear of those common to +the race and their disturbance is the result of the action of influences +which may befall any one of us, unbearable ideas with which some intense +emotional state is intimately associated. The normal function of these +mechanisms, simple at first and remaining fundamentally unaltered, +although possibly much modified gradually by added experiences from +within and without, depends on the maintenance of a harmonious balance +between stimuli received and emotional reaction and motor response to +those stimuli so that the feeling of well-being may arise.</p> + +<p>If from any cause there occurs a failure to appreciate the stimuli +clearly, if the emotional reactivity be disturbed, if the sense of value +becomes biassed in one direction or another so that the response is +recognized by the patient as abnormal there will result a disharmony and +a feeling of ill-being of the organism. Under these conditions the +processes of facilitation along certain definite lines and inhibition of +all other lines—processes which are essential to clear +consciousness—will become difficult or perhaps impossible and a mental +illness will develop. In the slighter degrees the disharmony may be +known to the patient without there being any outward manifestation to +betray the conflict going on within. In the severe degrees the mental +activity of the patient may be under the control of some dominant +emotional state so that it may be impossible for him to adapt himself to +his surroundings in a normal manner although his behavior may not appear +so irrational when we know the stimuli affecting him. Within these +extremes we discover all degrees of disturbance, and all varieties of +signs and symptoms may be encountered.</p> + +<p>But the signs which become obvious to superficial observation are, to a +large extent, secondary products. The primary symptoms are felt by the +patient as a disturbance of the capacity to perceive, to think, to feel, +to judge, and to act, and with these disabilities there will be +associated a certain degree of confusion and anxiety which cannot fail +to appear as the result of such alterations of function.</p> + +<p>The obvious signs may represent merely a more intense degree of the +primary affection, disturbed capacity together with some confusion and +anxiety; or they may represent efforts on the part of the patient to +overcome or to escape from the disturbance or to explain it to himself. +And now the total lack of knowledge of the processes on which mental +activity depends, the altered standard of judgment due to some degree of +dissociation, and the necessity of obtaining relief in some way or other +will have much to do with determining the character of the symptoms with +which we are all familiar. So many factors are concerned in the +production of these secondary characters that it is difficult to assign +to the symptoms their true value or to decide whether they possess much +value at all with regard to the fundamental disturbance which +constituted the primary illness. So often they appear to be mere +rationalizations, mere false judgments on the part of the patient; they +thus form subjects for investigation rather than fundamental +constituents of the illness.</p> + +<p>We, therefore, must not accept the outward and visible signs at their +face value but attempt to discover what past experiences in the life of +the patient have led to such disturbance of function, to such a change +in his mental activity.</p> + +<p>It will possibly be of some assistance to provide one or two examples in +order to demonstrate the importance of the past experiences as agents +capable of producing such alterations.</p> + +<p>The first case will illustrate the results produced by the development +of a dominant emotional tendency during early childhood. The patient up +to the fifth year of her life had been an ordinary, normal child, +attached to her mother, fond of her nurse, interested in her toys. +During the next two years she endured much bad treatment at the hands of +a new nurse which produced such an impression on her that she felt she +was a changed child. This nurse, described to me by the patient as a +handsome woman, having met the inevitable man, used frequently to meet +him clandestinely. The child was neglected, was sometimes left alone, on +one occasion in a graveyard, but she was forbidden to mention the +subject to any one under threats of being carried away by a "bogey-man." +The child became very frightened by this, to such an extent that one +night she had a severe nightmare in which a "bogey-man" came to carry +her away. At the end of two years a profound change had taken place in +her which she now describes thus: "I was a changed child; I was +separated from my mother and could no longer confide in her nor did I +wish to do things for her as I had done before; I could not enjoy my +toys; I had no confidence in myself; I was not like other children." And +from that time on, as girl and as woman, she has never felt that she has +been like others of her sex. Such a condition, being started and +confined by repetition, interfered with her free development and it was +remarkable how many incidents occurred in her life to confirm the +disability, but the germ of her serious breakdown thirty years later was +laid in her fifth and sixth years.</p> + +<p>The second case is that of a patient who, as a child, had some +convulsive attacks. She was therefore considered delicate and was +thoroughly spoiled. When nearly thirty she lived through a sexual +experience which caused extreme anxiety; she broke down and was admitted +to an asylum. After admission she looked across the dormitory and saw a +head appearing above the bed-clothes, the hair of which had been cut +short for hygienic reasons. With a memory of her sexual indiscretion +still vivid in her mind she jumped to the conclusion that she was in a +place where men and women were crowded together in the same room. She +got out of bed, refused to return to it, fought against the nurses and +was transferred to a single room, with the mattress on the floor and the +window shuttered. She wondered where she was and came to the conclusion +that she was in a horse-box. Then arose a feeling of terror that she +would be at the disposal of the grooms when they returned from work. The +sound of heavy footsteps of the patients passing along the corridor to +the tea-room suggested that the grooms were returning and that her room +would soon be invaded. The feeling of terror increased and she tried to +hide in the corner, drawing the mattress and clothes over her. And so +on.</p> + +<p>Months later when I had my first interview with her, her sole remark +during the hour was "How can I speak in a place like this?" This was +repeated almost without intermission throughout the hour. It formed a +good example of the origin of the process of perseveration, a process +frequently adopted by the patient to guard against the disclosure of a +troublesome secret.</p> + +<p>If we attempt to trace out some of the mechanisms employed in these two +cases we shall see that in response to definite stimuli each reacted in +a manner which cannot be considered abnormal in kind. It was normal +reaction for the child to be distressed at being separated from her +mother in such a way, to be frightened by being left in the graveyard +alone, or at the threat of her being carried away by a "bogey-man" if +she dared to mention anything of the clandestine meetings to her mother. +It was not very abnormal that after her sexual experience the other +patient while still in a confused state caused by the intense emotional +condition of anxiety, should, on seeing a head with the hair cropped +short, jump to the conclusion that there was a man in a bed in the same +ward with herself, or that she should feel frightened and wish to leave +the room.</p> + +<p>The mental activity in each case depended on mental content, that is, +memory of past experiences with their intense emotional states which +acted as the driving force and also made the recall of the experience go +extremely easy. The further developments after being placed in the +single room with mattresses on the floor and the window shuttered were +rationalizations also based on mental content, <i>i.e.</i>, on the memory of +rooms somewhat similar to that in which she found herself and of the use +of such rooms. It is interesting to note also in the first case that in +her wildest delirium during an acute attack she lived through episodes +of her past life. One example may be given. In the course of her +delirium she thought that a "blackbird" had flown to her, touched her +left wrist and taken away all her vitality. This depended on an +experience of her going to Germany when a girl and meeting a young +German officer whom she did not like. A few years later she went to +Germany and met the officer again. Without going into full details I may +say that on one occasion when walking with him he seized her left wrist +with his right hand and attempted to kiss her; she struggled fiercely +and ran from him. Here we see that not only is her delirium based on a +past experience, but that the whole memory is symbolized in the +"blackbird" which was the emblem of the German nation in whose army the +officer was then serving. Connected with this there was also another +unpleasant episode which dated from her tenth year. Much of her delirium +was worked out in such a way that most of the details could be traced +back to experiences of her earlier life.</p> + +<p>But however absurd her statement regarding her being touched by a +"blackbird" and all her vitality removed might appear to superficial +observation, it must be admitted that when we know the mental content of +that patient, we cannot but see that at any rate it was not so +irrational. And not only was this recognized by the doctor, but, and +this is much more important, by the patient herself.</p> + +<p>It is, therefore, the mental content which must be discovered before +doctor or patient can understand the disability and before any common +ground between the two can be found. And when the mental content is +known it will be easy to recognize the affective condition of the +patient to be a normal response. It will also be specific and if intense +will dominate the patient. "Why is it I can never feel joy as I used to +do?" was the pathetic inquiry of the patient dominated by a feeling of +misery and fear. Was it not for the reason that being dominated by +misery and fear, joy could find no place? The emotion of misery because +of its intensity could more or less inhibit the feeling of joy, but joy +could not inhibit the misery.</p> + +<p>No repetition of the memory of the unpleasant experiences with their +associated emotion of misery and fear led to the formation of a habit of +mind and feeling. And when once such a habit of mind is established it +is remarkable by what a host of stimuli received in ordinary daily life +the cause of the disturbance can be recalled.</p> + +<p>This question of stimuli deserves further notice. It is not so difficult +to realize the mechanism by which a stimulus which clearly crosses the +threshold of consciousness can lead to a given reaction. But it is +perhaps difficult to imagine how so many stimuli which do not cross the +threshold of consciousness or which, if they do, are not recognized by +the patient at the time as having any reference whatever to the special +memory can yet set the memory mechanism into action. The result may not +be seen till after the relapse of some considerable period of time, as +in the case of a man who for years had been disturbed by terrific +nightmares, based on the idea of snakes coming out of the ground and +attacking him. He complained one day that he was much worse, that three +nights before he had had the worst nightmare of his life. On being +questioned as to what could have suggested snakes to him he could not +tell. A few minutes later he said: "I think I know the cause now. I +spent the evening before I had that nightmare with a sergeant who had +returned from the service in India." This friend amongst other things +had mentioned that whenever they were about to bivouac they had to +search every hole under a stone and every tuft of grass to see that +there were no snakes there. This, which had been received as an ordinary +item of information, had been the stimulus which had set his memory +mechanism into action and the nightmare between two and three o'clock in +the morning had been the result.</p> + +<p>The result in many instances is evidenced by an emotional state alone +and the actual memory of the original experience may not come into +consciousness. Many examples of this might be given. The sound of a +trolley wheel on a tram wire in one case gave rise to terror instead of +its normal reaction, viz., that of satisfaction at getting to the +destination quickly and without effort. This terror was produced because +the sound on the wire resembled that of a shell which came over, blew in +a dugout, killed three men, and buried the patient. No memory of this +incident came into consciousness, only a terror similar to that +experienced at the time of the original incident was experienced. Or, +the time four o'clock in the afternoon could act as a stimulus to arouse +an emotional state of misery similar to that experienced at the same +time of day during an illness some years previously. Or, passing the +house of a doctor when on a bus could produce a sudden outburst of +anxiety, giddiness, and confusion; the patient had been taken into that +house at the time of an epileptic attack. Or, showing photographs of the +front could lead to an epileptic attack which was based on the memory of +the time when the patient was wounded in the head; this has occurred on +two separate occasions separated by an interval of some months. Or, +noticing a familiar critical tone in a remark made at a dinner-table +could lead to an acute change of feeling so that the subject who, +before dinner, had felt she would like to play a new composition on the +piano so as to obtain the opinion of the guest who had exhibited the +critical tone, after dinner felt incapable of doing so. Her feelings had +been hurt on many former occasions by critical remarks made by him in +that tone. The critical remarks were not called to memory but there +arose the feeling that under no circumstances could she play that piece +to him.</p> + +<p>Of special importance also are the experiences of childhood. An unhappy +home or unjust treatment as a child may warp the development of the +personality, lead to a lack of self-confidence, to the predominance of +one emotional tendency, and so prevent that balanced equilibrium which +will allow a rapid and suitable emotional reaction such as we may +consider normal. This may lead to a failure of development or a loss of +the sense of value, because the existence of one dominating emotional +tendency so often produces a prejudiced view which may render a just +appreciation of our general experience almost impossible and may +seriously disturb our mental activity.</p> + +<p>And if, as Bianchi suggests, all mental activity depends on a series of +reflex actions, or, as Bechterew and Pavlov have insisted, a series of +conditioned reflexes becomes established, it will assist us to +understand how such stimuli can give rise to mental disturbances, to +mental illnesses. We shall see that there may be something of real +importance underlying such remarks as "I felt I was a changed child"; or +"It is because of the treatment I received from my father that I have +taken life so seriously." "I have never imagined that what I went +through in my childhood could so influence me now"; or "I have never had +confidence in myself and often when I have appeared vivacious and +interested I have had an awful feeling of incapacity and dread within +myself."</p> + +<p>The outward and obvious manifestations, therefore, are not necessarily a +true index of our mental and emotional conditions. This is true of all +mental illnesses, even the most severe.</p> + +<p>One patient who had been in an asylum more than ten years illustrated +this in a most striking manner. His outward manifestations led one to +feel that he thought he possessed the institution in which he was +confined and also the surrounding property and that the authorities were +a set of usurpers and thieves who kept him incarcerated in order that +they might enjoy what was really his money and his property. On one +occasion I said to him, "George, what is that incident in your life +which you cannot forget and which has troubled you so seriously?" The +reply was a flood of abuse. I put the question to him several times +without getting any further answer, but when I came to leave the ward, +George came up behind me and whispered over my shoulder, "Who told you +about it?" No abuse, no shouting as usually occurred, but a whisper, +"Who told you about it?" Was not George running away from a memory with +its emotion which was unbearable to an idea which allowed him to be +angry with others instead of with himself? Many examples of this might +be given and really might be found by us in our own experience. It is +the mental content which is important, a mental content which can be +recalled by various stimuli, and which will be more persistently with us +the more intense is the emotion associated with it.</p> + +<p>But the basis of the condition is not completely understood when we have +apparently arrived at the psychic cause of the disturbance.</p> + +<p>It is recognized that the emotions are accompanied by physical changes, +changes which are specific for each emotional state. The physical +changes which normally are associated with fear differ from those of joy +or anger. This has been appreciated for a long time but recent +researches have recalled other reactions to us. Reactions in the +internal glands which further knowledge will probably prove to be of +great importance, in fact to form an integral part of the sum of +activities, connect with mental processes. The secretions of the glands +exert an influence on the sensibility and reaction of the organs +connected with psychic phenomena and their functions themselves are +affected by reactions occurring in the nervous system. Revival of a +memory may thus affect the functions of these glands, and the changes +produced in them may react on the sensibility and reactivity of the +nervous mechanisms. If this be so, it will be evident that the organism +works as a whole, that a disturbance of one organ may interfere with the +function of another and that in the repetition of all these influences +we may find an explanation of the chronicity of many of these illnesses. +A study of the activities and interactivities of all the organs of the +body is therefore essential and must be made before we shall understand +the biological significance of mental illness.</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_13_13'></a><a href='#FNanchor_13_13'>[13]</a> +<div class='note'><p> See <a href="#APPENDIX_III">Appendix III</a>, p. 200.</p></div> + + + +<hr style='width: 65%;' /> +<a name='RELATION'></a><h2>ADDRESS BY<br /> +DR. PIERRE JANET</h2> +<br /> + +<p><i>The Chairman</i>: Our country may be hesitating a little—I hope it will +not be for long—in joining a league of nations to prevent war, but +there can be no doubt of our immediate readiness to co-operate +internationally to prevent and reduce disease. Our distinguished guest +from gallant France, Dr. Pierre Janet, professor in the College of +France, evidently feels confident of our sympathy and willingness to +collaborate in this latter respect, for he has ventured across the +ocean, with Madame Janet, in response to our urgent invitation. His +introduction to an audience of American psychiatrists would be quite out +of place. His fame as a pathological psychologist has circled the world. +In the science of medicine he is a modern Titan. For to-day's address he +has chosen as a subject, +<span class="smcap"> +"The Relation of the Neuroses to the Psychoses." +</span> +</p> + +<br /> +<a name='DR_JANET'></a> +<h3>DR. JANET</h3> + +<p>Mr. President, my dear colleagues, ladies, and gentlemen: The Americans +and the French have met on the battle-fields and they have faced +together the same sufferings for the defense of their common ideal of +civilization and liberty; it is right that they should meet likewise +where Science stands up for the protection of health and human reason, +and that they should celebrate together the Festivals of Peace. The +President and the organizers of this Congress have greatly honored me in +asking me to represent France at the celebration of the centenary of the +Bloomingdale Hospital; but above all they have procured me a great +pleasure in offering me the opportunity of coming again to this +beautiful land, of meeting once more friends who had welcomed us kindly +in former days; our old friends of past happy days who have become still +dearer to us since they have been tried during the bad days.</p> + +<p>Allow me, in the first place, to present you with the best wishes of the +French Government who have had the kindness to charge me to interpret +the sentiments of sympathy which they feel for all manifestations +tending to render the relations that unite our two countries closer and +more fruitful. The Academy of Moral and Political Sciences has equally +charged me to assure you that it is happy to be represented by one of +its members at the commemoration of the centenary of Bloomingdale +Hospital that has so brilliantly and generously continued the tradition +of Pinel and Esquirol. The Academy takes a lively interest in the +psychological and moral studies of this Congress that seek the cure of +diseases of the mind and the lessening of mental disorders. The +Medico-Psychological Society, the Society of Neurology, the Society of +Psychology, the Society of Psychiatry of Paris are happy to take part in +these festivals and are desirous of associating still more closely their +work to that of the scientific societies of the United States.</p> + +<p>The celebration of the centenary of a lunatic asylum gives birth to-day +to a national festivity in which all civilized nations participate. This +is a fact that would have well astonished the first founders of lunatic +asylums, the Pinels, the Esquirols, the William Tukes, and the first +organizers of Bloomingdale. The public opinion respecting the diseases +of the mind, the care to be given to lunatics, is vastly different to +what it was a century ago. This transformation of ideas has taken place, +in a great measure, as a result of the studies devoted to neuroses and +that is why it seems to me interesting to present you to-day with a few +reflections on the connections which unite neuroses and psychoses; for +it is the discovery of these connections that has shown to the man sound +in mind, or who imagines himself to be so, how near he always was to +being a lunatic and how wise it was always to consider the lunatic as a +brother.</p> + +<p>Formerly a lunatic was considered as a separate being, quite apart from +other members of society. The old prejudices which banished the patient +from the tribe as a useless and dangerous individual had diminished no +doubt with respect to the diseases of the body, which were more and more +regarded as frequent and natural things to which each of us might be +exposed. But these prejudices persisted with respect to some sexual +diseases that were still considered ignominious and chiefly with respect +to diseases of the mind. No doubt some intelligent and charitable +physicians took interest in the lunatic, endeavored to spare him many +sufferings, to defend him, to take care of him. But the people feared +the lunatic and despised him as if he had been struck by some +malediction which excommunicated him. I have seen lately a patient's +parents upset with emotion, as they had to cross the gardens of the +asylum to visit their daughter, at the single thought that they might +catch sight of a lunatic. This individual, in fact, had lost in the eyes +of the public the particular quality of man, reason, which, it appears, +distinguishes us from beasts; he seemed still living, but he was morally +dead; he was no longer a man.</p> + +<p>No doubt it was a dreadful misfortune when some member of a family +became insane, but this terrible calamity, which nothing could make one +anticipate or avoid, was happily exceptional, like thunderbolts. The +other men and even the members of the family presented nothing similar +and regarded themselves with pride as very different to this wretched +being transformed into a beast. This victim of heavenly curse was +pitied, settled comfortably in a nice pavilion at Bloomingdale and never +more spoken of. People still preserve on this point ideas similar to +those they had formerly about tuberculosis, known only under the form of +terrible but exceptional pulmonary consumption. Now it has at last been +understood that there are slight tuberculoses, curable, but tremendously +frequent. It will be the same with mental disorders; one day it will be +recognized that under diverse forms, more or less attenuated they exist +to-day on all sides, among a crowd of individuals that one does not feel +inclined to consider as insane.</p> + +<p>Little by little, in fact, men have had to state with astonishment that +all lunatics were not at Bloomingdale. Outside the hospital, in the +family of the unfortunate lunatic, or even in other groups, one observed +strange complaints, moanings relating to lesions which were not visible, +inability to move notwithstanding the apparent integrity of the organs, +contradictory and incomprehensible affirmations; in one word, abnormal +behaviors, very different to normal behaviors, regularized by the laws +and by reason.</p> + +<p>What was the meaning of these queer behaviors? At first they were very +badly understood; they were supposed to have some connection with being +possessed (with the devil), with miasmata, vapors, unlikely +perturbations of the body and animal spirits that circulated in the +nerves. One spoke, as did still Prof. Pomme at the end of the eighteenth +century, "of the shrivelling up of the nerves."<a name='FNanchor_14_14'></a><a href='#Footnote_14_14'><sup>[14]</sup></a> But above all, one +preserved the conviction that these queer disorders were very different +to the mental disorders of lunacy. These peculiar individuals had, it +was said, all their reason; they remained capable of understanding their +fellow creatures and of being understood by them; they were not to be +expelled from society like the poor lunatics; therefore their illness +should be anything but the mental disorders of lunacy.</p> + +<p>Physicians, as it is just, watched their patients and only confirmed +their opinion by fine scientific theories. They christened these new +disorders by the name of neuroses, reserving the name of psychoses for +the mental disorders of lunatics. During the whole of the nineteenth +century the radical division of neuroses and psychoses was accepted as a +dogma; on the one side, one described epilepsies, hysterias, +neurasthenias; on the other, one studied manias, melancholias, +paranoias, dementias, without preoccupying oneself in the least with the +connections those very ill-defined disorders might have the ones with +the others. This division was accentuated by the organization of the +studies and the treatment of the patients. The houses that received the +neurotic patients and the insane were absolutely distinct. The +physicians who attended the ones and the others were different, and even +supplied by different competitions. In France, even now, the recruiting +of asylum house pupils and hospital house pupils, the recruiting of +asylum doctors and that of hospital doctors, give an opportunity for +different competitions. One might almost say that these two categories +of house pupils and doctors have quite a different education. The result +was that the examination of the patients, the study thereof, and even +their treatment, were for the most part often conceived in quite a +different manner. For example, neuroses were studied publicly; the +examination was on elementary sensibilities, the movements of the limbs, +and especially reflexes; the insane were more closely examined in the +mental point of view, in conversations held with them by the physician +alone. Their arguments, their ideas were noted more than their +elementary movements. Strange to say, just when the psycho-therapeutic +treatments by reasoning and moralizing with the patients were being +developed, they stood out the contrary of what one might have +supposed—that this treatment should be applied to neurotic patients +alone. It was admitted that lunatics were probably not able to feel this +moral and rational influence; they were treated by isolation, +shower-baths, and purgatives.</p> + +<p>This complete division did not fail to bring about singular and +unfortunate consequences. In a hospital such as La Salpetrière the tic +sufferers, the impulsive, those beset with obsessions, the hysterical +with fits and delirium were placed near the organic hemiplegics and the +tabetics who did not resemble them in the least, and completely +separated from the melancholic, the confused, the systematical raving, +notwithstanding evident analogies. If Charcot who, moreover, has brought +about so much progress in these studies, committed some serious errors +in the interpretation of certain phenomena of hysteria, is it not +greatly due to his having studied these neurotic patients with the +neurology methods without ever applying psychiatry methods? Is it not +strange to refuse psychological treatment precisely to those who present +psychological disorders to the highest degree, and to place the insane +who thinks and suffers altogether outside of psychology?</p> + +<p>In fine, this distinction between the neurotic sufferer and the mental +sufferer was mostly arbitrary and depended more than was believed on the +patient's social position and fortune. Important and rich families could +not be resigned to see one of their members blemished by the name of +lunatic, and the physician very often qualified him as neurasthenic to +please the family. A few years ago this distinction of the patients and +of the physicians gave rise to a very amusing controversy in the +newspapers. The professor of the clinic for diseases of the nervous +system asserted that neurotic sufferers should be patients set apart for +neurologist physicians alone, whereas the alienist should content +himself with real lunatics. The professor of the clinic for mental +diseases protested with much wit and claimed the right of attending +equally the neurotic patients. All this proved a great confusion in the +ideas.</p> + +<p>Notwithstanding these difficulties, Charcot's studies themselves on +hysterical accidents began to make people's minds uneasy and to modify +conceptions of neuroses. They showed that neurotic sufferers presented +disorders in their thoughts, that many of their accidents, in all +appearance physical, were in connection with ideas, with the +<i>conviction</i> of paralysis, of illness, with the remembrance of such or +such an event which had determined some great emotion. Without doubt, +this interpretation of hysteria, which I have myself contributed to +extend, must never be exaggerated, and it must not be concluded from +this that every neuropathic accident always and solely depends on some +remembrance or some emotion. In my opinion, this is only exact in a very +limited number of cases; and then it only explains the particular form +of such or such an accident and not the entire disease. Without doubt it +seems to me exaggerated to-day to see in neuroses those psychological +disorders alone, whereas the disorders of the circulation, the disorders +of internal secretions, the disorders of the functions of the +sympathetic which will be spoken of just here must also have a great +importance. But, however, this observation proved very useful at that +moment. A remembrance, an emotion, are evidently psychological +phenomena, and to connect neuropathic disorders with facts of the kind +is to include the study thereof with that of mental disorders. At this +time, in fact, they began to repeat on all sides a notion that had +already been indicated in a more vague manner; it is that neuroses were +at the root, were in reality diseases of the mind.</p> + +<p>If such is the case, what becomes of the classical distinction between +neuroses and psychoses? No one can deny that the latter are above all +diseases of the mind and we have here to review the reasons which seem +to justify their complete separation. Will it be said that with +psychoses the disorders of the mind last very much longer? But some +patients who enter the asylum with a certificate of insanity are very +frequently cured in a few months and some neuropathic disorders may last +years. I could name you patients who since thirty years keep the same +obsessions, and who at the age of fifty still ask themselves questions +upon their pact with heaven, as they did at the age of twenty. Shall we +speak of the consciousness the patient has of his state? But this +consciousness may be complete in certain melancholies and very +incomplete in certain impulsions.</p> + +<p>Is it necessary to insist on the presence or absence of anatomical +lesions which one tries to ascertain at the post-mortem examination? +Shall we say with Sandras, Axenfeld, Huchard, Hack, Tuke, that neuroses +are diseases without lesions? One finds lesions in general paralysis +which is ranged with insanity and we find some also in epilepsies which +are considered as neuroses; one no more finds lesions in melancholic +conditions than in conditions of obsessions. Besides, as I have often +repeated, this absence of lesions is of no importance; it is quite in +keeping with our ignorance. Every one admits that organic alterations +more or less momentary, but actually not suspected, must exist in +neuroses as in other diseases. Neuroses as well as psychoses are much +more likely to be diseases with unknown lesions than diseases without +lesions, and it is impossible to take this characteristic into account +to distinguish the ones from the others.</p> + +<p>In reality, the notion of lunatic has lost its former superstitious +signification and it has taken no precise medical signification. That +word is now the term of the police language. It indicates only an +embarrassment felt by the police before certain persons' conduct. When +an individual shows himself to be dangerous for others, the public +administration has the habit of defending us against him by the system +of threats and punishments. As a rule, in fact, when a normal mind is in +question, threats can stop him before the execution of crime, and +punishments, when crime has been committed, can prevent him from +beginning again; that is the psychological fact which has given birth to +the idea of responsibility. But in certain disorders it becomes evident +that neither threats nor punishments have a favorable effect, for the +individual seems to have lost the phenomenon of responsibility. When an +individual shows himself to be dangerous for others or for himself, and +that he has lost his responsibility, we can no longer employ the +ordinary means of defense; we are obliged to defend ourselves against +him, and defend him against himself by special means which it is useless +to apply to other men; we are obliged to modify legal conduct toward +him. All disorders of the mind oblige us to modify our social conduct +toward the patient, but only in a few cases are we obliged to modify at +the same time our legal conduct; and these are the sort of cases that +constitute lunacy.</p> + +<p>This important difference in the police point of view is of no great +importance in the psychological point of view nor in the medical point +of view, for the danger created by the patient is extremely varied. It +is impossible to say that such or such a disorder defined by medicine +leaves always the patient inoffensive and that such another always +renders him dangerous. There are melancholies, general paralytics, +insane who are inoffensive, and whom one should not call lunatics; there +are impulsive psychasthenics who are dangerous and whom one shall have +to call lunatics. The danger created by a patient depends a great deal +more upon the social circumstances in which he lives than upon the +nature of his psychological disorders. If he is rich, if he has no need +to earn his living, if he is surrounded by devoted watchfulness, if he +lives in the country, if his surroundings are simple, the very serious +mental disorders he may have do not constitute a danger. If he is poor, +if he has to earn his living, if he lives alone in a large town and his +position is delicate and complex, the same mental disorders, exactly at +the same degree, will soon constitute a danger, and the physician will +be forced to place him in an asylum with a good certificate. This is a +practical distinction, necessary for order in towns, which has no +importance in the point of view of medical science.<a name='FNanchor_15_15'></a><a href='#Footnote_15_15'><sup>[15]</sup></a> If we put these +accidental and slightly important differences on one side, we certainly +see a common ground in neuroses and psychoses. The question is always an +alteration in the conduct, and, above all, in the social conduct, an +alteration which tends, if I am not mistaken, toward the same part of +the conduct.</p> + +<p>The conduct of living beings is a special form of reaction by which the +living being adapts himself to the society to which he belongs. The +primitive adaptations of life are characterized by the organization of +internal physiological functions. Later on they consist in external +reactions, in displacements, in uniform movements of the body which +either keep him from or draw him near to the surrounding bodies. The +first of these movements are the reflex movements, then are developed +those combinations of movements which we called perceptive or suspensive +actions in keeping with perceptions. Later came the social acts, the +elementary intellectual acts which gave birth to language, the primitive +voluntary acts, the immediate beliefs, then the reflected acts, the +rational acts, experimental, etc. As I said formerly, there is, in each +function, quite a superior part which consists in its adaptation to the +particular circumstance existing at the present moment. The function of +alimentation, for instance, has to exercise itself at this moment when I +am to take aliments on this table in the midst of new people, that is to +say, among whom I have not yet found myself in this circumstance, +wearing a special dress and submitting my body and my mind to very +particular social rites. In reality it is nevertheless the function of +alimentation, but it must be noted that the act of dining, when wearing +a dress suit and talking to a neighbor, is not quite the same +physiological phenomenon as the simple secretion of the pancreas. +Certain patients lose only the superior part of this function of +alimentation which consists in eating in society, in eating in new and +complex circumstances, in eating while being conscious of what one is +doing, and in submitting to rules. Although the physiologist does not +imagine that these functions are connected with the exercise of sexual +functions in humanity, there is a pathology of the betrothal and of the +wedding-tour.</p> + +<p>It is just on this superior part of the functions, on their adaptation +to present circumstances, that the disorders of conduct +(self-government) which occupy us to-day bear. If one is willing to +understand by the word "evolution" the fact that a living being is +continually transforming himself to adapt himself to new circumstances, +neuroses and psychoses are disorders or halts in the evolution of +functions, in the development of their highest and latest part.<a name='FNanchor_16_16'></a><a href='#Footnote_16_16'><sup>[16]</sup></a></p> + +<p>This halt in evolution can be connected with different physiological +causes, hereditary weaknesses of origin, infections, intoxications, +disorders of internal secretions, disorders of the sympathetic system. +These diverse etiologies will most likely be of use later to distinguish +between forms of these diseases; but to-day the common character of +neuroses and psychoses is that this diminution of vitality bears upon +the highest functions of self-government.</p> + +<p>Whatever be the disorders you may consider, aboulias, hysterical +accidents, psychasthenic obsessions, periodical depressions, +melancholics, systematized deliriums, asthenic insanity, you will always +find a number of facts resulting from this general perturbation.</p> + +<p>In plenty of cases, the acts, far from being diminished, appear +exaggerated; the patient moves about a great deal, he accomplishes acts +of defense, of escape, of attack, he speaks enormously, he seems to +evoke many remembrances and combine all sorts of stories during +interminable reveries. But pray examine the value and the level of all +these acts; they are mere gestures, shocks of limbs, laughter, sobs, +reactions simply reflex or perceptive, in connection with immediate +stimulation, with inhibition, without choice, without adaptation by +reflection. The thoughts that fill these ruminations are childish and +stupid, just as the acts are vulgar and awkward; there is a manifest +return to childhood and barbarism. The behavior of the agitated +individual is well below that which he should show normally. It is easy +to explain these facts in the language we have adopted. The agitation +consists in an activity, more less complete, in inferior tendencies very +much below those the subject should normally utilize.</p> + +<p>It is that in reality the agitation never exists alone, it is +accompanied by another very important phenomenon which it dissimulates +sometimes, I mean the depression characterized by the diminution or the +disappearance of superior actions, appertaining to the highest level of +our hierarchy. It is always observed that with these patients certain +actions have disappeared, that certain acts executed formerly with +rapidity and facility can no longer be accomplished. The patients seem +to have lost their delicacy of feeling, their altruism, their +intelligent critique. The stopping of tendencies by stimulation, the +transformation of tendencies into ideas, the deliberation, the endeavor, +the reflection; in one word, both the moral effort and the call upon +reserves for executing painful acts are suppressed. There exists visibly +a lowering of level, and it is right to say that these patients are +below themselves.</p> + +<p>The two phenomena, agitation and depression, are almost always +associated in neuroses as well as in psychoses. It is likely that their +union depends upon some very general law, relating to the exhaustion of +psychological forces. It is probable that the superior phenomena exact +under a form of concentration, of particular tension, much more power +than acts of an inferior order, although the latter seem more violent +and more noisy. "When the force primitively destined to be spent for the +production of a certain superior phenomenon has become impossible, +derivations happen, that is to say, that this force is spent in +producing other useless and especially inferior phenomena."<a name='FNanchor_17_17'></a><a href='#Footnote_17_17'><sup>[17]</sup></a></p> + +<p>A very great number of phenomena observed in neuroses and psychoses are +in connection with depression and agitation. Convulsive attacks, diverse +fits of agitation, prove to us that before the fit there existed +disproportion between the quantity and the tension of the psychological +forces, and that the spending of forces during the fit re-establishes +the equilibrium. But at the same time, after this spending, one observes +a notable lowering of the mental level, a real psycholepsy. It is very +likely that studies of this kind will produce some day the key of the +epilepsy problem, for vertigos and certain epileptic fits are certainly +phenomena of relaxation, the meaning of which we do not comprehend +because we do not study sufficiently the state of psychological tension +before and after the accidents.</p> + +<p>The difficulty of accomplishing superior acts, the exhaustion resulting +from their accomplishment, renders them fearful to the patient who has +the fear, the phobia of these acts, just as he has the terror of that +depression which gives the feeling of the diminution of life. The +shrinking of activity and conscience, phobias, negativisms, generally +take their starting point in this fear of exhaustion caused by some +difficult action. In other cases the patient feels incapable of +accomplishing correctly the reflected acts necessary to social and moral +life, and feeling no longer protected by reflection, he is afraid of +willing or believing something, as one is afraid of walking in a +dangerous path, when one cannot see. The vertigo of life produces itself +like the vertigo of heights, when one is not sure of oneself.</p> + +<p>Depressed patients have felt, wrongly or rightly, a certain excitation +after a certain action. Through some curious mechanism, certain acts, +instead of exhausting them, have raised their psychological tension. The +need, the desire to raise themselves inspires them with the wish to +renew such acts, and we behold the impulsions to absorb poisons, +impulsions to command, to theft, to aggression, to extraordinary acts, +varied impulsions which play a great part in psychoses as well as in +neuroses.</p> + +<p>I shall not insist any more on a very interesting phenomenon in +connection with the oscillations of the mind and which still plays a +great part in these diseases. I am speaking of the change of feeling +which may accompany the same action in the course of the oscillations of +the mind. At the level with the reflected action, more or less complete, +the thought of an action which appears important and of which one often +thinks, determines interrogations, doubts, scruples. If the individual +descends one degree, if he becomes quite incapable of reflecting and +therefore of doubting, the same action he continues to think about may +present itself under the form of an impulsion more or less irresistible.</p> + +<p>There are patients who in the first stage have the fear and horror of +committing an act and who in the second stage are driven to accomplish +it. In other cases a subject may make use of an action as a means of +exciting and raising himself; he seeks it, and the thought of this +action is accompanied by love and desire. Let him become depressed and +he will no longer be able to accomplish this same action without +exhausting himself; he is then reduced to dread it and take an aversion +to it. That which was an object of love becomes an object of hatred. +Thence these turnings of mind that are so often to be observed in the +course of neuroses and psychoses. In a score of my observations the +frenzy of persecution and hatred presents itself as an evolution of +those obsessions of love and domination.</p> + +<p>These are very curious facts that one observes in the oscillations of +the mind, in particular when the psychasthenic depression becomes more +serious and transforms itself in psychasthenic delirium, which is more +frequent than one generally imagines. As a rule the properly so-called +psychasthenic has only disorders of the reflection; he doubts but he +does not rave. But under different influences, his depression may +augment, and when he drops below reflection he has no longer the doubts, +the hesitations, he no longer shows manias of love and of direction, he +transforms his obsessions into deliriums and often his loves into +hatreds.</p> + +<p>These are a few examples of the perturbations of conduct common to +neurotic sufferers and the diseased in mind. One perceives that the same +laws relating to the diminution of force and the lowering of the +psychological tension intervene in the same way with the one as with the +others. The distinctions, which have been established for social reasons +and practical conveniences, no longer exist when one tries to find, by +analysis of the symptoms, the nature of neuroses and psychoses.</p> + +<p>The latter reflection shows us, however, that in certain cases, at +least, there is a certain difference in degree between neuroses and +psychoses. The evolution of the human mind has been formed by degrees, +by successive stages, and we possess in ourselves a series of superposed +layers which correspond to diverse stages of the psychological +development; when our forces diminish we lose successively these diverse +layers commencing with the highest. It is the superior floors of the +buildings that are reached first by the bombardments of the war and the +cellars are not destroyed at first; they acquire even more importance, +as people are beginning to inhabit them. Well, according as the +depression descends more or less deeply, the disorders which result from +the loss of the superior functions and the exaggerated action of the +inferior ones become more and more serious and are appreciated +differently. The superior psychological functions are, in my opinion, +experimental tendencies and rational tendencies. They are tendencies to +special actions in which man takes in account remembrances of former +acts and of their results, in which he enforces on himself by a special +effort obedience to logical and moral laws. A little fatigue and a +slight degree of exhaustion are sufficient for such an action to become +difficult and impossible to prolong for a long time. Furthermore, the +disorders of the experimental conduct or of the rational conduct are +very frequent. These disorders only reach the superior actions which are +not absolutely necessary to the conservation of social order. They can +be easily repaired by inferior acts: if the man does not obey pure moral +principles, at least he can conduct himself in appearance in an +analogous manner through fear of the prison. Also, these disorders of +the superior functions are considered as slight; they are called errors, +or faults, and it is admitted that the subjects remain normal beings.</p> + +<p>At the other extremity of the hierarchical series of tendencies the acts +are simply reflex. When the disease descends to this level, when the +elementary acts can no longer be executed correctly, we do not hesitate +either, and we consider these disorders (related with known lesions) as +organic diseases of the nervous system. But between these two terms we +note disorders in behavior which are more difficult to interpret. These +disorders are too grave and too difficult to modify by our usual +processes of education and punishment for us to consider them as mere +errors or as moral faults; they are variable; they are not accompanied +by actually visible lesions and we have trouble in classing them among +the acknowledged deteriorations of the organism. There is the province +of neuroses and psychoses, intermedium between that of rational errors +and that of organic diseases of the nervous system. It corresponds to +the disorders of medium psychological functions, to the group of these +operations which establish a union more or less solid between the +language and the movements of limbs and which give birth to our wills +and beliefs.</p> + +<p>Can one establish, in this group, a distinction between neuroses and +psychoses that rests on some more precise notion and that is not limited +to distinguishing them in a legal point of view? A more profound +knowledge of the mechanisms of the will and belief would perhaps permit +us to do so. We are capable of wills and beliefs of a superior order +when we reach decision after reflection. The operation of reflection +which hinders tendencies and maintains them in the shape of ideas, which +compares ideas and which only decides after this deliberation, +constitutes the highest form of the medium operations of the human mind. +Lower, still, there exists will and belief, but they are formed without +reflection, without stoppage of ideas, without deliberation; they are +the result of an immediate assent which transforms verbal formulas into +wills and beliefs as soon as they strike the attention, as soon as they +are accompanied by a powerful sentiment. The immediate assent is the +inferior form of these tendencies.</p> + +<p>If one wished to establish a scientific distinction between neuroses and +psychoses, I should say, in a summary fashion, that in neuroses the +reflection alone is disturbed, that in psychoses the immediate assent +itself is affected. The shrinkage of the conscience, doubts, aboulias, +obsessions, scruples are always disorders of the reflected will and +belief. On the contrary, irresistible impulsions, deliriums, +indifferences which suppress desires and only allow elementary +agitations to subsist, show alterations in the immediate assent, in the +will, and the primitive belief and must be considered as psychoses. +Below could be placed the disorders of elementary intelligence, the +disorder of the perceptive and social functions which characterize the +mental deficiencies of imbeciles and idiots. One might also distinguish +these disorders according to the degree of depth the destruction of the +edifice has reached, according to the more or less distant state of +evolution to which the patient goes back. But these psychological +classifications are purely theoretical, and in practice many other +factors intervene which oblige us to consider such a patient as +incapable of doing any harm and such another as dangerous; this is the +only difference to-day between neuroses and psychoses. Later on, without +doubt, we shall be able to substitute for these simply symptomatical and +psychological diagnostics, some etiological and physiological +diagnostics. We shall be able from the very outset to recognize that a +disorder, in all appearance slight and which is not deeply set, presents +a bad prognosis, and we shall be able to foresee a serious and deep +psychosis in the future. To-day, without doubt, one can often +distinguish from the outset the future general paralytic from the simple +neurasthenic. But in the actual state of science this ability to +distinguish is not frequent and the future evolution of a depressed +state can scarcely be foreseen with precision.</p> + +<p>Certain individuals pass in a few years from psychasthenic depression +with doubts and obsessions to psychasthenic deliriums with stubbornness +and negativism, then to asthenic insanity with irremediable and complete +want of power. Is it necessary to say that we made a mistake in our +diagnostic and that from the first demential psychosis should have been +recognized? I am not convinced of this: these diseases, excepting a few +cases with rapid evolution, are not characterized from the outset. +Without doubt we must note that these depressions which disturb the +reflective tendencies of young patients in full period of formation, +are dangerous and can bring on still deeper depressions of the +psychological tension. But that evolution is rarely fatal; it can very +often be checked, and it seems to me fair to preserve the distinction +between neuroses and psychoses considered as different degrees of +psychological decadence.</p> + +<p>Neuroses are, therefore, the intermedium between the errors and the +faults which appeared to us almost normal, and alienation which seemed +exceptional and distant from us. The first appearances of that +depression which in a continuous manner descends to alienation are to be +found already in the disorders of character which seemed to be quite +insignificant. The miser, the misanthrope, the hypocrite are described +by the writer before they are claimed by the physician. A great number +of neuropathic disorders which I have described are related to the +popular type of mother-in-law. This type is not necessarily that of a +woman whose daughter has married, but the type of a depressed woman of +about fifty, aboulic, discontented with herself and others, domineering, +and jealous, because she suffers from the mania of being loved though +she is incapable of acquiring any one's affection. All exhaustions, all +moral failings have the closest connection with neuroses and psychoses.</p> + +<p>These reflections prove to us that the alienist physician should +interest himself more and more in the treatment of neuroses even slight, +to rectifying the disorders of temper, to the education of the young, to +the direction of the moral hygiene of his country. On many of these +points America leads the way; your works of social hygiene, the good +battle you are righting against alcoholism, are examples for us. You are +the new world, younger, not rendered so inactive by secular habits. You +can act more easily than we. We may have the advantage, in the old +world, of the experience of old people and the habit of observation, but +we are slack in reform and action. "If youth had experience and old age +ability," says one of our proverbs. We must remain united and join your +strength to our experience for the greater progress of the studies which +are dear to us and for the greater good benefit of our two countries.</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_14_14'></a><a href='#FNanchor_14_14'>[14]</a><div class='note'><p> <i>Cf.</i> Janet, P., Les névroses, 1909, p. 370.</p></div> + +<a name='Footnote_15_15'></a><a href='#FNanchor_15_15'>[15]</a><div class='note'><p> <i>Cf.</i> Les Médications psychologiques, 1920, I, p. 112.</p></div> + +<a name='Footnote_16_16'></a><a href='#FNanchor_16_16'>[16]</a><div class='note'><p> "Les Nevroses," 1909, p. 384.</p></div> + +<a name='Footnote_17_17'></a><a href='#FNanchor_17_17'>[17]</a><div class='note'><p> <i>Cf.</i> Janet, P., "Obsessions et Psychestenic," 1903, vol. +I, p. 997.</p></div> + + + +<hr style='width: 65%;' /> +<a name='MEDICAL'></a><h2>ADDRESS BY<br /> +DR. WILLIAM L. RUSSELL</h2> + + <div class="figcenter" + style="width:100%;"> + + <a name="illus148"></a> + <a href="images/illus148.jpg"><img width="100%" + src="images/illus148_th.jpg" + alt="Bloomingdale Hospital, 1921" /> + </a><br /> + +BLOOMINGDALE HOSPITAL, WHITE PLAINS, NEW YORK, 1921 +</div> + + +<p><i>The Chairman</i>: The year 1921 is rich in anniversaries for the New +York Hospital. Next October we plan to celebrate the one hundred and +fiftieth anniversary of the granting of our charter. To-day we are +occupied with the Bloomingdale Centenary. A fortnight ago the +twenty-fifth annual graduating exercises of our Training School for +Nurses were held in this room. This year also marks the decennial of Dr. +Russell's term of office as Medical Superintendent. When his devoted +predecessor, Dr. Samuel B. Lyon, asked in 1911 to be relieved from +active duty and became our first Medical Superintendent Emeritus, we +were most fortunate in securing as his successor Dr. Russell. Coming to +this institution after a broad psychiatric and administrative +experience, he has taken up our special problems with deep insight and +gratifying success. He has selected for his subject this afternoon +<span class="smcap"> +"The Medical Development of Bloomingdale Hospital." +</span> +No one can speak with +greater authority on a theme of which it may be said <i>quorum magna +pars</i>—fortunately not only <i>fuit</i>—but <i>est</i> and <i>erit</i> as well.</p> + +<br /> +<a name='DR_RUSSELL'></a> +<h3>DR. RUSSELL</h3> + +<p>The object of this celebration is not merely to glorify the past and +least of all is it to laud the present. What we hope from it is that it +will establish a milestone, not only to mark the progress thus far made +but to point the way to a path of greater usefulness. The advances in +medical science and practice and in the specialty of psychiatry during +the past hundred years fill one with wonder and hope. It is worth while +to review them merely to obtain this help. The outlook for the century +to come is, however, so far as can be anticipated, still brighter.</p> + +<p>To review the past is, at a time like this, not unprofitable. It may +prevent us, in our zeal for the new, from discarding what is valuable in +the old, and from overvaluing some things which may have outlived their +usefulness. We must be careful that we do not fall into errors similar +to those from which the medical profession was rescued by the movement +of which Bloomingdale Asylum was an offspring. It should be recalled +that the establishment of the asylum was due to the initiative of the +Governors of the New York Hospital, especially Mr. Eddy, rather than to +the active interest and direction of physicians. The object of the +establishment was, according to Mr. Eddy, to afford an opportunity of +ascertaining how far insanity may be relieved by moral treatment alone, +which, he says, "it is believed, will, in many instances, be more +effective in controlling the maniacs than medical treatment." The moral +management he referred to, though advocated by Pinel and a few others, +some of whom were benevolent and intelligent laymen, had not been +accepted by physicians as a distinct form of medical treatment. Few +physicians of the period had accepted management of the mind as +described and practised by Pinel as being a distinct medical procedure, +as having the same value in overcoming mental disorders as the drastic +medical remedies which they were accustomed to employ, or as having any +exclusive healing power. This is clearly shown by the case records of +the mental department of the New York Hospital which have been preserved +since 1817, and of those of Bloomingdale Asylum for some years after its +opening in 1821. It is plainly set forth in Dr. Rush's book on diseases +of the mind, which was first published in 1810 and again in a fourth +edition in 1830. Rush was physician to the Pennsylvania Hospital and his +book was the principal, if not the only, one of the period by an +American author. American physicians like their European brothers, had, +as Pinel observes, "allowed themselves to be confined within the fairy +circle of antiphlogisticism, and by that means to be deviated from the +more important management of the mind." Rush believed that madness was a +disease of the blood-vessels of the brain of the same nature as fever, +of which it was a chronic form. "There is," he says, "not a single +symptom that takes place in an ordinary fever, except a hot skin, that +does not occur in an acute attack of madness." He found in his autopsy +observations confirmation of this view and concludes that "madness is to +phrenitis what pulmonary consumption is to pneumony, that is, a chronic +state of an acute disease." The reason for believing that madness was a +disease of the blood-vessels, which seemed to him most conclusive, was +"from the remedies which most speedily and certainly cure it being +exactly the same as those which cure fever or disease in the +blood-vessels from other causes and in other parts of the body." The +treatment he recommended and which was generally employed was copious +blood-letting, blisters, purges, emetics, and other severe depleting +measures. When Bloomingdale Asylum was established, therefore, the +provision for moral treatment did not contemplate that this should be +applied by the physician or that he should have full control of the +resources by means of which it could be applied. The records do not +indicate that either the physicians or the Governors realized that this +might be necessary or advantageous. The present system of administration +in which the chief physician is also the chief executive officer of the +institution was a result of an evolution which took many years to reach +its full consummation.</p> + +<p>Pinel, many years before Bloomingdale Asylum was opened, had shown by +the most careful observation and practice that the management and +discipline of the hospital was a most powerful agent in the treatment of +the patients. The manner in which he was led to this conclusion is a +remarkable example of the scientific method. When he became physician to +the Bicetre he found that the methods of classification and treatment +recommended in the books seemed to be inadequate, and, desiring further +information, he says: "I resolved to examine myself the facts which were +presented to my attention; and, forgetting the empty honor of my titular +distinction as a physician, I viewed the scene that opened to me with +the eye of common sense and unprejudiced observation.... From systems of +nosology, I had little assistance to expect; since the arbitrary +distributions of Sauvages and Cullen were better calculated to impress +the conviction of their insufficiency than to simplify my labor. I, +therefore, resolved to adopt that method of investigation which has +invariably succeeded in all the departments of natural history, viz., to +notice successively every fact, without any other object than that of +collecting materials for future use; and to endeavor, as far as +possible, to divest myself of the influence, both of my own +prepossessions and the authority of others. With this view, I first of +all took a general statement of the symptoms of my patients. To +ascertain their characteristic peculiarities, the above survey was +followed by cautious and repeated examinations into the condition of +individuals. All our new cases were entered at great length upon the +journals of the house." Having thus studied carefully the course of the +disease in a number of patients who were subjected only to the guidance +and control made possible by the management of the hospital under the +direction of a remarkably highly qualified Governor, it came to him with +the force of a new discovery that this man who was not a physician was +doing more for the patients than he was, and that insanity was curable +in many instances by mildness of treatment and attention to the state of +mind exclusively. "I saw with wonder," he says, "the resources of nature +when left to herself, or skilfully assisted in her efforts. My faith in +pharmaceutic preparations was gradually lessened, and my scepticism +went at length so far as to induce me never to have recourse to them, +until moral remedies had completely failed." So convinced did he become +of the significance and importance of the management and discipline of +the hospital in the treatment of the patients, that, when a few years +later, he wrote his "Treatise on Insanity," he states that one of the +objects of his writing it was, "to furnish precise rules for the +internal police and management of charitable establishments and asylums; +to urge the necessity of providing for the insulation of the different +classes of patients at houses intended for their confinement; and to +place first, in point of consequence, the duties of a humane and +enlightened superintendency and the maintenance of order in the services +of the Hospitals."</p> + +<p>Pinel's views had apparently not been fully understood or adopted by the +physicians of America at the time Bloomingdale Asylum was planned and +established. Dr. Rush did not mention him in his book, and Mr. Eddy, in +his communication to the Governors of the New York Hospital, referred +only to the writings of Drs. Creighton, Arnold, and Rush and the Account +of the York Retreat by Samuel Tuke.</p> + +<p>When Bloomingdale Asylum was opened, the form of organization +introduced was that under which the department at the New York Hospital +had been conducted. Mr. Laban Gardner was made Superintendent or Warden +with two men and three women keepers to aid him in the control and +management of the seventy-five patients. There was an Attending +Physician who visited once a week and a Resident Physician, neither of +whom received salaries. There is nothing in the records to indicate that +in the beginning, the Governors of the Hospital looked upon the moral +treatment of the patients, which was the object for which the +institution was established, as the task of the Physicians. The aim was +to furnish employment, diversion, discipline, and social enjoyment, +without much attempt at precision or close medical direction and +control. For a time the results were considered to be satisfactory. In +1824, however, a joint Committee of the Board reported that they were +impressed by the necessity of improving the moral treatment, and +recommended that two discreet persons be appointed to take charge of +such of the patients as might from time to time be in a condition to be +amused or employed on the farm or in walking exercises in the open or in +classes to be designated by the Resident Physician "with," however, "the +approbation of the Superintendent," who you will recall was not a +physician. These patients were, the report recommends, to be +particularly under the charge of the Resident Physician when thus +employed or amused "out of the Asylum." At this time, the Attending and +Resident Physicians were placed on a small salary, and the Resident +Physician was instructed to "devote a greater portion of his time and +attention to the moral part of the establishment and to communicate to +the Committee such improvements as his experience shall suggest to be +useful and necessary in carrying into more complete effect the system of +moral treatment and to report from time to time to the Committee the +effect of the measure adopted." This seems to have been the beginning of +a realization that the moral management of the patients was inseparable +from medical treatment and must necessarily be the task of the +physician. Seven years after this, in 1831, the Committee found it +advisable to spread upon the minutes an "interpretation and +regulations," relating to the Superintendent and Matron of the Asylum +and to the Asylum physicians, to the effect that the Committee +understood that the regulations "placed the moral treatment on the +physician alone, under the direction of the Asylum Committee, and that +the responsibility remains with him alone, that this treatment commenced +with the reception of the patient, the ward where he shall be placed, +his exercises, amusement, admission of friends, the time of discharge +from the house.... And that all orders to nurses and keepers which the +physicians may think necessary to carry these orders into effect <i>shall +be communicated through the Superintendent</i>" (or Warden). In 1832, the +Resident Physician, Dr. James Macdonald, who had just returned from +Europe after having spent a year in visiting the institutions for mental +disorders there, made a report in which he rather significantly referred +to the impracticability of making a sharp distinction between the +medical and moral treatment of the patients, it being difficult to say +where the one ended and the other began, or to put one into successful +operation without bringing in the other. At this time the position of +Attending Physician was abolished and the Resident Physician was made +the Chief Medical Officer of the Asylum. It was not until 1837 that an +amendment to the by-laws regulating the powers of the physician and the +Warden was adopted which gave to the physician the power of appointing +and discharging at pleasure all the attendants on the patients, while to +the Warden was reserved the power of appointing and dismissing all other +employees. Fourteen years had thus elapsed since the opening of the +Asylum before the physician was given control of even the nursing +service. The first Annual Report of the Resident Physician of the +Asylum to be published appeared in 1842. In this, Dr. William Wilson +makes a general statement in regard to the beneficial effects of the +moral as well as the medical treatment pursued in the institution, and +refers particularly to occupations, exercise in the open air, amusement, +religious services, and he asks that a workshop be erected for the men. +It is evident that by this time the authority of the physician in the +management of the institution had been extended and it is perhaps +significant that in his report of the following year Dr. Wilson refers +to a plan for distribution of food which had been evolved in +co-operation with the Warden. Under the direction of Dr. Pliny Earle, +who was appointed physician to the Asylum in 1844, treatment directed to +the mind was further elaborated and systematized, and the place of the +physician in the management of the hospital was more firmly established.</p> + +<p>This brief survey indicates how, in the development of the work of the +institution, it required years of practical experience to show to the +Governors that, in order to secure for the patients the treatment which +the Asylum had been established to furnish, it was necessary to extend +the powers and duties of the physician so that he could control and +direct the internal management and discipline, and all the resources +for social as well as individual treatment. This extension was continued +until finally the present form of organization was adopted in which the +chief physician is also the chief executive officer of the institution. +This was, however, not fully accomplished until 1877. It is now +universally recognized that the physician must be the supreme head of +the organization, and all American institutions and most, if not all, of +those in other countries are now similarly organized.</p> + +<p>In the early development of Bloomingdale Asylum, this extension of the +influence and authority of the physician is the outstanding medical +fact. It did away with division of responsibility and removed from +discussion the question of moral as distinct from medical treatment. +Thereafter a harmonious and effective application of all the resources +of the institution to the problems of the patients became more easily +and certainly possible. Since then, the resources for treatment directed +to the mind have been developed as steadily and fully as those required +for the treatment of physical conditions. The use of the organized +agencies which were regarded by the founders as the main reliance in +moral treatment, namely occupations, physical exercises and games, +diversion, social contacts, and enjoyment, and management of behavior +has been greatly extended, and specialized departments have been +created for their application with system and growing precision. Great +advances have also been made in the methods of examining the minds of +the patients and of determining the mental factors in their disorders +and the means of restoring their capacity for adjustment to healthy +thinking and acting. Psychiatry has been furnished with a body of +well-arranged facts, and with a technic which is not inferior in system +and precision to that of many other branches of medicine. In the study +and management of the minds of the patients the physician is thus +enabled to apply himself to the task as he does to any other medical +problem.</p> + +<p>The advances in general medical science and practice have also +necessitated great elaboration of the resources for the study and +treatment of the physical condition of the patients. Instruments of +precision, laboratories, x-ray departments, dental and surgical +operating rooms, massage and hydrotherapy departments, facilities for +eye, throat, nose, and ear examinations and treatment, and all the other +means of determining disease processes and applying proper treatment +have been supplied and the methods and standards of modern clinical +medicine and surgery are utilized. It can now be clearly seen that it is +necessary to direct attention to the whole personality of the patient, +including his original physical and mental constitution, the physical as +well as the mental factors which may be operating to produce his +disorder, and the environmental conditions to which he has been and may +again be exposed. In the treatment of mental disorders it is necessary +to beware of what Pinel found to be the fault of the physicians and +medical authors of his time, who he says were more concerned with the +recommendation of a favorite remedy than with the natural history of the +disease, "as if," he says, "the treatment of every disease without +accurate knowledge of its symptoms involved in it neither danger nor +uncertainty," and he quotes the following maxim of Dr. Gault: "We cannot +cure diseases by the resources of art, if not previously acquainted with +their terminations, when left to the unassisted efforts of nature." +Exclusive attention to the physical condition and factors, or to the +mental condition and factors, or concentration on one theory or one form +of treatment to the exclusion of all others is sure to lead to neglect +of that careful general inquiry into the whole personality of the +patient, into the conditions out of which his disorder arose, and into +all the manageable factors in the situation which is so essential to +intelligent and effective treatment. Notwithstanding the great benefit +which has been derived from physical measures in the study and +treatment of mental disorders, and the well-founded hopes of greater +advances in this direction, the main task still continues to be what +Pinel calls the management of the mind. Experience and increasing +knowledge show that this is a task which can only be successfully +performed by the physician and by means of organized resources which are +under medical direction and control. The hospital for mental disorders +furnishes the means of providing social as well as individual treatment. +It is a medical mechanism and for its proper management and use it is +required of physicians that they accept the burden of much executive +work and give their attention to many subjects and activities that may +interfere seriously with what they have been taught to regard as more +strictly professional interests. Like Pinel, one must be willing to +forget the empty honor of one's titular distinction as a physician, and +do whatever may be necessary to make the institution a truly medical +agency for the healing of the sick. Considerable progress has been made +in developing executive assistants to relieve the physicians of much of +the administrative work which requires little or no medical supervision +and direction. Special provision for the training of such executives +has, however, received insufficient attention. This question might, with +great advantage, be taken up by the hospitals and colleges. Nothing +would add more to the quality of the service which the hospitals render +than to supplement the work of the physicians by that of well educated +and highly trained executive assistants who would themselves find an +extremely interesting and productive field for their efforts.</p> + +<p>A period has now been reached in this field of work when what amounts to +a movement not inferior in significance and importance to that of a +hundred years ago, seems to be in active operation. The character and +scope of this movement and the lines of its progress have, to some +extent, been indicated in the illuminating formulations which have been +presented here to-day. The medical study and treatment of the mind is no +longer so exclusively confined within the walls of institutions nor to +the type or degree of disorder which necessitates compulsory seclusion. +Psychiatry is extending out from the institutions into the communities +by means of out-patient clinics and social workers, through newly +created organized agencies, through informed individuals, physicians, +nurses, and lay workers, and through the general spread of psychiatric +knowledge. This process is being expedited by the efforts of organized +bodies such as the National and State Committees and Societies for +Mental Hygiene, and the public is rapidly learning what can properly be +expected of institutions, officials, physicians, nurses, and other +responsible individuals in whom special knowledge and ability are +supposed to be found. As in the prevention of tuberculosis, so, in the +prevention of mental disorders, the informed public is likely to start a +campaign which the medical profession may have to make haste to follow +in order to maintain its needed leadership. Although much is yet +required to improve the facilities necessary in carrying on the present +work, it seems to us that at such a time a further extension of the +activities of an institution such as Bloomingdale Hospital may be +necessary to enable it to fulfil its possibilities for greater +usefulness. To extend the work our experience indicates that a +department in the city at the General Hospital would be of great +advantage. During the past few years the oversight of discharged +patients has grown to such an extent that it seems as though some +organized method of carrying it on may soon become necessary. This and +out-patient work generally could be best attended to in a city +department. Much emergency work and preliminary observation and the +treatment of certain types of cases now frequently subjected to +unfortunate delays, neglect, and unskilful treatment would also be thus +provided for. It can be seen too that developments in construction and +organization which would furnish organized treatment for types of +disorders which are not so incapacitating as the pronounced psychoses +might be of advantage in the treatment of both adults and children. The +property on which the Hospital is located is large enough to permit of +further extensions and developments which could be as closely connected +with, or as widely separated and distinguished from, the present +provision as circumstances required. In this way much needed provision +for the treatment of persons suffering from the psychoneuroses and minor +psychoses could be furnished. Better provision for a further period of +readjustment after a patient is ready to leave the Hospital but not yet +ready to face the risk of ordinary conditions in the community is a felt +want. A group of supervised homes or an occupational colony might best +serve this purpose. The more extensive use of the Hospital as a teaching +centre is also a subject for consideration. A School for Nurses is now +conducted, and much instruction is given in the occupational +departments. More, however, could be done, especially in medical +teaching, which could be best carried on in a department in the city and +would tend to advance the standard of medical service throughout the +Hospital.</p> + +<p>The lines of further development are, perhaps, not yet perfectly clear +in all directions. It seems certain, however, that they will lead toward +a broader field of usefulness, in which the hospital will be regarded as +a responsible agency for dealing with psychiatric problems in the +community which it serves and will take part with other agencies in +extending psychiatric knowledge and in applying it to prevention, and to +the management of mental disorders as an individual and social problem +beyond the walls of the institution. We hope that this meeting will +prove a real starting point for this development. We are greatly +indebted to those who have taken part in it both as speakers and as +audience. We are especially indebted to those who came across the sea to +be with us. It is peculiarly fitting that representatives of France and +of England should have been here, for to Pinel, the Frenchman, and to +Tuke, the Englishman, are due more than to any others whose names we +know the foundations of the modern institutional treatment of mental +disorders.</p> + + + +<hr style='width: 65%;' /> +<p><i>The Chairman:</i> This, ladies and gentlemen, concludes our exercises. As +the representative of the Governors, I find it quite impracticable, in +supplementing what Dr. Russell has just said, to express adequately our +admiration of and gratitude to these eminent scientists and apostles of +light for their presence here and for their inspiring addresses. These, +if I may be permitted to appraise them, seem to make a notable addition +to medical literature, and, with the permission of their authors, we +purpose, for our own gratification and for the benefit of the +profession, to have all of the addresses preserved in a volume recording +this centenary celebration. In due course a copy of this volume will be +sent to each of our guests. The celebration itself, I think you will all +agree with me, has been a moving one, with an underlying note of +philanthropic endeavor as high as the stars. You heard its refrain in +the pageant on the lawn this afternoon. As I have listened to-day to +these words of profound wisdom, uttered in so noble a spirit of human +ministry, my mind has gone back to the sentence from Cicero's plea for +Ligarius,<a name='FNanchor_18_18'></a><a href='#Footnote_18_18'><sup>[18]</sup></a> which formed the text for Dr. Samuel Bard's eloquent +appeal in 1769, mentioned this morning, for the establishment of the New +York Hospital, and which may be freely rendered, "In no act performed by +man does he approach so closely to the Gods as when he is restoring the +sick to the blessings of health." And surely when that restoration to +health consists in "razing out the written trouble of the brain" and +reviving in the patient the conscious exercise of divine reason, it is +difficult to imagine a more Godlike act.</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_18_18'></a><a href='#FNanchor_18_18'>[18]</a><div class='note'><p> Homines enim ad Deos nulla re proprius accedunt, quam +salutem hominibus dando.</p></div> + + + +<hr style='width: 65%;' /> +<a name='TABLEAU'></a><h2>THE TABLEAU-PAGEANT</h2> + + <div class="figcenter" + style="width:100%;"> + + <a name="illus172"></a> + <a href="images/illus172.jpg"><img width="100%" + src="images/illus172_th.jpg" + alt="The Tableau-Pageant" /> + </a><br /> +SCENE FROM THE TABLEAU PAGEANT PRESENTED ON THE GROUNDS +OF BLOOMINGDALE HOSPITAL, MAY 26, 1921 +</div> + + +<h3>SYNOPSIS</h3> + +<p>While the Symbolic Father Time bears witness, the Muse of History, as +the Narrator, after alluding to the remote past, briefly summarizes the +incidents leading up to the establishment of the Society of the New York +Hospital by Royal Charter in 1771. The succeeding scenes are +self-revealing. The familiar picture of Pinel at Salpetrière depicts +conditions in that period. Several portraits of personalities intimately +associated with the early history of Bloomingdale Hospital follow. +These, together with an episode from the life of Dorothy Dix, stimulate +our imagination with reference to the revival of interest in the care of +the mentally ill in the first half of the last century. The closing +scenes suggest the great advance which has taken place during the +century, and the part that work and play take to-day in re-establishing +and maintaining life's balances. Finally, in symbolic processional, +tribute is paid to Hygeia, the goddess of Health and Happiness.</p> +<br /> + +<h3>CHARACTERS AND SCENES IN TABLEAU-PAGEANT</h3> + +<div class='blkquot2'> +<table summary="Music: Orchestra" width="100%"> +<tr><td align="left">Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center>Overture</center> +<br /> + +<h4><i>Prologue</i></h4> +<div class='blkquot2'> +<table summary="Cast" width="100%"> +<tr><td>The Muse of History (Narrator)</td><td align="right">Adelyn Wesley</td></tr> +<tr><td>Spirit of the Past (Time)</td><td align="right">Dr. D. Austin Sniffen</td></tr> +<tr><td>Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center>"Amaryllis"</center> +<br /> +<h4><span class="smcap">Scene I</span></h4> +<h5>COURT OF KING GEORGE III.—GRANTING OF THE CHARTER</h5> + +<div class='blkquot2'>Characters:</div> +<div class='blkquot'> +<table summary="Characters" width="100%"> +<tr><td width="66%">King George III</td><td>Court Ladies</td></tr> +<tr><td>Queen Charlotte</td><td>Emissaries</td></tr> +<tr><td>Prince of Wales</td><td>Cherokee Chief</td></tr> +<tr><td>Court Chamberlain</td><td>Gavot</td></tr> +</table> +</div> + +<center>Minuet</center> + +<div class='blkquot'><p>Through dramatic license, this scene takes place in the Court of + King George III. Colonial emissaries, accompanied by a North + American Indian, attend, and are graciously granted by the King a + Royal Charter establishing the Society of the New York Hospital, + along with a seal, insignia, and a money gift. A bit of color and + romance attaches to the Cherokee's appearance in the scene. </p></div> + +<div class='blkquot2'> +<table summary="Music: Orchestra" width="100%"> +<tr><td width="50%">Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center> +"God Save the King"<br /> +"Minuet Don Juan"<br /> +"Largo"<br /> +"Amaryllis" +</center> +<br /> +<h4>SCENE II</h4> + +<h5>PINEL À LA +<ins class="correction" +title="Transcriber's note: original reads 'SALPTERIÈRE'">SALPETRIÈRE</ins></h5> +<br /> + +<div class='blkquot2'>Characters:</div> +<div class='blkquot'> +<table summary="Characters" width="100%"><tr> +<td width="33%">Pinel</td> +<td width="33%">Patients</td> +<td width="33%">Aides and Attendants</td> +</tr></table> +</div> + +<div class='blkquot'><p>A courtyard scene in Salpetrière in 1792. Hopelessness and chained + despair are pictured. Pinel enters, is saddened and indignant at + the sight of so much unnecessary suffering, and instantly orders + the chains to be struck off. The historic episode closes in a + graphic tableau depicting the gratitude of the released. </p></div> + +<div class='blkquot2'> +<table summary="Music: Orchestra" width="100%"> +<tr><td align="left">Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center> +"Kammenoi Ostrow" +</center> + +<br /> +<h4>SCENE III</h4> + +<h5>PORTRAITS—PERSONALITIES OF THE PAST</h5> + +<div class='blkquot'> +<p>Thomas Eddy, of the Board of Governors, 1815-1827.</p> + +<p>Dr. James Macdonald, First Resident Physician, 1825-1837.</p> + +Dr. Pliny +<ins class="correction" +title="Transcriber's note: original reads 'Early'">Earle</ins>, Organizer, +1844-1849.<br /> + +<p>Miss Eliza Macdonald, daughter of Dr. Macdonald, unveils the portrait of +her father.</p> +</div> + +<div class='blkquot2'> +<table summary="Music: Orchestra" width="100%"> +<tr><td align="left">Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center>"Long, Long Ago"</center> +<br /> + +<h4>SCENE IV</h4> + +<h5>DOROTHY LYNDE DIX BEFORE A LEGISLATIVE COMMITTEE</h5> + +<div class='blkquot2'>Characters:</div> +<div class='blkquot'> +<table summary="Music: Orchestra" width="100%"> +<tr><td width="30%">Dorothy L. Dix</td> +<td width="45%">Members of the Committee</td> +<td width="25%">Chairman</td> +</tr></table> +</div> + +<div class='blkquot'><p>Miss Dix appears before a Committee of the Legislature and is heard + in an impassioned appeal on behalf of adequate provision and care + for the mentally ill. The scene closes with the Committee + indicating their approval and congratulating Miss Dix on her + successful effort. </p></div> + +<div class='blkquot2'> +<table summary="Music: Orchestra" align="center" width="100%"> +<tr><td align="left">Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center> +"Maryland, My Maryland"<br /> +"Columbia, the Gem of the Ocean" +</center> + +<br /> +<h4>SCENE V</h4> + +<h5>OCCUPATIONAL-RECREATIONAL ACTIVITIES</h5> + +<div class='blkquot'> +<table summary="Recreational Activities" width="100%"> +<tr><td width="66%">Men's Crafts</td><td>Men's Sports</td></tr> +<tr><td>Women's Sports</td><td>Women's Crafts</td></tr> +</table> +</div> + +<center>Maypole Dance</center> + +<div class='blkquot'><p>Supplementing the general medical work, the therapeutic value of + organized occupational and recreational activities is gaining + increasing recognition. Those arts and crafts lending themselves to + graphic presentation are here selected: dyeing, weaving, spinning, + basketry, caning, modelling, painting, pottery, metal work, net + making, gardening, etc.: and similarly, in the recreative + activities, tennis, golf, hockey, baseball, croquet, bowling, + skiing, and skating. A Maypole dance closes the scene.</p></div> + +<div class='blkquot2'> +<table summary="Music: Orchestra" width="100%"> +<tr><td align="left">Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center> +"Boccherina"<br /> +"Henry VIII, Maypole Dance"</center> +<br /> + +<h4>SCENE VI</h4> + +<h5>INSPIRATIONS</h5> + +<div class='blkquot2'>Characters:</div> +<div class='blkquot'> +<table summary="Characters" width="100%"> +<tr><td width="66%">Hygeia</td><td>Britannia</td></tr> +<tr><td>La Belle France</td><td>Columbia</td></tr> +</table> +</div> + +<div class='blkquot'><p>The closing scene is in the nature of a processional symbolizing + international unity of purpose and a determination to pursue, until + finally attained, the goal of Health and Happiness, personified by + the goddess Hygeia. </p></div> + +<div class='blkquot2'> +<table summary="Music: Orchestra" width="100%"> +<tr><td align="left">Music</td><td align="right">Orchestra</td></tr> +</table> +</div> +<center> +"Marseillaise"<br /> +"God Save the King"<br /> +"Battle Hymn of the Republic"<br /> +"The Star Spangled Banner"<br /> +"Tammany" +</center> + + + + +<hr style='width: 65%;' /> +<a name='NAMES'></a> +<h2>NAMES OF THOSE WHO ATTENDED THE EXERCISES<a name='FNanchor_19_19'></a><a href='#Footnote_19_19'><sup>[19]</sup></a></h2> +<br /> + +<table summary="Name, Home" width="100%"> +<tr><td width="50%">E. Stanley Abbot, M.D.</td><td>Philadelphia, Pa.</td></tr> +<tr><td>Louise Acton</td><td>White Plains, N.Y.</td></tr> +<tr><td>Elizabeth I. Adamson, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>William H. Alleé, M.D.</td><td>Ridgefield, Conn.</td></tr> +<tr><td>Thaddeus H. Ames, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. George S. Amsden</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Isadora Anschutz</td><td>White Plains, N.Y.</td></tr> +<tr><td>Grosvenor Atterbury</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Pearce Bailey, M.D.</td><td>New York City.</td></tr> +<tr><td>Amos T. Baker, M.D.</td><td>Bedford Hills, N.Y.</td></tr> +<tr><td>Mrs. Amos T. Baker</td><td>Bedford Hills, N.Y.</td></tr> +<tr><td>Lewellys F. Barker, M.D.</td><td>Baltimore, Md.</td></tr> +<tr><td>Clifford W. Beers</td><td>New York City.</td></tr> +<tr><td>Christopher C. Beling, M.D.</td><td>Newark, N.J.</td></tr> +<tr><td>Harrison Betts, M.D.</td><td>Yonkers, N.Y.</td></tr> +<tr><td>Anna T. Bingham, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. Martha Bird</td><td>Middletown, N.Y.</td></tr> +<tr><td>Charles E. Birch, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>J. Fielding Black, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. J. Fielding Black</td><td>White Plains, N.Y.</td></tr> +<tr><td>G. Alder Blumer, M.D.</td><td>Providence, R.I.</td></tr> +<tr><td>Leonard Blumgart, M.D.</td><td>New York City.</td></tr> +<tr><td>J. Arthur Booth, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss Helen Booth</td><td>New York City.</td></tr> +<tr><td>S.M. Boyd</td><td>Scarsdale, N.Y.</td></tr> +<tr><td>Mrs. S.M. Boyd</td><td>Scarsdale, N.Y.</td></tr> +<tr><td>Mrs. Sidney C. Borg</td><td>New York City.</td></tr> +<tr><td>Rose Bell Bradley</td><td>New York City.</td></tr> +<tr><td>V.C. Branham, M.D.</td><td>New York City.</td></tr> +<tr><td>Holly Brown</td><td>White Plains, N.Y.</td></tr> +<tr><td>Helen Brown, M.D.</td><td>New York City.</td></tr> +<tr><td>Sanger Brown, 2d, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss Elizabeth O. Buckingham</td><td>Chicago, Ill.</td></tr> +<tr><td>Alfred C. Buckley, M.D.</td><td>Frankford, Philadelphia, Pa.</td></tr> +<tr><td>Alice Gates Bugbee, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Jesse C.M. Bullowa, M.D.</td><td>New York City.</td></tr> +<tr><td>William Browning, M.D.</td><td>Brooklyn, N.Y.</td></tr> +<tr><td>Marie von H. Byers</td><td>New York City.</td></tr> +<tr><td>Karl M. Bowman, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Karl M. Bowman</td><td>White Plains, N.Y.</td></tr> +<tr><td>Edna L. Byington</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>C.N.B. Camac, M.D.</td><td>New York City.</td></tr> +<tr><td>C. Macfie Campbell, M.D.</td><td>Boston, Mass.</td></tr> +<tr><td>Mrs. C. Macfie Campbell, M.D.</td><td>Boston, Mass.</td></tr> +<tr><td>Robert Carroll, M.D.</td><td>Asheville, N.C.</td></tr> +<tr><td>Mrs. Robert Carroll</td><td>Asheville, N.C.</td></tr> +<tr><td>Louis Casamajor, M.D.</td><td>New York City.</td></tr> +<tr><td>Ross McC. Chapman, M.D.</td><td>Towson, Md.</td></tr> +<tr><td>Helen Childs</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Anne Choate</td><td>Pleasantville, N.Y.</td></tr> +<tr><td>E.H. Clarke</td><td>New York City.</td></tr> +<tr><td>Miss Marjory Clark, R.N.</td><td>New York City.</td></tr> +<tr><td>Joseph Collins, M.D.</td><td>New York City.</td></tr> +<tr><td>Michael Collins</td><td>White Plains, N.Y.</td></tr> +<tr><td>Arthur S. Corwin, M.D.</td><td>Rye, N.Y.</td></tr> +<tr><td>Mrs. Margaret Cornwell</td><td>New Rochelle, N.Y.</td></tr> +<tr><td>Henry A. Cotton, M.D.</td><td>Trenton, N.J.</td></tr> +<tr><td>Edith Cox</td><td>White Plains, N.Y.</td></tr> +<tr><td>C. Burns Craig, M.D.</td><td>New York City.</td></tr> +<tr><td>Henry W. Crane</td><td>New York City.</td></tr> +<tr><td>Raymond S. Crispell, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. Seymour Cromwell</td><td>Mendham, N.Y.</td></tr> +<tr><td><div class="hangindent">Hugh S. Cummings, M.D., +Surgeon-General U.S. +Public Health Service</div></td><td>Washington, D.C.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Charles L. Dana, M.D.</td><td>New York City.</td></tr> +<tr><td>Thomas K. Davis, M.D.</td><td>New York City.</td></tr> +<tr><td>Henderson Brooke Deady, M.D.</td><td>New York City.</td></tr> +<tr><td>John W. Dean</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Aline S. Devin</td><td>Eliot, Maine.</td></tr> +<tr><td>Allen Ross Diefendorf, M.D.</td><td>New Haven, Conn.</td></tr> +<tr><td>William Elliott Dold, M.D.</td><td>Astoria, L.I., N.Y.</td></tr> +<tr><td>George Drake</td><td>White Plains, N.Y.</td></tr> +<tr><td>John W. Draper, M.D.</td><td>New York City.</td></tr> +<tr><td>Nataline Dullas</td><td>White Plains, N.Y.</td></tr> +<tr><td>Charles S. Dunlap, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. Alfred F. DeNike</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>R. Condit Eddy, M.D.</td><td>New Rochelle, N.Y.</td></tr> +<tr><td>Joseph P. Eidson, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Emma Eldridge</td><td>Tuckahoe, N.Y.</td></tr> +<tr><td>Charles A. Elsberg, M.D.</td><td>New York City.</td></tr> +<tr><td>William Else, M.D.</td><td>New York City.</td></tr> +<tr><td><div class="hangindent">Everett S. Elwood, +Secretary State +Hospital Commission</div></td><td>Albany, New York.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Mrs. Ezra H. Fitch</td><td>New York City.</td></tr> +<tr><td>Ralph P. Folsom, M.D.</td><td>New York City.</td></tr> +<tr><td>Harold E. Foster, M.D.</td><td>Boston, Mass.</td></tr> +<tr><td>Diana Fowler</td><td>White Plains, N.Y.</td></tr> +<tr><td>Florence Fuller</td><td>White Plains, N.Y.</td></tr> +<tr><td>Isaac J. Furman, M.D.</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Leslie Gager, M.D.</td><td>New York City.</td></tr> +<tr><td>William C. Garvin, M.D.</td><td>Kings Park, N.Y.</td></tr> +<tr><td>Arnold Gesell, M.D.</td><td>New Haven, Conn.</td></tr> +<tr><td>Bernard Glueck, M.D.</td><td>New York City.</td></tr> +<tr><td>J. Riddle Goffe, M.D.</td><td>New York City.</td></tr> +<tr><td>S. Philip Goodhart, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss Annie W. Goodrich, R.N.</td><td>New York City.</td></tr> +<tr><td>Phyllis Greenacre, M.D.</td><td>Baltimore, Md.</td></tr> +<tr><td>Menas S. Gregory, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss Pauline P. Gunderson</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Louis J. Haas</td><td>White Plains, N.Y.</td></tr> +<tr><td>Thomas H. Haines, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss Dorothy Hale</td><td>New York City.</td></tr> +<tr><td>Miss Natalie Hall</td><td>White Plains, N.Y.</td></tr> +<tr><td>Robert B. Hammond, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Miss Elisa Hansen</td><td>White Plains, N.Y.</td></tr> +<tr><td>Milton A. Harrington, M.D.</td><td>Alfred, N.Y.</td></tr> +<tr><td>Isham G. Harris, M.D.</td><td>Brooklyn, N.Y.</td></tr> +<tr><td>George A. Hastings</td><td>New York City.</td></tr> +<tr><td>Winifred Hathaway</td><td>New York City.</td></tr> +<tr><td>Edna Haverstock</td><td>White Plains, N.Y.</td></tr> +<tr><td>C. Floyd Haviland, M.D.</td><td>Middletown, Conn.</td></tr> +<tr><td>F. Ross Haviland, M.D.</td><td>Brooklyn, N.Y.</td></tr> +<tr><td>Charles E. Haynes, M.D.</td><td>New York City.</td></tr> +<tr><td>Eunice W. Haydon</td><td>New York City.</td></tr> +<tr><td>Miss Katherine F. Hearn, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Edna Hemingson</td><td>White Plains, N.Y.</td></tr> +<tr><td>George W. Henry, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. George W. Henry</td><td>White Plains, N.Y.</td></tr> +<tr><td>Marcus B. Heyman, M.D.</td><td>New York City.</td></tr> +<tr><td>Beatrice M. Hinkle, M.D.</td><td>New York City.</td></tr> +<tr><td>L.E. Hinsie, M.D.</td><td>New York City.</td></tr> +<tr><td>P.F. Hoffman, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>John F. Holden, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Hubert S. Howe, M.D.</td><td>New York City.</td></tr> +<tr><td>Thomas Howell, M.D.</td><td>New York City.</td></tr> +<tr><td>J. Ramsay Hunt, M.D.</td><td>New York City.</td></tr> +<tr><td>Helen Hunt</td><td>White Plains, N.Y.</td></tr> +<tr><td>Miss Augusta M. Huppuch</td><td>New York City.</td></tr> +<tr><td>Richard H. Hutchings, M.D.</td><td>Utica, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Frank N. Irwin, M.D.</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Martha Joffe</td><td>White Plains, N.Y.</td></tr> +<tr><td>Walter B. James, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. Walter James</td><td>White Plains, N.Y.</td></tr> +<tr><td>Professor Pierre Janet, M.D.</td><td>Paris, France.</td></tr> +<tr><td>Madame Pierre Janet</td><td>Paris, France.</td></tr> +<tr><td>M.E. Jarvis, M.D.</td><td>New York City.</td></tr> +<tr><td>Rev. Oscar Jarvis</td><td>White Plains, N.Y.</td></tr> +<tr><td>Walter Jennings</td><td>Cold Spring Harbor, L.I., N.Y.</td></tr> +<tr><td>Miss Gudron Johannessen, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Miss Marguerite Jewell</td><td>White Plains, N.Y.</td></tr> +<tr><td>Miss Florence M. Johnson.</td><td>New York City.</td></tr> +<tr><td>Kenneth B. Jones, M.D.</td><td>Thiells, N.Y.</td></tr> +<tr><td>Miss Minnie Jordan, R.N.</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Mrs. De Lancey A. Kane</td><td>New Rochelle, N.Y.</td></tr> +<tr><td>Lilian A. Kelm</td><td>New York City.</td></tr> +<tr><td>James P. Kelleher, M.D.</td><td>New York City.</td></tr> +<tr><td>Foster Kennedy, M.D.</td><td>New York City.</td></tr> +<tr><td>Marion E. Kenworthy, M.D.</td><td>New York City.</td></tr> +<tr><td>John Joseph Kindred, M.D.</td><td>Astoria, L.I., N.Y.</td></tr> +<tr><td>George W. King, M.D.</td><td>Secaucus, N.J.</td></tr> +<tr><td>Hermann G. Klotz, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>George W. Kline, M.D.</td><td>Boston, Mass.</td></tr> +<tr><td>George H. Kirby, M.D.</td><td>New York City.</td></tr> +<tr><td>Henry Klopp, M.D.</td><td>Allentown, Pa.</td></tr> +<tr><td>Augustus S. Knight, M.D.</td><td>New York City.</td></tr> +<tr><td>Frank Henry Knight, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mary S. Kirkbride</td><td>Albany, N.Y.</td></tr> +<tr><td>Walter M. Kraus, M.D.</td><td>New York City.</td></tr> +<tr><td>Edward J. Kempf, M.D.</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Alexander Lambert, M.D.</td><td>New York City.</td></tr> +<tr><td>Charles I. Lambert, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Charles I. Lambert</td><td>White Plains, N.Y.</td></tr> +<tr><td>Arthur G. Lane, M.D.</td><td>Greystone Park, N.J.</td></tr> +<tr><td>G. Alfred Lawrence, M.D.</td><td>New York City.</td></tr> +<tr><td>W.A. Lawrence, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Ruth W. Lawton</td><td>White Plains, N.Y.</td></tr> +<tr><td>Helen Letson</td><td>White Plains, N.Y.</td></tr> +<tr><td>Samuel Leopold, M.D.</td><td>Philadelphia, Pa.</td></tr> +<tr><td>Maurice J. Lewi, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. Maurice J. Lewi</td><td>New York City.</td></tr> +<tr><td>Miss Ella H. Lowe</td><td>White Plains, N.Y.</td></tr> +<tr><td>Walter E. Lowthian, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>F.R. Lyman, M.D.</td><td>Hastings-on-Hudson, N.Y.</td></tr> +<tr><td>Samuel B. Lyon, M.D.</td><td>New York City.</td></tr> +<tr><td>Winslow Lyon</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>William H. McCastline, M.D.</td><td>New York City.</td></tr> +<tr><td>John T. McCurdy, M.D.</td><td>New York City.</td></tr> +<tr><td>Carlos F. MacDonald, M.D.</td><td>New York City.</td></tr> +<tr><td>D.W. McFarland, M.D.</td><td>Greens Farms, Conn.</td></tr> +<tr><td>Miss Eliza Macdonald</td><td>Flushing, L.I., N.Y.</td></tr> +<tr><td>John W. Mackintosh</td><td>White Plains, N.Y.</td></tr> +<tr><td>Daniel W. Maloney</td><td>White Plains, N.Y.</td></tr> +<tr><td>Grace F. Marcus, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>L. Markham, M.D.</td><td>Amityville, N.Y.</td></tr> +<tr><td>Miss Anna Maxwell, R.N.</td><td>New York City.</td></tr> +<tr><td>John F.W. Meagher, M.D.</td><td>Brooklyn, N.Y.</td></tr> +<tr><td>Adolf Meyer, M.D.</td><td>Baltimore, Md.</td></tr> +<tr><td>Carlos J. Miller, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Henry W. Miller, M.D.</td><td>Brewster, N.Y.</td></tr> +<tr><td>Mrs. R. Van C. Miller</td><td>New York City.</td></tr> +<tr><td>George W. Mills, M.D.</td><td>Central Islip, N.Y.</td></tr> +<tr><td>Henry Moffett, M.D.</td><td>Yonkers, N.Y.</td></tr> +<tr><td>Mrs. Maude G. Moody</td><td>New York City.</td></tr> +<tr><td>Miss Madeline Moore</td><td>White Plains, N.Y.</td></tr> +<tr><td>Joseph W. Moore, M.D.</td><td>Beacon, N.Y.</td></tr> +<tr><td>Eugene T. Morrison, M.D.</td><td>New Rochelle, N.Y.</td></tr> +<tr><td>Miss Cecil Morrison</td><td>White Plains, N.Y.</td></tr> +<tr><td>Richard W. Moriarty, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Herman Mortensen, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Walter W. Mott, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Florence Munn</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Theodore W. Neumann, M.D.</td><td>Central Valley, N.Y.</td></tr> +<tr><td>Ethan A. Nevin, M.D.</td><td>Newark, N.J.</td></tr> +<tr><td>Miss Christine M. Nuno</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>George O'Hanlon, M.D.</td><td>New York City.</td></tr> +<tr><td>James M. O'Neill</td><td>Harrison, N.Y.</td></tr> +<tr><td>Herman Ostrander, M.D.</td><td>Kalamazoo, Mich.</td></tr> +<tr><td>Mary F. O'Grady</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Flavius Packer, M.D.</td><td>Riverdale, N.Y.</td></tr> +<tr><td>Mrs. Flavius Packer</td><td>Riverdale, N.Y.</td></tr> +<tr><td>Irving H. Pardee, M.D.</td><td>New York City.</td></tr> +<tr><td>Jason S. Parker, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Frederick W. Parsons, M.D.</td><td>Buffalo, N.Y.</td></tr> +<tr><td>Miss Margaret Patin</td><td>White Plains, N.Y.</td></tr> +<tr><td>Stewart Paton, M.D.</td><td>Princeton, N.J.</td></tr> +<tr><td>Christopher J. Patterson, M.D.</td><td>Troy, N.Y.</td></tr> +<tr><td>Guy Payne, M.D.</td><td>Cedar Grove, N.J.</td></tr> +<tr><td>Arthur M. Phillips, M.D.</td><td>New York City.</td></tr> +<tr><td><div class="hangindent">Charles W. Pilgrim, M.D., Chairman, +State Hospital Commission, N.Y.</div></td><td>Central Valley, N.Y.</td></tr> +<tr><td>Mason Pitman, M.D.</td><td>Riverdale-on-Hudson, N.Y.</td></tr> +<tr><td>Miss Leah Pitman</td><td>White Plains, N.Y.</td></tr> +<tr><td>Miss Adele S. Poston, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Howard W. Potter, M.D.</td><td>Thiells, N.Y.</td></tr> +<tr><td>Wilson M. Powell</td><td>New York City.</td></tr> +<tr><td>Mrs. Margaret J. Powers</td><td>New York City.</td></tr> +<tr><td>Miss Nina Prey</td><td>New York City.</td></tr> +<tr><td>W.B. Pritchard, M.D.</td><td>New York City.</td></tr> +<tr><td>Morton Prince, M.D.</td><td>Boston, Mass.</td></tr> +<tr><td>Rose Pringle, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Sylvanus Purdy, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Paul R. Radosvljevich, M.D.</td><td>New York City.</td></tr> +<tr><td>E. Benjamin Ramsdell, M.D.</td><td>New York City.</td></tr> +<tr><td>Edwin G. Ramsdell, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mortimer W. Raynor, M.D.</td><td>New York City.</td></tr> +<tr><td>Lawrence F. Rainsford, M.D.</td><td>Rye, N.Y.</td></tr> +<tr><td>Mrs. Lawrence F. Rainsford</td><td>Rye, N.Y.</td></tr> +<tr><td>Henry A. Riley, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss Elise Reilly</td><td>White Plains, N.Y.</td></tr> +<tr><td>Frank W. Robertson, M.D.</td><td>New York City.</td></tr> +<tr><td>M.A. Robinson, M.D.</td><td>New York City.</td></tr> +<tr><td>William C. Roden, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td>A.J. Rosanoff, M.D.</td><td>Kings Park, N.Y.</td></tr> +<tr><td>Miss Catherine Ross, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td>John T.W. Rowe, M.D.</td><td>New York City.</td></tr> +<tr><td>Richard G. Rows, M.D.</td><td>London, England.</td></tr> +<tr><td>Frederick D. Ruland, M.D.</td><td>Westport, Conn.</td></tr> +<tr><td>William L. Russell, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. William L. Russell</td><td>White Plains, N.Y.</td></tr> +<tr><td>Earnest F. Russell, M.D.</td><td>New York City.</td></tr> +<tr><td>Paul L. Russell</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Paul L. Russell</td><td>White Plains, N.Y.</td></tr> +<tr><td>Walter G. Ryon, M.D.</td><td>Poughkeepsie, N.Y.</td></tr> +<tr><td>Miss Helen K. Ryce</td><td>Poughkeepsie, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Miss Helen Sayre</td><td>White Plains, N.Y.</td></tr> +<tr><td>Thomas W. Salmon, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. Thomas W. Salmon</td><td>New York City.</td></tr> +<tr><td>Irving J. Sands, M.D.</td><td>Brooklyn, N.Y.</td></tr> +<tr><td>James P. Sands, M.D.</td><td>Philadelphia, Pa.</td></tr> +<tr><td>William C. Sandy, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss E. Saul</td><td>New York City.</td></tr> +<tr><td>William G. Schauffler, M.D.</td><td>Princeton, N.J.</td></tr> +<tr><td>Paul Schlegman, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>H. Ernest Schmid, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Miss Gertrude Schmid</td><td>White Plains, N.Y.</td></tr> +<tr><td>Augusta Scott, M.D.</td><td>New York City.</td></tr> +<tr><td>Major Louis L. Seaman, M.D.</td><td>New York City.</td></tr> +<tr><td>Edward W. Sheldon</td><td>New York City.</td></tr> +<tr><td>George Sherrill, M.D.</td><td>Stamford, Conn.</td></tr> +<tr><td>Miss Eloise Shields, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Lewis M. Silver, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. A. Slesingle</td><td>New York City.</td></tr> +<tr><td>Mrs. Anna C. Schermerhorn</td><td>New York City.</td></tr> +<tr><td>Rev. Frank H. Simmonds</td><td>White Plains, N.Y.</td></tr> +<tr><td>Clarence J. Slocum, M.D.</td><td>Beacon, N.Y.</td></tr> +<tr><td>Mrs. Clarence J. Slocum</td><td>Beacon, N.Y.</td></tr> +<tr><td>Augustine J. Smith</td><td>New York City.</td></tr> +<tr><td>Miss M. Smith, R.N.</td><td>Titusville, Pa.</td></tr> +<tr><td>Philip Smith, M.D.</td><td>New York City.</td></tr> +<tr><td>Rev. George H. Smyth</td><td>Scarsdale, N.Y.</td></tr> +<tr><td>D. Austin Sniffen, D.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>John D. Southworth, M.D.</td><td>New York City.</td></tr> +<tr><td>Edith E. Spaulding, M.D.</td><td>New York City.</td></tr> +<tr><td>M. Allen Starr, M.D.</td><td>New York City.</td></tr> +<tr><td>Samuel A. Steele</td><td>White Plains, N.Y.</td></tr> +<tr><td>William Steinach, M.D.</td><td>New York City.</td></tr> +<tr><td>George S. Stevenson, M.D.</td><td>New York City.</td></tr> +<tr><td>Adolf Stern, M.D.</td><td>New York City.</td></tr> +<tr><td>Emil Strateman</td><td>White Plains, N.Y.</td></tr> +<tr><td>Israel Strauss, M.D.</td><td>New York City.</td></tr> +<tr><td>Frank K. Sturgis</td><td>New York City.</td></tr> +<tr><td>Miss Mary Ruth Swann, R.N.</td><td>Washington, D.C.</td></tr> +<tr><td>C.C. Sweet, M.D.</td><td>Ossining, N.Y.</td></tr> +<tr><td>Sarah Swift</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>William B. Terhune, M.D.</td><td>New Haven, Conn.</td></tr> +<tr><td>William J. Tiffany, M.D.</td><td>New York City.</td></tr> +<tr><td>Walter Clark Tilden, M.D.</td><td>Hartsdale, N.Y.</td></tr> +<tr><td>Frederick Tilney, M.D.</td><td>New York City.</td></tr> +<tr><td>Walter Timme, M.D.</td><td>New York City.</td></tr> +<tr><td>Howard Townsend</td><td>New York City.</td></tr> +<tr><td>E. Clark Tracy, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Walter L. Treadway, M.D.</td><td>Washington, D.C.</td></tr> +<tr><td>Miss Gertrude Trefrey, R.N.</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Miss Mary G. Urquhart</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>J.L. Van deMark, M.D.</td><td>Albany, N.Y.</td></tr> +<tr><td>T.J. Vosburgh, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Henry J. Vier, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Emory M. Wadsworth, M.D.</td><td>Brooklyn, N.Y.</td></tr> +<tr><td>Miss Lillian D. Wald, R.N.</td><td>New York City.</td></tr> +<tr><td>Professor Howard C. Warren</td><td>Princeton, N.J.</td></tr> +<tr><td>Mrs. Caroline E. Washburn</td><td>White Plains, N.Y.</td></tr> +<tr><td>Miss Martha Washburn</td><td>White Plains, N.Y.</td></tr> +<tr><td>G.F. Washburne, M.D.</td><td>Hastings-on-Hudson, N.Y.</td></tr> +<tr><td>Chester Waterman, M.D.</td><td>New York City.</td></tr> +<tr><td>James J. Waygood, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. James J. Waygood</td><td>White Plains, N.Y.</td></tr> +<tr><td>R.G. Wearne, M.D.</td><td>New York City.</td></tr> +<tr><td>Edward W. Weber, M.D.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Israel S. Wechsler, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss Kathryn I. Wellman.</td><td>White Plains, N.Y.</td></tr> +<tr><td>Mrs. Adelyn Wesley</td><td>New York City.</td></tr> +<tr><td>Lt. Col. Arthur W. Whaley, M.D.</td><td>New York City.</td></tr> +<tr><td>Mrs. Arthur W. Whaley</td><td>New York City.</td></tr> +<tr><td>Miss Margaret Wheeler</td><td>Short Hills, N.J.</td></tr> +<tr><td>Payne Whitney</td><td>New York City.</td></tr> +<tr><td>Frankwood E. Williams, M.D.</td><td>New York City.</td></tr> +<tr><td>Rodney R. Williams, M.D.</td><td>Poughkeepsie, N.Y.</td></tr> +<tr><td>O.J. Wilsey, M.D.</td><td>Amityville, N.Y.</td></tr> +<tr><td>John E. Wilson, M.D.</td><td>New York City.</td></tr> +<tr><td>Miss A. Wilson</td><td>New York City.</td></tr> +<tr><td>J.M. Winfield, M.D.</td><td>Brooklyn, N.Y.</td></tr> +<tr><td>G. Howard Wise</td><td>New York City.</td></tr> +<tr><td>Miss Frances E. Wood</td><td>White Plains, N.Y.</td></tr> +<tr><td>Robert C. Woodman, M.D.</td><td>Middletown, N.Y.</td></tr> +<tr><td>Robert S. Woodworth, Ph.D.</td><td>New York City.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Rev. John C. York</td><td>Brooklyn, N.Y.</td></tr> +<tr><td> </td><td></td></tr> +<tr><td>Edwin G. Zabriskie, M.D.</td><td>New York City.</td></tr> +<tr><td>Charles C. Zacharie, M.D.</td><td>White Plains, N.Y.</td></tr> +</table> + +<p>FOOTNOTES:</p> + +<a name='Footnote_19_19'></a><a href='#FNanchor_19_19'>[19]</a><div class='note'><p> If any names are omitted it is because these names and +addresses were not obtained.</p></div> + + + +<hr style='width: 65%;' /> +<h2>APPENDICES</h2> + + + +<hr style='width: 65%;' /> +<a name='APPENDIX_I'></a><h2>APPENDIX I</h2> + +<a name="COMMUNICATIONS"></a> +<h3>COMMUNICATIONS FROM DR. BEDFORD PIERCE, MEDICAL SUPERINTENDENT OF THE +RETREAT, YORK, ENGLAND</h3> + + +<p class="right2">May 5th, 1921.</p> + +<span class="smcap">Dear Dr. Russell:</span><br /> + +<p>I have read with much pleasure your pamphlet giving the history of +Bloomingdale Hospital. The reproduction in facsimile of Thomas Eddy's +communication<a name='FNanchor_20_20'></a><a href='#Footnote_20_20'><sup>[20]</sup></a> is especially interesting and it will be placed with +the records of the early days of the Retreat.</p> + +<p>We have looked through the Minutes, which are complete from the opening +of the Retreat in 1796, and also examined a large number of original +letters of William and Samuel Tuke respecting the Institution, but have +not succeeded in tracing the letter from S. Tuke to William Eddy, to +which you refer. As you are probably aware, S. Tuke was the grandson of +William Tuke, the founder, and when he published the History of the +Retreat in 1812 he was but twenty-eight years of age. This book had a +far-reaching influence on the treatment of the insane, and it is +remarkable that a man untrained in medicine and without university +education should have been able to write it. The book is now very rare, +but as we have three duplicate copies, I am authorized by the Directors +of the Retreat to present your Hospital with one of them. I have already +sent you a copy of an address of my own dealing with Psychiatry in +England at about the time your Hospital was instituted.</p> + +<p>The use of the term "moral treatment" as opposed to treatment of +physical disease has in recent years become especially interesting. It +is clear that Tuke and Pinel foresaw that psychotherapeutic treatment is +necessary, and their efforts were directed towards providing effective +"sublimation" of misdirected psychical energy.</p> + +<p>One is pleased to see in your report the extent to which organized +occupations are developed at Bloomingdale—a pleasure not unmixed with +envy at seeing the picture of the men's occupational pavilion, and the +prospective erection of a similar building for women.</p> + +<p>In the early days of the Retreat large numbers of visitors came from all +parts of the world. There is a gap in the Visitors' Book between +1800-1815, and the list of visitors is not complete.</p> + +<p>We have copied out the names of the American Visitors, together with an +entry by John W. Francis, M.D., in 1815. It is interesting to note that +an American woman Friend, Hannah Field, was accompanied to the Retreat +by Elizabeth Fry. In 1818 a party of North American Indians visited the +Retreat and signed the Visitors' Book with pictorial representations of +their names. These we have had photographed and I send the prints +herewith.</p> + +<p>May I congratulate you on the centenary of your Hospital and also +congratulate you and the Governors on its remarkable development and +progress. Here at the Retreat we carry on using the original buildings +still, striving to give our patients modern treatment in premises now +almost ancient, but which do not appear so out of date in this City of +York. York congratulates New York upon its wonderful prosperity, and we +gladly recognize its development in the practice of psychiatry fully +corresponds with its development in other directions.</p> + +<p style="text-align: right; margin-right: 15em;">I remain,</p> +<p style="text-align: right; margin-right: 9em;">Yours sincerely,</p> +<p class="right0"><span class="smcap">Bedford Pierce</span>.</p> + +<hr style='width: 45%;' /> + +<a name="EXTRACT"></a> +<h3>Extract from Minutes of Board of Directors of the Retreat</h3> + +<h4>The Retreat, York</h4> + +<h4>Meeting of Directors held on April the 30th, 1921</h4> + +<h4>Copy of Minute No. 8</h4> + +<p>At this Meeting of the Directors and Agents of York Retreat we hear with +pleasure that the Bloomingdale Hospital, the section of the Society of +the New York Hospital devoted to the Treatment of Mental Diseases, is to +celebrate next month the centenary of its foundation. The facsimile +reproduction of the letter of Thomas Eddy which has been presented to +the Retreat Library is specially interesting to us as it acknowledges +the pioneer work at the Retreat and specially refers to correspondence +with Samuel Tuke. We have pleasure in sending to the Governors of the +Bloomingdale Hospital a copy of Samuel Tuke's classical work "The +Description of the Retreat" in the belief that the principles therein +set forth are of lasting importance. We send our hearty congratulations +to the Bloomingdale Hospital on its century of good work and wish it +every success in the future.</p> + +<p style="text-align: right; margin-right: 15em;">Signed,</p> + +<p class="right0"><span class="smcap">Charles Weomans</span>, <i>Chairman</i>.</p> + +<p class="right0"><span class="smcap">Oscar F. Rumlen</span>, <i>Treasurer</i>.</p> + +<hr style='width: 45%;' /> + +<a name="TRANSCRIPT"></a> +<h3><span class="smcap">Transcript from the Visitors Book of The Retreat</span></h3> + +<h4>EARLY AMERICAN VISITORS</h4> +<br /> +<div style="text-indent: -3.5em; margin-left: 3.5em;"> +<p>1803. 3 mon 11th. <i>Abrm. Barker</i>, New Bedford, Massachusits, a young man +(a Friend) on a tour; has been in Russia, Denmark, Sweden & +Holland. (In William Tuke's writing)</p> + +<p>1815. Nov. 30. <i>John W. Francis</i>, M.D. of N. York. J.W. Francis is not +wholly ignorant of the State of the Lunatic Asylums in North +America, and he has visited almost all the institutions for the +Insane that are established in England. He now embraces this +opportunity of stating that after an examination of the Retreat +for some hours, he should do injustice to his feelings were he +not to declare that this establishment far surpasses anything of +the kind he has elsewhere seen, and that it reflects equal credit +on the wisdom and humanity of its conductors.</p> + +<p style="text-indent: 0em;">Perhaps it is no inconsiderable honour to add that institutions +of a similar nature and on the same plan are organizing in +different parts of the United States. The New World cannot do +better than imitate the old so far as concerns the management of +those who labour under mental infirmities. J.W.F.</p> + +<p>1816. 1 Mon 4. <i>Sharon Carter</i>, Philadelphia.</p> + +<p>1816. 1 mon. <i>Wm. S. Warder</i>, from Philadelphia.</p> + +<p>1816. 2 mon 21. Rev. Thomas H. Gallaudet, who visits Europe for the +purpose of qualifying himself to superintend an Asylum for the +Deaf and Dumb, proposed to be established in Hartford, +Connecticut, of the United States of America.</p> + +<p>1816. 4 mon 8th. <i>Archibald Gracie</i>, Junr., New York.</p> + +<p>1816. April 29th. <i>George F. Randolph</i>, Philadelphia. <i>John Hastings</i>, +Baltimore.</p> + +<p>1816. 6 mon 19th. <i>Charles Longstreth</i>, from Philadelphia.</p> + +<p>1816. 6 mon 19th. <i>Jacob Smedley</i>, from Philadelphia.</p> + +<p>1817. 7 mon. <i>Henry Kollock</i>, of Savannah, Georgia. +<i>Dr. Wm. Parker</i>, Savannah. +<i>G.C. Versslanchi</i>, of New York.</p> + +<p>1817. 11/24. <i>Hannah Field</i>, North America, with Elizabeth Fry.</p> + +<p>1817. 12 Mo. <i>G.J. Browne</i>, United States of America (Cincinnati).</p> +</div> + + <div class="figcenter" + style="width:100%;"> + + <a name="illus195"></a> + <a href="images/illus195.jpg"><img width="100%" + src="images/illus195_th.jpg" + alt="Thomas Eddy" /> + </a><br /> +In 1815 Thomas Eddy, one of the Governors of the Society of the New York +Hospital, presented a communication in which he advocated the +establishment in the country of a branch for the moral treatment of the +insane. This led to the establishment of Bloomingdale Asylum. +</div> + + + +<p>FOOTNOTES:</p> + +<a name='Footnote_20_20'></a><a href='#FNanchor_20_20'>[20]</a><div class='note'><p> Bloomingdale Hospital Press.</p></div> + + +<hr style='width: 65%;' /> +<a name='APPENDIX_II'></a><h2>APPENDIX II</h2> + +<h3>A LETTER ON PAUPER LUNATIC ASYLUMS<a name='FNanchor_21_21'></a><a href='#Footnote_21_21'><sup>[21]</sup></a></h3> +<br /> + +<p>The Governors of the New York Hospital, conceiving that the very +judicious remarks and sentiments contained in the following letter, +might be highly useful to the community, as well as to the institution +with which they are connected, have requested the same to be published. +The work alluded to in the letter, called, "Practical hints on the +construction and economy of Pauper Asylums," is believed to be one of +the most valuable and interesting works of the kind ever published. This +work was sent by the author to one of the Governors, and is now +deposited in the Hospital library. It is very desirable that it should +be republished in this country; but as such republication would be +expensive, on account of the few copies that would be wanted, the +Governors have directed, that if any person, or trustees of any public +institution, in any part of the United States, should be desirous of +obtaining a copy of this very valuable work, with a view to aid them in +erecting a similar Asylum, or the improvement of any already +established, that a manuscript copy shall be furnished them, upon an +application to the subscriber,</p> + +<p class="right2"><span class="smcap">Thomas Eddy.</span></p> + +<p>New-York, 12th month, 30th, 1815.</p> + + +<p class="right2"><span class="smcap">York</span>, 7mo. 17th, 1815.</p> + +<p>To Thomas Eddy,</p> + +<p>Our mutual friend, L. Murray, has put into my hands a letter and +pamphlet, lately received from thee, respecting the erection of an +asylum for lunatics near New-York.<a name='FNanchor_22_22'></a><a href='#Footnote_22_22'><sup>[22]</sup></a> He has wished me to make any +remarks which may occur to me on the perusal; but, having just +published a few hints on the construction and economy of Pauper Lunatic +Asylums, which contain much of the information thou requests, I shall +have but little to add. Those hints, however, relating to institutions +for the poorest class of society, must be applied with some +modifications to establishments for persons of different pervious +habits, and for whom a greater portion of attendance can be afforded. +The great objects, however, which are stated in the hints to be so +important for the comfort of lunatics, apply equally to those of all +ranks and classes.</p> + +<p>From the sum you propose to receive from the patients, intended to +occupy the new building, I conclude you are providing for patients of +the middle ranks of life, a class hardly less to be commiserated, when +thus afflicted, than the very poorest, since the expense and difficulty +of private management, may bring to ruin a respectable family, as well +as expose it to great personal dangers. There would, I think, be +considerable objection to the accumulation of 40 patients of this class, +in three contiguous rooms, as proposed in the hints for pauper lunatics. +You purpose building for 50 patients, and as you probably intend to +accommodate both sexes, the number of each sex may be very suitable for +the accommodation of three contiguous rooms, which, of course, need not +be so large as those in the Wakefield Asylum. It would be difficult to +offer a detailed plan, without knowing more than we do of your local +circumstances, and the classes of patients you purpose to admit. I +doubt, however, whether you can do better than to adopt the general form +of the Wakefield Asylum, and as you are providing for only a small +number, it deserves consideration whether all the rooms might not be +advantageously placed on the ground floor. This plan affords great +facilities to easy inspection, and safe communication with airing +grounds, and the roof might project so far over the building, as to form +an excellent collonnade for the patients; which seems peculiarly +desirable under an American Sun.</p> + +<p>With these views, I send a sketch drawn by the Architect whose plan is +to be adopted at Wakefield; and though it may not be, in many respects, +adapted to your particular wants, yet I hope it will not be altogether +useless. Should it be thought too expensive, I think the rooms, 1, 2, +and 3, might be dispensed with, and rooms marked "attendants, sick and +bath," might be appropriated to the patients during the day. The +attendants room is not a requisite, though it has been thought that it +would be more agreeable to patients of superior rank, not to have the +society of a servant. This, however, chiefly applies to the +convalescents, and these might occupy the room marked 'sick', whilst the +middle class, and the attendants, would be in the centre, marked +"attendants." A sick and bath room might probably be obtained in the +galleries: if you are inclined for the sake of appearance, to make the +centre building two stories high, you might bring the wings nearer to +the centre, and accommodate most of the convalescent patients with bed +rooms in the upper story. In this case, perhaps it would be desirable to +give the wings a radiating form. You will however be best able to modify +the sketch to your particular wants, if the general idea should meet +your approbation.</p> + +<p>I observe with pleasure, that one leading feature of your new +institution, is the introduction of employment amongst the patients, an +object which I am persuaded is of the utmost importance in the moral +treatment of insanity. It is related of an institution in Spain, which +accommodated all ranks, and in which the lower class were generally +employed, that a great proportion of these recovered, whilst the number +of the Grandees was exceedingly small. It will however, require great +address to induce patients to engage in manual labour, who have not been +accustomed to it previously to their indisposition, and it must be +admitted, that where the reluctance on the part of the patient is great, +the irritation which compulsory means are likely to excite, will +probably be more injurious to the patient, than the exercise will be +beneficial. The employment of insane persons should, as far as it is +practicable, be adapted to their previous habits, inclinations and +capacities, and, though horticultural pursuits may be most desirable, +the greatest benefit will, I believe, be found to result from the +patient being engaged in that employment in which he can most easily +excel, whether it be an active or a sedentary one. If it be the latter, +of course sufficient time should be allotted to recreation in the air. +Some persons imagine, that exercises of diversion, are equally +beneficial with those that are useful. The latter appear to me to +possess a decided preference, by imparting to the mind that calm feeling +of satisfaction, which the mere arts of amusement, though not to be +neglected, can never afford. To the melancholy class, this is an +important distinction between amusing and useful employments, and labour +is to be prefered for the maniacal class as less calculated to stimulate +the already too much excited spirits.</p> + +<p>It is proposed that the new asylum should be placed a few miles from the +city. The visitors to it, (I do not mean the medical ones) will, I +presume, be residents in New-York, and from what I have seen of the zeal +of persons under such appointments in this country, it appears +desirable, to render the performance of this duty, so important for the +welfare of asylums, as easy as it can be with propriety. One mile +perhaps would not be objectionable, and might probably afford as good +air and retirement, as a greater distance.</p> + +<p>I need hardly say, I was much gratified to find by the pamphlet, that +the importance of moral treatment in the cure of insanity, was duly +appreciated in America. When we consider, as Lord Bacon observes, +speaking of common diseases, that "all wise physicians in the +prescription, of their regimen to their patients, do ever consider +accidentia animi, as of great force to further or hinder remedies or +recoveries;" it is difficult to account for the general neglect of moral +considerations in the treatment of deranged mind. I hope, however, +though in many instances medicine may not be employed with advantage, +and its indiscriminate use has been seriously injurious, that we shall +not abandon it as altogether useless, in what we term disease of the +mind. All the varieties, included under this general term, have been +produced by physical causes: by external accidents, by intoxication, the +improper use of medicines, repelled eruptions, obstructed secretions, +&c. In some instances, dissection has discovered, after death, the cause +of the mental affection, and though, in many instances, no physical +cause can be detected, yet, when it is considered, how limited are the +investigations of the anatomist, and that the art is so imperfect, that +diseases occasioning instant death, cannot always be discovered on the +most minute dissection, it is not unreasonable to suppose, that the body +is in all cases the true seat of the disease.</p> + +<p>All I would infer from this speculation is, the importance of having +judicious medical attendants, to watch the progress of the disorder, to +be ready to apply their art as bodily symptoms may arise, and to +ascertain, with greater precision than has hitherto been done, "how and +how far the humours and effects of the body, do alter and work upon the +mind; and how far the passions and apprehensions of the mind, do alter +and work upon the body." Even if the disease is not confined to the +corporal organs of mind, but extends to the pure and eternal +intelligence, medical aid may still be useful from the well known +reciprocal action of the two parts of our system upon each other.</p> + +<p>I hope my unknown friend will excuse the length and freedom of this +letter: its length has much exceeded my intentions, yet I may have +omitted information which the experience of the Retreat might afford, +and which would have been useful to promoters of the New-York Asylum, +Should this be the case, I shall be glad to answer, as well as I am +able, any questions which they may propose; and, with the best wishes +for the success of their benevolent and important undertaking,</p> + +<p style="text-align: right; margin-right: 13em;">I remain, respectfully,</p> + +<p style="text-align: right; margin-right: 9em;">Thy friend,</p> + +<p class="right2"><span class="smcap">Samuel Tuke.</span></p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_21_21'></a><a href='#FNanchor_21_21'>[21]</a><div class='note'><p> A letter on Pauper Lunatic Asylums, by Samuel Tuke, New +York, 1815. Reprinted Bloomingdale Hospital Press, June 3, 1919.</p></div> + +<a name='Footnote_22_22'></a><a href='#FNanchor_22_22'>[22]</a> +<div class='note'><p><a href="#APPENDIX_III">Appendix III</a>.</p></div> + + + +<hr style='width: 65%;' /> +<a name='APPENDIX_III'></a><h2>APPENDIX III</h2> + +<h3>THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815<a name='FNanchor_23_23'></a><a href='#Footnote_23_23'><sup>[23]</sup></a></h3> +<br /> + +<p>Of the numerous topics of discussion on subjects relating to the cause +of humanity, there is none which has stronger claims to our attention, +than that which relates to the treatment of the insane.</p> + +<p>Though we may reasonably presume, this subject was by no means +overlooked by the ancients, we may fairly conclude, it is deservedly the +boast of modern times, to have treated it with any degree of success.</p> + +<p>It would have been an undertaking singularly interesting and +instructive, to trace the different methods of cure which have been +pursued in different ages, in the treatment of those labouring under +mental derangement: and to mark the various results with which they were +attended. The radical defect, in all the different modes of cure that +have been pursued, appears to be, that of considering mania a <i>physical</i> +or <i>bodily</i> disease, and adopting for its removal merely physical +remedies. Very lately, however, a spirit of inquiry has been excited, +which has given birth to a new system of treatment of the insane; and +former modes of medical discipline have now given place to that which is +generally denominated <i>moral management</i>.</p> + +<p>This interesting subject has closely engaged my attention for some +years, and I conceive that the further investigation of it may prove +highly beneficial to the cause of humanity, as well as to science, and +excite us to a minute inquiry, how far we may contribute to the relief +and comfort of the maniacs placed under our care. In pursuing this +subject, my views have been much extended, and my mind considerably +enlightened, by perusing the writings of Doctors Creighton, Arnold, and +Rush; but, more particularly, the account of the Retreat near York, in +England. Under these impressions I feel extremely desirous of submitting +to the consideration of the Governors, a plan to be adopted by them, for +introducing a system of moral treatment for the lunatics in the Asylum, +to a greater extent than has hitherto been in use in this country. The +great utility of confining ourselves almost exclusively to a course of +moral treatment, is plain and simple, and incalculably interesting to +the cause of humanity; and perhaps no work contains so many excellent +and appropriate observations on the subject, as that entitled, <i>The +Account of the Retreat</i>. The author, Samuel Tuke, was an active manager +of that establishment, and appears to have detailed, with scrupulous +care and minuteness, the effects of the system pursued toward the +patients. I have, therefore, in the course of the following remarks, +with a view of illustrating the subject with more clearness, often +adopted the language and opinions of Tuke, but having frequently mixed +my own observations with his, and his manner of expression not being +always adapted to our circumstances and situation, I have attempted to +vary the language, so as to apply it to our own institution; this will +account for many of the subsequent remarks not being noticed as taken +from Tuke's work.</p> + +<p>It is, in the first place, to be observed, that in most cases of +insanity, from whatever cause it may have arisen, or to whatever extent +it may have proceeded, the patient possesses some small remains of +ratiocination and self-command; and although many cannot be made +sensible of the irrationality of their conduct or opinions, yet they are +generally aware of those particulars for which the world considers them +proper objects of confinement. Thus it frequently happens, that a +patient, on his first introduction into the asylum, will conceal all +marks of mental aberration; and, in some instances, those who before +have been ungovernable, have so far deceived their new friends, as to +make them doubt their being insane.</p> + +<p>It is a generally received opinion, that the insane who are violent, +may be reduced to more calmness and quiet, by exciting the principle of +<i>fear</i>, and by the use of chains or corporal punishments. There cannot +be a doubt that the principle of fear in the human mind, when moderately +and judiciously excited, as it is by the operation of just and equal +laws, has a salutary effect on Society. It is of great use in the +education of children, whose imperfect knowledge and judgment, occasion +them to be less influenced by other motives. But where fear is <i>too +much</i> excited, and especially, when it becomes the chief motive of +action, it certainly tends to contract the understanding, weaken the +benevolent affection, and to debase the mind. It is, therefore, highly +desirable, and more wise, to call into action, as much as possible, the +operation of superior motives. Fear ought never to be induced, except +when an object absolutely necessary cannot be otherwise obtained. +Maniacs are often extremely irritable; every care, therefore, should be +taken, to avoid that kind of treatment that may have any tendency +towards exciting the passions. Persuasion and kind treatment, will most +generally supersede the necessity of coercive means. There is +considerable analogy between the judicious treatment of children and +that of insane persons. Locke has observed "the great secret of +education is in finding out the way to keep the Child's Spirit easy, +active and free; and yet, at the same time, to restrain him from many +things he has a mind to, and to draw him to things which are uneasy to +him." Even with the more violent and vociferous maniacs, it will be +found best to approach them with mild and soft persuasion. Every pains +should be taken to excite in the patient's mind a desire of esteem. +Though this may not be sufficiently powerful to enable them to resist +the strong irregular tendency of their disease; yet, <i>when properly +cultivated</i>, it may lead many to struggle to overcome and conceal their +morbid propensities, or at least, to confine their deviations within +such bounds as do not make them obnoxious to those about them. This +struggle is highly beneficial to the patient; by strengthening his mind, +and conducing to a salutary habit of self-restraint, an object, no +doubt, of the greatest importance to the care of insanity by <i>moral +means</i>.</p> + +<p>It frequently occurs, that one mark of insanity is a fixed false +conception, and a total incapacity of reasoning. In <i>such</i> cases, it is +generally advisable to avoid reasoning<a name='FNanchor_24_24'></a><a href='#Footnote_24_24'><sup>[24]</sup></a> with them, as it irritates +and rivets their false perception more strongly on the mind. On this +account, every means ought to be taken to seduce the mind from unhappy +and favourite musings; and particularly with melancholic patients; they +should freely partake of bodily exercises, walking, riding, +conversations, innocent sports, and a variety of other amusements; they +should be gratified with birds, deer, rabbits, etc. Of all the modes by +which maniacs may be induced to restrain themselves, regular employment +is perhaps the most efficacious; and those kind of employments are to be +preferred, both on a moral and physical account, which are accompanied +by considerable bodily action, most agreeable to the patient, and most +opposite to the illusions of his disease.</p> + +<p>In short the patient should be always treated as much like a rational +being as the state of his mind will possibly allow. In order that he may +display his knowledge to the best advantage, such topics should be +introduced as will be most likely to interest him; if he is a mechanic +or an agriculturalist, he should be asked questions relating to his art, +and consulted upon any occasion in which his knowledge may be useful. +These considerations are undoubtedly very material, as they regard the +comforts of insane persons; but they are of far greater importance as +they relate to the cure of the disorder. The patient, feeling himself of +some consequence, is induced to support it by the exertion of his +reason, and by restraining those dispositions, which, if indulged, would +lessen the respectful treatment he wishes to receive, or lower his +character in the eyes of his companions and attendants.</p> + +<p>Even when it is absolutely necessary to employ coercion, if on its +removal the patient promises to control himself, great reliance may +frequently be placed upon his word, and under this engagement, he will +be apt to hold a successful struggle with the violent propensities of +his disorder. Great advantages may also be derived, in the moral +management of maniacs, from an acquaintance with the previous +employment, habits, manners, and prejudices of the individual: this may +truly be considered as indispensably necessary to be known, as far as +can be obtained; and, as it may apply to each case, should be registered +in a book for the inspection of the Committee of the Asylum, and the +physician; the requisite information should be procured immediately on +the admission of each patient; the mode of procuring it will be spoken +of hereafter.</p> + +<p>Nor must we forget to call to our aid, in endeavouring to promote +self-restraint, the mild but powerful influence of the precepts of our +holy religion. Where these have been strongly imbued in early life, they +become little less than principles of our nature; and their restraining +power is frequently felt, even under the delirious excitement of +insanity. To encourage the influence of religious principles over the +mind of the insane, may be considered of great consequence, as a means +of cure, provided it be done <i>with great care and circumspection</i>. For +this purpose, as well as for reasons still more important, it would +certainly be right to promote in the patient, <i>as far as circumstances +would permit</i>, an attention to his accustomed modes of paying homage to +his Maker.</p> + +<p>In pursuing the desirable objects above enumerated, we ought not to +expect too suddenly to reap the good effects of our endeavours; nor +should we too readily be disheartened by occasional disappointments. It +is necessary to call into action, as much as possible, every remaining +power and principle of the mind, and to remember, that, "in the wreck of +the intellect, the affections very frequently survive." Hence the +necessity of considering <i>the degree</i> in which the patient may be +influenced by moral and rational inducements.</p> + +<p>The contradictory features in their characters, frequently render it +exceedingly difficult to insure the proper treatment of insane persons; +to pursue this with any hopes of succeeding, so that we may in any +degree ameliorate their distressed condition, renders it indispensably +necessary that attendants only should be chosen who are possessed of +good sense, and of amiable dispositions, clothed, as much as possible, +with philosophical reflexion, and above all, with that love and charity +that mark the humble Christian.</p> + +<p>Agreeably to these principles, I beg leave to suggest the following +regulations to be adopted, in accomplishing the objects in view.</p> + +<p>1st. No patient shall hereafter be confined by chains.</p> + +<p>2nd. In the most violent states of mania, the patient should be confined +in a room with the windows, etc., closed, so as nearly to exclude the +light, and kept confined if necessary, in a straight jacket, so as to +walk about the room or lie down on the bed at pleasure; or by strops, +etc., he may, particularly if there appears in the patient a strong +determination to self-destruction, be confined on the bed, and the +apparatus so fixed as to allow him to turn and otherwise change his +positions.</p> + +<p>3rd. The power of judicious kindness to be generally exercised, may +often be blessed with good effects, and it is not till after other moral +remedies are exercised, that recourse should be had to restraint, or the +power of fear on the mind of the patient; yet it may be proper +sometimes, by way of punishment, to use the shower bath.</p> + +<p>4th. The common attendants shall not apply any extraordinary coercion by +way of punishment, or change in any degree the mode of treatment +prescribed by the physician; on the contrary, it is considered as their +indispensable duty, to seek by acts of kindness the good opinion of the +patients, so as to govern them by the influence of esteem rather than of +severity.</p> + +<p>5th. On the first day of the week, the Superintendent, or the principal +keeper of the Asylum, shall collect as many of the patients as may +appear to them suitable, and read some chapters in the Bible.</p> + +<p>6th. When it is deemed necessary to apply the strait-jacket, or any +other mode of coercion, by way of punishment or restraint, such an ample +force should be employed as will preclude the idea of resistance from +entering the mind of the patient.</p> + +<p>7th. It shall be the duty of the deputy-keeper, immediately on a patient +being admitted, to obtain his name, age, where born, what has been his +employment or occupation, his general disposition and habits, when first +attacked with mania; if it has been violent or otherwise, the cause of +his disease, if occasioned by religious melancholy, or a fondness for +ardent spirits, if owing to an injury received on any part of the body, +or supposed to arise from any other known cause, hereditary or +adventitious, and the name of the physician who may have attended him, +and his manner of treating the patient while under his direction.</p> + +<p>8th. Such of the patients as may be selected by the physician, or the +Committee of the Asylum, shall be occasionally taken out to walk or ride +under the care of the deputy-keeper; and it shall be also his duty to +employ the patients in such manner, and to provide them with such kinds +of amusements and books as may be approved and directed by the +Committee.</p> + +<p>9th. The female keeper shall endeavour to have the female patients +Constantly employed at suitable work; to provide proper amusements, +books, etc., to take them out to walk as may be directed by the +Committee.</p> + +<p>10th. It shall be the indispensable duty of the keepers, to have all the +patients as clean as possible in their persons, and to preserve great +order and decorum when they sit down to their respective meals.</p> + +<p>11th. It shall be the duty of the physician to keep a book, in which +shall be entered an historical account of each patient, stating his +situation, and the medical and moral treatment used; which book shall be +laid before the Committee, at their weekly meetings.</p> + +<p>The sentiments and improvements proposed in the preceding remarks, for +the consideration of the Governors, are adapted to our present situation +and circumstances; but a further and more extensive improvement has +occurred to my mind, which I conceive, would very considerably conduce +towards affecting the cure, and materially ameliorate the condition, and +add to the comfort of the insane; at the same time that it would afford +an ample +<ins class="correction" +title="Transcriber's note: original reads 'apportunity'">opportunity</ins> +of ascertaining how far that disease may be removed by moral management +alone, which it is believed, will, in many instances, be more effectual +in controlling the maniac, than medical treatment especially, in those +cases where the disease has proceeded from causes operating directly on +the mind.</p> + +<p>I would propose, that a lot, not less than ten acres, should be +purchased by the Governors, conveniently situated, within a few miles of +the city, and to erect a substantial building, on a plan calculated for +the accommodation of fifty lunatic patients; the ground to be improved +in such a manner as to serve for agreeable walks, gardens, etc., for the +exercise and amusement of the patients: this establishment might be +placed under the care and superintendence of the Asylum Committee, and +be visited by them once every week: a particular description of patients +to remain at this Rural Retreat; and such others as might appear +suitable objects might be occasionally removed there from the Asylum.</p> + +<p>The cost and annual expense of supporting this establishment, are +matters of small consideration, when we duly consider the important +advantages it would offer to a portion of our fellow-creatures, who have +such strong claims on our sympathy and commiseration.</p> + +<p>But, it is a fact that can be satisfactorily demonstrated, that such an +establishment would not increase our expenses; and, moreover, would +repay us even the interest of the money that might be necessary to be +advanced, for the purchase of the ground and erecting the buildings. The +board of patients (supposing fifty) would yield two hundred dollars per +week, or ten thousand four hundred dollars per annum.</p> + +<p>Supposing the ground, building, etc., to cost $50,000, the interest on +this sum at 6 per cent. would be $3,000, there would yet remain $7,400, +for the maintenance and support of the establishment; a sum larger than +would be required for that purpose.</p> + +<p>We had lately in the Asylum, more than ninety patients; and, at that +time, had repeated applications to receive an additional number; the +Committee however, concluded, that as the building was not calculated to +accommodate more than seventy-five, it would be an act of injustice to +take in any more; they, therefore, concluded to reduce the number of +seventy-five, and strictly to refuse receiving any beyond that number. +This may serve clearly to show, that we might safely calculate, that we +should readily have applications to accommodate one hundred and +twenty-five patients.</p> + +<p>This succinct view of the subject may suffice, at this time, as outlines +of my plan; and which is respectfully submitted to the Governors, for +their Consideration.</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_23_23'></a><a href='#FNanchor_23_23'>[23]</a><div class='note'><p> "Hints for Introducing an Improved Mode of Treating the +Insane in the Asylum"; read before the Governors of the New York +Hospital on the 4th of Fourth-month, 1815. By Thomas Eddy, one of the +Asylum Committee. New York, 1815. Reprinted Bloomingdale Hospital Press, +1916.</p></div> + +<a name='Footnote_24_24'></a><a href='#FNanchor_24_24'>[24]</a><div class='note'><p> The following anecdotes illustrate the observation before +made, that maniacs frequently retain the power of reasoning to a certain +extent; and that the discerning physician may oftimes successfully avail +himself of the remains of this faculty in controlling the aberrations of +his patient:—A patient in the Pennsylvania Hospital, who called his +physician his father, once lifted his hand to strike him. "What!" said +his physician, (Dr. Rush), with a plaintive tone of voice, "Strike your +father?" The madman dropped his arm, and instantly showed marks of +contrition for his conduct. The following was related to me by Samuel +Coates, President of the Pennsylvania Hospital:—maniac had made several +attempts to set fire to the Hospital: upon being remonstrated with, he +said, "I am a salamander"; "but recollect," said my friend Coates, "all +the patients in the house are not salamanders;" "That is true," said the +maniac, and never afterwards attempted to set fire to the Hospital.</p></div> + + + +<hr style='width: 65%;' /> +<a name='APPENDIX_IV'></a><h2>APPENDIX IV</h2> + +<h3>EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TO +ACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED APRIL, 1815</h3> +<br /> + +<p><i>April 4, 1815.</i></p> + +<p>A communication was received from Thos. Eddy suggesting several +improvements in the mode of treating Insane persons, which is referred +to Dr. Hugh Williamson, George Newbold, William Johnson, Peter A. Jay, +and John R. Murray—Resolved that the Treasurer have fifty copies of the +report printed for use of the Governors.</p> +<br /> + +<p><i>July 3, 1815.</i></p> + +<p>The Committee on the communication from Thos. Eddy, relative to the +treatment of Insane patients, report attention to the subject and that +in their opinion it is advisable to have a few acres of land purchased +in the vicinity of the City for the better accommodation of this unhappy +class of our fellow creatures—the Committee are continued.</p> + +<p>On motion Resolved that Thomas Eddy, John A. Murray, and John Aspinwall, +be a Committee to look out for a suitable spot of land, and to make a +purchase, if in their opinion it shall become necessary.</p> +<br /> + +<p><i>8th Month (August) 1st, 1815.</i></p> + +<p>The Committee on the communication from Thomas Eddy, made the following +Report, which was intended to have been laid before the last meeting of +the Board; which was now accepted, and ordered to be inserted in the +minutes.</p> + +<p>"The Committee appointed to consider the expediency of erecting another +Building for the accommodation of Insane Persons Report:</p> + +<p>That another building for the use of those unfortunate persons who have +lost the use of their reason, is not only advisable, but seems to be +absolutely necessary.</p> + +<p>That though there are at present more patients in the Asylum, by nearly +one third, than can with perfect Safety, and the best hopes of recovery, +be lodged there; many more insane persons, perhaps twenty within a few +months, have by their friends been soliciting a place in that +Building—In speaking of the want of safety, the Committee only mean to +express an opinion, that when two or more insane persons, from the want +of room are lodged together in one cell, the life of the weaker must be +somewhat endangered by the stronger, who in a high Paroxysm of insanity +might strangle him in his sleep, or otherwise destroy him.</p> + +<p>That such additional Building, from the want of room, cannot possibly be +erected near the hospital, in this city.</p> + +<p>That there are many reasons for believing that the recovery from a state +of insanity would be greatly promoted, by having a considerable space of +ground adjoining the Asylum or Public Building, in which many of the +patients might have the privilege of walking, or taking other kinds of +exercise.</p> + +<p>That considering the various kinds of insanity, your Committee, are +clearly of the opinion, that two buildings should be erected at the +distance of at least one hundred yards from each other. The sedate or +melancholy madman should not have his slumbers broken by living under +the same roof with disorderly persons, who by singing, or other noisy +proceedings, will not suffer their neighbours to sleep.</p> + +<p>That for the above and similar considerations, it would be advisable, +to purchase, within a few miles of this City, at least twenty acres of +land, detached from private buildings, in a healthy and pleasant +situation, where the water is good and where materials for buildings may +be obtained on easy terms: and the portage of fuel not expensive.</p> + +<p>Your Committee are aware that a smaller lot of ground might suffice for +all the buildings that are now required, or all this Corporation may, in +a short time, be enabled to complete. But they count it advisable to +prepare for a period that must certainly come; a period in which such a +lot will be needed, and not easily obtained, for it is evident from the +topography, and geographical position of this City, that the time must +come, when New York will be not only the greatest City in the United +States, or in America; but must rival the most distinguished City's in +the old Continent.</p> + +<p>Wherefore it is recommended, that a Committee be appointed, who shall +examine the sundry places, corresponding with the above description, +that may be purchased. And that they report the means of making the +purchase, and of erecting such Buildings, as seem at this time to be +required."</p> + +<p>The Committee to whom was referred, to purchase a suitable Lot of Land +for the erection of a House for the accommodation of maniacs, Report +that they have purchased 38 acres of Land, being part of the Estate +belonging to Gerard Depeyster at Bloomingdale, at the rate of $246. per +acre, payable 25 per cent down, 37½ per cent on 1st November and 37¾ per +cent on 1st February next, with interest.</p> + +<p class="right2"><span class="smcap">Thomas Eddy</span>, Chairman</p> +<br /> + +<p>August 1st, 1815</p> + +<p>Whereupon Resolved that the Report of the Committee be accepted, and +they are instructed to take the Titles, after P.A. Jay shall have +examined the Records, and be satisfied that the property is free of +incumbrance.</p> + + + +<hr style='width: 65%;' /> +<a name='APPENDIX_V'></a><h2>APPENDIX V</h2> + +<h3>ADDRESS TO THE PUBLIC BY THE GOVERNORS 1821<a name='FNanchor_25_25'></a><a href='#Footnote_25_25'><sup>[25]</sup></a></h3> +<br /> + +<p>The Governors of the New-York Hospital have the satisfaction to announce +to the public, the completion of the Asylum for the insane; and that it +will be open for the reception of patients, from any part of the United +States, on the first day of June.</p> + +<p>This Asylum is situated on the Bloomingdale road, about seven miles from +the City Hall of the city of New-York, and about three hundred yards +from the Hudson River. The building is of hewn free-stone, 211 feet in +length, and sixty-feet deep, and is calculated for the accommodation of +about two hundred patients. Its +<ins class="correction" +title="Transcriber's note: original reads 'scite'">site</ins> is elevated, commanding an extensive and delightful view of the +Hudson, the East River, and the Bay and Harbour of New-York, and the +adjacent country, and is one of the most beautiful and healthy spots on +New-York Island. Attached to the building are about seventy acres of +land, a great part of which has been laid out in walks, ornamental +grounds, and extensive gardens.</p> + +<p>This institution has been established by the bounty of the Legislature +of the state of New-York, on the most liberal and enlarged plan, and +with the express design to carry into effect that system of management +of the insane, happily termed <i>moral treatment</i>, the superior efficacy +of which has been demonstrated in several of the Hospitals of Europe, +and especially in that admirable establishment of the Society of +Friends, called +<span class="smcap"> +"The Retreat," +</span> +near York, in England. This mild and +humane mode of treatment, when contrasted with the harsh and cruel +usage, and the severe and unnecessary restraint, which have formerly +disgraced even the most celebrated lunatic asylums, may be considered as +one of the noblest triumphs of pure and enlightened benevolence. But it +is by no means the intention of the governors to rely on moral, to the +exclusion of medical treatment. It is from a judicious combination of +both, that the greatest success is to be expected in every attempt to +cure or mitigate the disease of insanity.</p> + +<p>In the construction of the edifice and in its interior arrangements, it +has been considered important to avoid, as far as practicable, +consistently with a due regard to the safety of the patients, whatever +might impress their minds with the idea of a prison, or a place of +punishment, and to make every thing conduce to their health and to their +ease and comfort. The self-respect and complacency which may thus be +produced in the insane, must have a salutary influence in restoring the +mind to its wonted serenity. In the disposition of the grounds attached +to the Asylum, everything has been done with reference to the amusement, +agreeable occupation, and salutary exercise of the patients.</p> + +<p>Agricultural, horticultural, and mechanical employments, may be resorted +to, whenever the inclination of the patient, or their probable +beneficial effects may render them desirable. To dispel gloomy images, +to break morbid associations, to lead the feelings into their proper +current, and to restore the mind to its natural poise, +<ins class="correction" +title="Transcriber's note: original reads 'varius'">various</ins> +less active amusements +will be provided. Reading, writing, drawing, innocent sports, tending +and feeding domestic animals, &c. will be encouraged as they may be +found conducive to the recovery of the patients. A large garden has been +laid out, orchards have been planted, and yards, containing more than +two acres, have been inclosed for the daily walks of those whose +disorder will not allow more extended indulgence. The plants of the +Elgin Botanic garden, presented to this institution by the Trustees of +Columbia College, have been arranged in a handsome green-house, prepared +for their reception.</p> + +<p>The apartments of the house are adapted to the accommodation of the +patients, according to their sex, degree of disease, habits of life, and +the wishes of their friends. The male and female apartments are entirely +separated, so as to be completely secluded from the view of each other.</p> + +<p>Care has been taken to appoint a Superintendent and Matron, of good +moral and religious characters, possessing cheerful tempers, and kind +dispositions, united with firmness, vigilance and discretion. A +Physician will reside in the house, and one or more Physicians, of +established character and experience, will attend regularly, and afford +medical aid in all cases where the general health, or the particular +cause of the patient's insanity, may require it. The relations or +friends of patients will be at liberty, if they prefer it, to employ +their own physicians, who will be allowed to attend patients, subject to +the general regulations of the house.</p> + +<p>The institution will be regularly visited and inspected by a committee +of the Governors of the Hospital, who will, as often as they may think +it advantageous, be attended by some of the physicians of the city of +high character and respectability.</p> + +<p>The charges for board and the other advantages of the institution, will +be moderate, and proportioned to the different circumstances of the +patients, and the extent of the accommodations desired for them.</p> + +<p>Patients at the expense of the different towns of the state, will be +received at the lowest rate.</p> + +<p>Application for the admission of patients into the Asylum, must be made, +at the New York Hospital, in Broadway, where temporary accommodation +will be provided for such patients as may require it, previously to +their being carried to the Asylum out of town. A committee of the +Governors will, when necessary, attend at the Hospital in Broadway, for +the purpose of admitting patients into the Asylum, and to agree on the +terms and security for payment to be given.</p> + +<p><i>By order of the board of Governors.</i></p> + +<p class="right2"><span class="smcap">Matthew Clarkson</span>, <i>President.</i></p> + +<p><span class="smcap">Thomas Buckley</span>, <i>Secretary.</i></p> + +<p><i>New-York, 10th May, 1821.</i></p> + +<p>N.B. The friends of the patients are requested to send with them an +account of their cases, stating the probable causes of their insanity, +the commencement and peculiar character of the disorder. It is desirable +that this statement, where it is practicable, should be drawn up by a +physician.</p> + +<p>Applications from abroad, for information relative to the admission of +patients, may be made by letters addressed to +<span class="smcap">Thomas Buckley</span>, Secretary +of the New-York Hospital.</p> + +<p>FOOTNOTES:</p> + +<a name='Footnote_25_25'></a><a href='#FNanchor_25_25'>[25]</a><div class='note'><p> Address of the Governors of the New York Hospital to the +Public, Relative to the Asylum for the Insane at Bloomingdale. New York, +May 10th, 1821. Reprinted Bloomingdale Hospital Press, May 1921.</p></div> + + + +<hr style='width: 65%;' /> +<a name='APPENDIX_VI'></a><h2>APPENDIX VI</h2> + +<h3>BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL</h3> + +<h3>1821 AND 1921</h3> +<br /> +<h3>1821</h3> +<center> +Matthew Clarkson, President<br /> +Thomas Eddy, Vice President<br /> +Thomas Franklin<br /> +Jonathan Little<br /> +Thomas Buckley<br /> +William Johnson<br /> +Andrew Morris<br /> +John R. Murray<br /> +John B. Lawrence<br /> +George Newbold<br /> +Ebenezer Stevens<br /> +Peter A. Jay<br /> +Najah Taylor<br /> +Cadwallader D. Colden<br /> +Robert H. Bowne<br /> +Robert I. Murray<br /> +Thomas C. Taylor<br /> +John Adams, Treasurer<br /> +John McComb<br /> +Benjamin W. Rogers, +Assistant Treasurer<br /> +William Bayard<br /> +Nathan Comstock<br /> +Duncan P. Campbell<br /> +Rev. F.C. Schaeffer<br /> +John Clark, Jr.<br /> +William Edgar, Jr. +</center> +<br /> +<h3>1921</h3> +<center> +Hermann H. Cammann<br /> +Henry W. deForest<br /> +Richard Trimble<br /> +Howard Townsend<br /> +George F. Baker<br /> +Augustine J. Smith<br /> +Charles S. Brown<br /> +Edward W. Sheldon, President<br /> +Bronson Winthrop<br /> +Frank K. Sturgis<br /> +David B. Ogden<br /> +Joseph H. Choate, Jr.<br /> +Henry G. Barbey<br /> +Cornelius B. Bliss, Jr.<br /> +Paul Tuckerman, Treasurer<br /> +William Woodward<br /> +Arthur Iselin<br /> +Payne Whitney, Vice President<br /> +G. Beekman Hoppin<br /> +Lewis Cass Ledyard, Jr.<br /> +Henry R. Taylor<br /> +R. Horace Gallatin<br /> +Walter Jennings<br /> +</center> +<br /> + +<h3>BLOOMINGDALE COMMITTEE</h3> +<br /> +<h3>1821</h3> +<center> +Thomas Eddy<br /> +Cadwallader D. Colden<br /> +Thomas C. Taylor<br /> +John Adams<br /> +Thomas Buckley<br /> +John B. Lawrence<br /> +</center> +<br /> +<h3>1921</h3> +<center> +Frank K. Sturgis<br /> +Augustine J. Smith<br /> +Henry R. Taylor<br /> +Henry G. Barbey<br /> +Walter Jennings<br /> +Howard Townsend<br /> +</center> + + +<hr style='width: 65%;' /> +<a name='APPENDIX_VII'></a><h2>APPENDIX VII</h2> + +<h3>ORGANIZATION OF BLOOMINGDALE HOSPITAL</h3> + +<h3>1821 AND 1921</h3> + + +<h3>1821</h3> +<table summary="Job, How Many" width="100%"> +<tr><td width="80%">Superintendent or Warden</td><td>1</td></tr> +<tr><td>Housekeeper</td><td>1</td></tr> +<tr><td>Keepers, Men</td><td>3</td></tr> +<tr><td>Keepers, Women</td><td>2</td></tr> +<tr><td>Chambermaids</td><td>1</td></tr> +<tr><td>Cooks</td><td>3</td></tr> +<tr><td>Baker</td><td>1</td></tr> +<tr><td>Assistant Baker</td><td>1</td></tr> +<tr><td>Dairymaid</td><td>1</td></tr> +<tr><td>Washerwoman</td><td>1</td></tr> +<tr><td>Assistant washerwoman</td><td>1</td></tr> +<tr><td>Yard Keeper</td><td>1</td></tr> +<tr><td>Waitresses</td><td>2</td></tr> +<tr><td>Gardener</td><td>1</td></tr> +<tr><td>Farmer</td><td>1</td></tr> +<tr><td>Assistant farmer</td><td>1</td></tr> +<tr><td> </td><td></td></tr> +<tr><td> Total</td><td>22</td></tr> +<tr><td>Number of patients</td><td>75</td></tr> +</table> +<br /> +<h3>1921</h3> +<br /> +Officers and employees:<br /> +<div class="blkquot2"> +<table summary="Officers and employees" width="30%"> +<tr><td width="20%">Men</td><td align="right">217</td></tr> +<tr><td>Women</td><td align="right">195</td></tr> +<tr><td></td><td align="right">——</td></tr> +<tr><td>Total</td><td align="right">412</td></tr> +</table> +</div> +<br /> +Patients:<br /> +<div class="blkquot2"> +<table summary="Patients" width="30%"> +<tr><td width="20%">Men</td><td align="right">132</td></tr> +<tr><td>Women</td><td align="right">156</td></tr> +<tr><td></td><td align="right">——</td></tr> +<tr><td>Total</td><td align="right">288</td></tr> +</table> +</div> +<br /> +<table summary="Job, How Many" width="100%"> +<tr><td width="80%"><span class="org0">General Administration:</span></td></tr> +<tr><td><span class="org2">Medical Superintendent</span></td><td>1</td></tr> +<tr><td><span class="org2">Steward</span></td><td>1-2</td></tr> +<tr><td><span class="org0">Clinical and Laboratory Service:</span></td></tr> +<tr><td><span class="org2">Physicians:</span></td></tr> +<tr><td><span class="org4">Resident</span></td><td>9</td></tr> +<tr><td><span class="org4">Consultants</span></td><td>3</td></tr> +<tr><td><span class="org2">Dentist</span></td><td>1</td></tr> +<tr><td><span class="org2">Assistant</span></td><td>1</td></tr> +<tr><td><span class="org2">Apothecary</span></td><td>1</td></tr> +<tr><td><span class="org2">Technicians</span></td><td>2</td></tr> +<tr><td><span class="org2">Stenographers</span></td><td>5-22</td></tr> +<tr><td><span class="org0">Nursing Service</span>:</td></tr> +<tr><td><span class="org2">Director, Assistant, and Instructor</span></td><td>3</td></tr> +<tr><td><span class="org2">Nurses, attendants, and pupils</span></td><td>135</td></tr> +<tr><td><span class="org2">Maids and porters</span></td><td>46-184</td></tr> +<tr><td><span class="org0">Occupational Therapy</span></td><td>13</td></tr> +<tr><td><span class="org0">Physical Training</span></td><td>7</td></tr> +<tr><td><span class="org0">Hydrotherapy and Massage</span></td><td>5</td></tr> +<tr><td><span class="org0">Dietary Department</span></td><td>25</td></tr> +<tr><td><span class="org0">Housekeeping and Laundry Departments</span></td><td>60</td></tr> +<tr><td><span class="org0">Financial, Purchasing, and Supplies</span></td><td>10</td></tr> +<tr><td><span class="org0">Engineering Department</span></td><td>18</td></tr> +<tr><td><span class="org0">Building Department</span></td><td>20</td></tr> +<tr><td><span class="org0">Industrial Department</span></td><td>5</td></tr> +<tr><td><span class="org0">Farm and Grounds</span></td><td>38</td></tr> +<tr><td><span class="org0">Miscellaneous</span></td><td>8</td></tr> +<tr><td><span class="org2">Chaplain, Librarian, Watchmen, +Telephonists, Postal Clerk, Barber.</span></td></tr> +</table> + +<h3>STATISTICS: 1821-1921</h3> + +<table summary="Type of Cases, Number" width="80%" align="center"> +<tr><td>Number of cases admitted 1821 to 1921</td><td align="right">13,411</td></tr> +<tr><td>Number discharged recovered 1821 to 1921</td><td align="right">4,651</td></tr> +<tr><td>Number discharged improved 1821 to 1921</td><td align="right">3,873</td></tr> +</table> + + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of A Psychiatric Milestone, edited by +Howard Townsend, Bronson Winthrop and R. 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Horace Gallatin + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: A Psychiatric Milestone + Bloomingdale Hospital Centenary, 1821-1921 + +Author: Various + +Editor: Howard Townsend + Bronson Winthrop + R. Horace Gallatin + +Release Date: March 14, 2005 [EBook #15365] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK A PSYCHIATRIC MILESTONE *** + + + + +Produced by Suzanne Lybarger, Kathryn Lybarger and the +Online Distributed Proofreading Team. + + + + + + +[Illustration: THE NEW YORK HOSPITAL, DUANE STREET AND BROADWAY + +The building to the left was erected in 1808 for the exclusive use of +patients suffering from mental disorders.] + + +A PSYCHIATRIC MILESTONE + +BLOOMINGDALE HOSPITAL CENTENARY + +1821-1921 + + "Cum corpore ut una +Crescere sentimus, pariterque senescere mentem." + --LUCRETIUS + +PRIVATELY PRINTED + +BY THE SOCIETY OF THE NEW YORK HOSPITAL + +1921 + + +ANNIVERSARY COMMITTEE + +HOWARD TOWNSEND +BRONSON WINTHROP +R. HORACE GALLATIN + + + + +PREFACE + + +The opening of Bloomingdale Asylum on June 1, 1821, was an important +event in the treatment of mental disorders and in the progress of +humanitarian and scientific work in America. Hospital treatment for +persons suffering from mental disorders had been furnished by the New +York Hospital since its opening in 1792, and the Governors had given +much thought and effort to securing the facilities needed. The treatment +consisted, however, principally in the administration of drugs and the +employment of such other physical measures as were in vogue at that +time. Little attempt was made to study the minds of the patients or to +treat them by measures directed specifically to influencing their +thoughts, feelings, and behavior, and what treatment of this character +there was had for its object little more than the repression of +excitement and disordered activity. The value and importance of +treatment directed to the mind had, indeed, been long recognized, but in +practice it had been subordinated to treatment of the actual and assumed +physical disorders to which the mental state of the patient was +attributed, and, in the few hospitals where persons suffering from +mental disorders were received, means for its application were almost or +quite entirely lacking. The establishment of Bloomingdale Asylum for the +purpose of ascertaining to what extent the recovery of the patients +might be accomplished by moral as well as by purely medical treatment +marked, therefore, the very earliest stages of the development in +America of the system of study and treatment of mental disorders which +with increasing amplification and precision is now universally employed. + +A hundred years of growth and activity in the work thus established have +now been accomplished, and it seemed fitting to the Governors of the +Hospital that the event should be commemorated in a way that would be +appropriate to its significance and importance. It was decided that the +principal place in the celebration should be given to the purely medical +and scientific aspects of the work, with special reference to the +progress which had been made in the direction of the practical +usefulness of psychiatry in the treatment of illness generally, and in +the management of problems of human behavior and welfare. Arrangements +were made for four addresses by physicians of conspicuous eminence in +their particular fields, and invitations to attend the exercises were +sent to the leading psychiatrists, psychologists, and neurologists of +America, and to others who were known to be specially interested in the +field of study and practice in which the Hospital is engaged. It was +felt that, in view of the place which France and England had held in the +movement in which Bloomingdale Asylum had its origin, it would add +greatly to the interest and value of the celebration if representatives +of these countries were present and made addresses. How fortunate it +was, then, that it became possible to welcome from France Dr. Pierre +Janet, who stands pre-eminent in the field of psychopathology, and from +England Dr. Richard G. Rows, whose contributions to the study and +treatment of the war neuroses and to the relation between psychic and +physical reactions marked him as especially qualified to present the +more advanced view-point of British psychiatry. The other two principal +addresses were made by Dr. Adolf Meyer, who, by reason of his scientific +contributions and his wonderfully productive practical work in clinical +and organized psychiatry and in mental hygiene, is the acknowledged +leader of psychiatry in America, and by Dr. Lewellys F. Barker, who, +because of his eminence as an internist and of the extent to which he +has advocated and employed psychiatric knowledge and methods in his +practice, has contributed greatly to interesting and informing +physicians concerning the value and importance of psychiatry in general +medical practice. The addresses given by these distinguished physicians, +representing advanced views in psychiatry held in Europe and America, +were peculiarly appropriate to the occasion and to the object of the +celebration. They were supplemented by an historical review of the +origin and development of the Hospital and of its work by Mr. Edward W. +Sheldon, President of the Society of the New York Hospital, and by a +statement concerning the medical development, made by Dr. William L. +Russell, the Medical Superintendent. The greetings of the New York +Academy of Medicine were presented in an interesting address by Dr. +George D. Stewart, President of the Academy. + +Of scarcely less significance and interest than the addresses was the +pageant presented on the lawn during the intermission between the +sessions, depicting scenes and incidents illustrating the origin and +development of the Hospital, and of psychiatry and mental hygiene. The +text and the scenes displayed were prepared by Dr. Charles I. Lambert, +First Assistant Physician of the Hospital, and by Mrs. Adelyn Wesley, +who directed the performance and acted as narrator. The performers were +persons who were connected with the Hospital, twenty-two of whom were +patients. + +The celebration was held on May 26, 1921. The weather was exceptionally +clear, with bright sunshine and moderate temperature. The grounds, in +their Spring dress of fresh leaves and flowers, were especially +beautiful. This added much to the attractiveness of the occasion and the +pleasure of those who attended. Luncheon was served on the lawn in front +of the Brown Villa and the pageant was presented on the adjoining +recreation grounds. The beauty of the day and the surroundings, the +character of the addresses and of the speakers, the remarkable felicity +and grace with which they were introduced by the President, the dignity +and noble idealism of his closing words, and the distinguished character +of the audience, all contributed to make the celebration one of +exceptional interest and value to those who were present, and a notable +event in the history of the Hospital. + +For the purpose of preserving, and of perhaps extending to some who were +not present, the spirit of the occasion, and of placing in permanent +form an account of the proceedings and the addresses which were made, +this volume has been published by the Society of the New York Hospital. + +WILLIAM L. RUSSELL. + + + + +CONTENTS + + Page +PREFACE vii + +INVOCATION 3 + REV. FRANK H. SIMMONDS + +HISTORICAL REVIEW 7 + EDWARD W. SHELDON, ESQ. + President of the Society of the New York Hospital + +"THE CONTRIBUTIONS OF PSYCHIATRY TO THE UNDERSTANDING OF LIFE PROBLEMS" 17 + ADOLF MEYER, M.D. + Director of the Henry Phipps Psychiatric Clinic, Johns Hopkins + Hospital, and Professor of Psychiatry, Johns Hopkins University, + Baltimore, Maryland + +"THE IMPORTANCE OF PSYCHIATRY IN GENERAL MEDICAL PRACTICE" 55 + LEWELLYS F. BARKER, M.D. + Professor of Clinical Medicine, Johns Hopkins Medical School, + Baltimore, Maryland + +GREETINGS FROM THE NEW YORK ACADEMY OF MEDICINE 79 + GEORGE D. STEWART, M.D. + President of the Academy + +"THE BIOLOGICAL SIGNIFICANCE OF MENTAL ILLNESS" 89 + RICHARD G. ROWS, M.D. + Director of the Section on Mental Illnesses of the Special + Neurological Hospital, Tooting, London, England + +"THE RELATION OF THE NEUROSES TO THE PSYCHOSES" 115 + PIERRE JANET, M.D. + Professor of Psychology, College de France + +"THE MEDICAL DEVELOPMENT OF BLOOMINGDALE HOSPITAL" 147 + WILLIAM L. RUSSELL, M.D. + Medical Superintendent + +THE TABLEAU-PAGEANT 171 + +NAMES OF THOSE WHO ATTENDED THE EXERCISES 177 + +APPENDIX I 191 + COMMUNICATIONS FROM DR. BEDFORD PIERCE + Medical Superintendent of The Retreat, York, England + EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE RETREAT, + APRIL 30, 1921. + TRANSCRIPT FROM THE VISITORS BOOK OF THE RETREAT, 1803-17. + +APPENDIX II 195 + A LETTER ON PAUPER LUNATIC ASYLUMS FROM SAMUEL TUKE TO + THOMAS EDDY, 1815. + +APPENDIX III 200 + THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815. + +APPENDIX IV 209 + EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TO + ACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED + APRIL, 1815. + +APPENDIX V 212 + ADDRESS TO THE PUBLIC BY THE GOVERNORS, 1821. + +APPENDIX VI 216 + BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL, 1821 + AND 1921. + +APPENDIX VII 218 + ORGANIZATION OF BLOOMINGDALE HOSPITAL, 1821 AND 1921. + + + + +ILLUSTRATIONS + +New York Hospital and Lunatic Asylum, 1808 _Frontispiece_ + FACING PAGE +Bloomingdale Asylum, 1821 2 +Bloomingdale Asylum, 1894 80 +Bloomingdale Hospital, 1921 148 +The Tableau-Pageant 172 +Thomas Eddy 195 + + + + +THE SOCIETY OF THE NEW YORK HOSPITAL + + + + +[Illustration: BLOOMINGDALE ASYLUM + +As it appeared when it was opened in 1821. It was located near the seven +mile stone on the Bloomingdale Road, now 116th Street and Broadway.] + + + + +BLOOMINGDALE HOSPITAL CENTENARY + + +The One Hundredth Anniversary of the establishment of Bloomingdale +Hospital as a separate department for mental diseases of The Society of +the New York Hospital was celebrated at the Hospital at White Plains on +Thursday, May 26, 1921. The addresses were given in the Assembly Hall. + +Mr. Edward W. Sheldon, the President of the Society, acted as Chairman. + + +MORNING SESSION + +The exercises opened with an invocation by the Reverend Frank H. +Simmonds, rector of Grace Episcopal Church at White Plains: + +Oh, most mighty and all-merciful God, whose power is over all Thy works, +who willest that all men shall glorify Thee in the constant bringing to +perfection those powers of Thine which shall more and more make perfect +the beings of Thy creation, we glorify Thee in the gift of Thy Divine +Son Jesus Christ, the Great Physician of our souls, the Sun of +Righteousness arising with healing in His wings, who disposeth every +great and little incident to the glory of God the Father, and to the +comfort of them that love and serve him, we render thanks to Thee and +glorify Thy Name, this day, which brings to completion the hundredth +anniversary of this noble institution's birthday. Oh, Thou, who didst +put it into the hearts and minds of men to dedicate their lives and +fortunes to the advancement of science and medicine for the sick and +afflicted, we render Thee most high praise and hearty thanks for the +grace and virtue of the founders of this institution--men whose names +are written in the Golden Book of life as those who loved their fellow +men. + +We praise Thee for such men as Thomas Eddy, James Macdonald, Pliny +Earle, and these endless others, who from age to age have held high the +torch of knowledge and have kept before them the golden rule of service. +Inasmuch as ye have done it unto one of the least of these my brethren, +ye have done it unto me. + +Be pleased, oh merciful Father, to bless this day and gathering. Lift up +and enlighten our hearts and minds to a higher perception of all that is +noble, all that is true, all that is merciful. Awaken our dull senses to +the full knowledge of light in Thee, and may all that is said and done +be with the guiding of Thy Holy Spirit. + +We pray for the continued blessing of this institution and hospital, and +on all those who are striving to bring out of darkness those unhappy +souls, into the pure light of understanding. + +Bless the Governors, physicians, and nurses, direct their judgments, +prosper their undertakings, and dispose their ministry that the world +may feel the blessing and comfort of life in the prevention of disease +and the preservation of health. And may we all be gathered in this +nation to a more perfect unity of life and purpose in the desire to +spend and be spent in the service of our fellow men. + +We ask it all in the name and through the mediation of Thy Son Jesus +Christ, our Lord. Amen. + + + + +ADDRESS BY +MR. EDWARD W. SHELDON + +MR. SHELDON + + +It is with profound gratification that the Governors welcome your +generous presence to-day on an occasion which means so much to us and +which has perhaps some general significance. For we are met in honor of +what is almost a unique event in our national history, the centennial +anniversary celebration of an exclusively psychopathic hospital. A +summary of its origin and development may be appropriate. + +A hundred and fifty years ago the only institutions on this side of the +Atlantic which cared for mental diseases were the Pennsylvania Hospital, +chartered in 1751, a private general hospital which had accommodations +for a few mental cases, and the Eastern State Hospital for the insane, +at Williamsburg, Virginia, a public institution incorporated in 1768. No +other one of the thirteen Colonies had a hospital of any kind, general +or special. With a view of remedying this deplorable lack in New York, +steps were taken in 1769 to establish an adequate general hospital in +the City of New York. This resulted in the grant, on June 11, 1771, of +the Royal Charter of The Society of the New York Hospital. Soon +afterward the construction of the Hospital buildings began on a spacious +tract on lower Broadway opposite Pearl Street, in which provision was +also to be made for mental cases; but before any patients could be +admitted, an accidental fire, in February, 1775, consumed the interior +of the buildings. Reconstruction was immediately undertaken and +completed early in the spring of 1776. But by that time the +Revolutionary War was in full course, and the buildings were taken over +by the Continental authorities as barracks for troops, and were +surrounded by fortifications. When the British captured the city in +September, 1776, they made the same use of the buildings for their own +troops, who remained there until 1783. A long period of readjustment +then ensued, and it was not until January, 1791, that the Hospital was +at last opened to patients. In September, 1792, the Governors directed +the admission of the first mental case, and for the hundred and +twenty-nine years since that time the Society has continuously devoted a +part of its effort to the care of the mentally diseased. After a few +years a separate building for them was deemed desirable, and was +constructed. The State assisted this expansion of the Hospital by +appropriating to the Society $12,500 a year for fifty years. This new +building housed comfortably seventy-five patients, but ten years later +even this proved inadequate in size and undesirable in surroundings. In +the meanwhile a wave of reform in the care of the insane was rising in +Europe under the influence of such benefactors as Philippe Pinel in +France, and William and Samuel Tuke in England. Thomas Eddy, a +philanthropic Quaker Governor of the Society, who was then its Treasurer +and afterward in succession its Vice-President and President, becoming +aware of this movement, and having made a special study of the care and +cure of mental affections, presented a communication to the Governors in +which he advocated a change in the medical treatment, and in particular +the adoption of the so-called moral management similar to that pursued +by the Tukes at The Retreat, in Yorkshire, England. This memorable +communication was printed by the Governors, and constitutes one of the +first of the systematic attempts made in the United States to put this +important medical subject on a humane and scientific basis. To carry out +his plan, Mr. Eddy urged the purchase of a large tract of land near the +city and the erection of suitable buildings. He ventured the moderate +estimate that the population of the city, then about 110,000, might be +doubled by 1836, and quadrupled by 1856. In fact, it was more than +doubled in those first twenty years, and sextupled in the second +twenty. He was justified, therefore, in believing that the hospital +site on lower Broadway would soon be surrounded by a dense population, +and quite unsuited for the efficient care of mental diseases. The +Governors gave these recommendations immediate and favorable +consideration. Various tracts of land, containing in all about +seventy-seven acres, and lying on the historic Harlem Heights between +what are now Riverside Drive and Columbus Avenue, and 107th and 120th +Streets, were subsequently bought by the Society for about $31,000. To +aid in the construction and maintenance of the necessary hospital +buildings, the Legislature, by an act reciting that there was no other +institution in the State where insane patients could be accommodated, +and that humanity and the interest of the State required that provision +should be made for their care and cure, granted an additional annual +appropriation of $10,000 to the Society from 1816 until 1857. The main +Hospital, built of brownstone, stood where the massive library of +Columbia University now is, and the brick building still standing at the +northeast corner of Broadway and 116th Street was the residence of the +Medical Superintendent. The only access to this site by land was over +what was known as the Bloomingdale Road, running from Broadway and 23d +Street through the Bloomingdale district on the North River to 116th +Street, and from that fact our institution assumed the name of +Bloomingdale Asylum, or, as it is now called, Bloomingdale Hospital. +This beautiful elevated site overlooking the Hudson River and the Harlem +River was admirably fitted for its purpose. The spacious tract of land, +laid out in walks and gardens, an extensive grove of trees, generous +playgrounds and ample greenhouses, combined to give the spot unusual +beauty and efficiency. This notable work finished, the Governors of the +Society issued on May 10, 1821, an "Address to the Public"[1] which +marks so great an advance in psychiatry in our country that it deserves +study. The national character of the institution was indicated in the +opening paragraph, where it announced that the Asylum would be open for +the reception of patients from any part of the United States on the +first of the following June. Accommodation for 200 patients was +provided, and to these new surroundings were removed on that day all the +mental cases then under treatment at the New York Hospital on lower +Broadway. + +In this retired and ideal spot the work of Bloomingdale Hospital was +successfully prosecuted for three-quarters of a century. But the seven +miles that separated it from the old hospital was steadily built over, +and before fifty years had gone the growth of the city had passed the +asylum grounds. Foreseeing that they could not maintain that verdant +oasis intact for many years longer, the Governors, in 1868, bought this +300-acre tract on the outskirts of the Village of White Plains. After +prolonged consideration of the time and method of development of the +property, final plans were adopted in December, 1891, construction was +begun May 1, 1892, and two years later, under the direction of our +Medical Superintendent, Dr. Samuel B. Lyon, all the patients were moved +from the old to this new Bloomingdale. The cost of the new buildings was +about $1,500,000. From time to time the original Bloomingdale site was +sold and now supplies room, among other structures, for Columbia +University, Barnard College, the Cathedral of St. John the Divine, St. +Luke's Hospital, the Woman's Hospital, and the National Academy of +Design. With the proceeds of those sales of the old Bloomingdale, not +only was the cost of the new Bloomingdale met, but the permanent +endowment of the Society was substantially increased, and Thomas Eddy +was proved to have been both a wise humanitarian and a far-sighted +steward of charitable funds. + +In their "Address to the Public" to which I have referred, issued when +Bloomingdale Hospital was opened in 1821, the Governors of the Society +spoke of the new conception of moral treatment of the mentally afflicted +which had been established in several European hospitals and which was +supplanting the harsh and cruel usage of former days, as "one of the +noblest triumphs of pure and enlightened benevolence." In that same +spirit those founders dedicated themselves to the conduct of this +institution. Their devotion to the work was impressive. Looking back on +those early days we see a constant personal attention to the details of +institutional life that commands admiration. The standards then set have +become a tradition that has been preserved unbroken for a hundred years. +Humane methods of care, the progressively best that medical science can +devise, the utilization of a growingly productive pursuit of research, +have consistently marked the administration of this great trust. The +Governors of to-day are as determined as any of their predecessors to +maintain that ideal of "pure and enlightened benevolence." New paths are +opening and larger resources are becoming available. Under the guidance +of our distinguished Medical Superintendent, with his able and devoted +staff of physicians, a broader and more intensive development is +already under way. Animated by that resolve and cheered by that +prospect, we may thus confidently hope, as we begin the second century +of Bloomingdale's career, for results not less fruitful and gratifying +than those which we celebrate to-day. + +FOOTNOTES: + +[Footnote 1: Address of the Governors of the New York Hospital, to the +Public, relative to the Asylum for the Insane at Bloomingdale, New York, +May 10th, 1821. Reprinted by Bloomingdale Hospital Press, White Plains, +May 26, 1921. See Appendix V, p. 212.] + + + + +ADDRESS BY +DR. ADOLF MEYER + + +_The Chairman_: In celebrating our centenary we are naturally dealing +also with the larger subject of general psychiatry. Our success in this +discussion should be materially promoted by the presence with us of Dr. +Adolf Meyer, Professor of Psychiatry in the Medical School of Johns +Hopkins University, and Director of the Phipps Psychiatric Clinic, of +Baltimore. Before taking up this important work in that famous medical +centre, Dr. Meyer was actively engaged for several years in psychopathic +work in New York. He will speak to us on "THE CONTRIBUTIONS OF +PSYCHIATRY TO THE UNDERSTANDING OF LIFE PROBLEMS." + + +DR. MEYER + +When Dr. Russell honored me with the invitation to speak at this +centenary celebration of the renowned Bloomingdale Hospital, my +immediate impulse was to choose as my topic a phase of psychiatric +development to which this Hospital has especially contributed through +our greatly missed August Hoch and his deeply appreciated coworker +Amsden. I have in mind the great gain in concreteness of the physician's +work with mind and the resulting contribution of psychiatry to a better +knowledge of human life and its problems. The great gain this passing +century is able to hand on to its successor is the clearer recognition +of just what the psychiatrist actually works with and works on. + +Of all the divisions of medicine, psychiatry has suffered longest from +man's groping for a conception of his own nature. Psychiatry means, +literally, the healing of souls. What then do we actually mean by soul +or by psyche? This question has too long been treated as a disturbing +puzzle. + +To-day we feel that modern psychiatry has found itself--through the +discovery that, after all, the uncritical common-sense view of mind and +soul is not so far remote from a critical common-sense view of the +individual and its life activity, freed from the forbidding and +confusing assumptions through which the concept of mind and soul has +been held in bewildering awe. + +Strange to say, good old Aristotle was nearer an understanding than most +of the wise men and women that have succeeded him for these more than +two thousand years. He saw in the psyche what he called the form and +realization or fulfilment of the human organism; he would probably now +say with us, the activity and function as an individual or person. + +Through the disharmonies and inevitable disruption of a +self-disorganizing civilization, the Greek and Roman world was plunged +into the dark centuries during which the perils of the soul and the +sacrificial attainment of salvation by monastic life and crusades +threatened to overshadow all other concern. This had some inevitable +results: it favored all those views through which the soul became like a +special thing or substance, in contrast to and yet a counterpart of the +physical body. As long as there was no objective experimental science, +the culminating solution of life problems had to be intrusted to that +remarkable development of religious philosophy which arose from the +blending of Hebrew religion and tradition and the loftiest products of +the Greek mind, in the form which St. Paul and the early Church fathers +gave to the teachings of Christ. From being the form and activation, or +function, of the organism in life, the soul feature of man was given an +appearance in which it could neither be grasped nor understood, nor +shaped, nor guided by man when it got into trouble. From the Middle Ages +there arose an artificial soul and an artificial world of souls +presented as being in eternal conflict with the evil of the flesh--_and +thus the house of human nature was divided against itself_. + +Science of the nineteenth century came nearer bringing mind and body +together again. The new astronomical conception of the world and the +growing objective experimental science gradually began to command +confidence, and from being a destroyer of excessively dogmatic notions, +science began to rise to its modern constructive and creative position. +But the problem of _mind_ remained on a wrong basis and still does so +even with most scientists. Too much had been claimed for the psyche, and +because of the singling out of a great world of spirit, the world of +fact had been compromised and left cold and dry and unattractive and +unpromising. No doubt it was necessary that the scientist should become +hardened and weaned from all misleading expectation, and shy of all the +spurious claims of sordid superstition and of childish fancy. He may +have been unduly radical in cutting out everything that in any way +recalled the misleading notions. In the end, we had to go through a +stage of psychology without a "soul," and lately even a psychology +without "consciousness," so that we might be safe from unscientific +pretensions. All the gyrations no doubt tended to retard the wholesome +practical attack upon the problems in the form in which we find them in +our common-sense life. + +The first effort at a fresh start tried to explain everything rather +one-sidedly out of the meagre knowledge of the body. Spinoza had said in +his remarkable Ethics (III, Prop. II, Schol.): "Nobody has thus far +determined what the body can do, _i.e._, nobody has as yet shown by +experience and trial what the body can do by the laws of nature alone in +so far as nature is considered merely as corporeal and extended, and +what it cannot do save when determined by mind." + +This challenge of Spinoza's had to be met. With some investigators this +seemed very literally all there was to be done about the study of +man--to show how far the body could explain the activity we call "the +mind." The unfortunate feature was that they thought they had to start +with a body not only with mind and soul left out but also with +practical disregard of the whole natural setting. They studied little +more than corpses and experimental animals, and many a critic wondered +how such a corpse or a frog could ever show any mind, normal or +abnormal. To get things balanced again, the vision of man had to expand +to take a sane and practical view of all of human life--not only of its +machinery. + +The human organism can never exist without its setting in the world. All +we are and do is of the world and in the world. The great mistake of an +overambitious science has been the desire to study man altogether as a +mere sum of parts, if possible of atoms, or now of electrons, and as a +machine, detached, by itself, because at least some points in the +simpler sciences could be studied to the best advantage with this method +of the so-called elementalist. It was a long time before willingness to +see the large groups of facts, in their broad relations as well as in +their inner structure, finally gave us the concept and vision of +integration which now fits man as a live unit and transformer of energy +into the world of fact and makes him frankly a consciously integrated +psychobiological individual and member of a social group. + +It is natural enough that man should want to travel on the road he knows +and likes best. The philosopher uses his logic and analysis and +synthesis. The introspectionist wants to get at the riddle of the +universe by crawling into the innermost depth of his own self-scrutiny, +even at the risk--to use a homely phrase--of drawing the hole in after +him and losing all connection with the objective world. The physicist +follows the reverse course. He gives us the appreciation of the +objective world around and in us. The chemist follows out the analytic +and synthetic possibilities of his atoms and elements, and the biologist +the growth and reproduction and multiplication of cells. Each sees an +open world of possibilities and is ready to follow as far as facts will +carry and as far as the imagination will soar. Each branch has created +its rules of the game culminating in the concept of objective science, +and the last set of facts to bring itself under the rules of objective +science, and to be accepted, has been man as a unit and personality. + +The mind and soul of man have indeed had a hard time. To this day, +investigators have suffered under the dogma that mind must be treated as +purely subjective entity, something that can be studied only by +introspection, or at least only with ultra-accurate instruments--always +with the idea that common sense is all wrong in its psychology. +Undoubtedly it was, so long as it spoke of a mind and soul as if what +was called so had to be, even during life, mysterious and inaccessible, +something quite different from any other fact of natural-history study. + +The great step was taken when all of life was seen again in its broad +relations, without any special theory but frankly as common sense finds +it, viz., as the activities and behavior of definite individuals--very +much as Aristotle had put it--"living organisms in their 'form' or +activity and behavior." Psychology had to wake up to studying other +minds as well as one's own. Common sense has always been willing to +study other persons besides our own selves, and that exactly as we study +single organs--viz., for what they are and do and for the conditions of +success and failure. Nor do we have to start necessarily from so-called +elements. Progress cannot be made merely out of details. It will not do +merely to pile up fragments and to expect the aggregates to form +themselves. It also takes a friend of facts with the capacity for +mustering and unifying them, as the general musters his army. Biology +had to have evolutionists and its Darwin to get on a broad basis to +start with, and human biology, the life of man, similarly had to be +conceived in a new spirit, with a clear recognition of the opportunities +for the study of detail about the brain and about the conditions for +its working and its proper support, but also with a clear vision of the +whole man and all that his happiness and efficiency depend upon. + +All this evolution is strongly reflected in the actual work of +psychiatry and medicine. For a time, it looked to the physician as if +the physiology and pathology of the body had to make it their ambition +to make wholly unnecessary what traditional psychology had accumulated, +by turning it all into brain physiology. The "psychological" facts +involved were undoubtedly more difficult to control, so much so that one +tried to cut them out altogether. As if foreshadowing the later academic +"psychology without soul and consciousness," the venerable +Superintendent of Utica, Dr. Gray, was very proud when in 1870 he had +eliminated the "mental and moral causes" from his statistics of the +Utica State Hospital, hiding behind the dogma that "mind cannot become +diseased, but only the body." To-day "mental and moral causes" are +recognized again in truer form--no longer as mere ideas and +uninvestigated suppositions taken from uncritical histories, but as +concrete and critically studied life situations and life factors and +life problems. Our patients are not sick merely in an abstract mind, but +by actually living in ways which put their mind and the entire organism +and its activity in jeopardy, and we are now free to see how this +happens--since we study the biography and life history, the resources of +adaptation and of shaping the life to success or to failure. + +The study of life problems always concerns itself with the interaction +of an individual organism with life situations. The first result of a +recognition of this fact was a more whole-hearted and practical concept +of personality. + +In 1903 I put together for the first time my analysis of the neurotic +personality, which was soon followed by a series of studies on the +influences of the mental factors, and in 1908 a paper on "What Do +Histories of Cases of Insanity Teach Us Concerning Preventive Mental +Hygiene During the Years of School Life?" All this was using for +psychiatry the growing appreciation of a broad biological view-point in +its concrete application. It was a reaction against the peculiar fear of +studying the facts of life simply and directly as we find and experience +them--scoffed at because it looked as if one was not dealing with +dependable and effective data. Many of the factors mentioned as causes +do not have the claimed effects with sufficient regularity. It is quite +true that not everybody is liable to any serious upset by several of the +handicaps sometimes found to be disastrous during the years of +development; but we have learned to see more clearly why the one person +does and the other does not suffer. Evidently, not everybody who is +reserved and retiring need be in danger of mental disorder, yet there +are persons of just this type of make-up that are less able than others +to stand the strains of isolation, of inferiority feeling, of exalted +ambitions and one-sided longings, intolerable desires, etc. The same +individual difference of susceptibility holds even for alcohol. With +this recognition we came to lay stress again on the specific factors +which make for the deterioration of habits, for tantrums with +imaginations, and for drifting into abnormal behavior, and conditions +incompatible with health. + +It was at this point that our great indebtedness to the Bloomingdale +Hospital began. Dr. August Hoch, then First Assistant of the +Bloomingdale Hospital, began to swing more and more toward the +psychobiological trend of views, and with his devoted and very able +friend Amsden he compiled that remarkable outline,[2] which was the +first attempt to reduce the new ideals of psychobiology to a practical +scheme of personality study--that clear and plain questionnaire going +directly at human traits and reactions such as we all know and can see +at work without any special theories or instruments. + +After studying in each patient all the non-mental disorders such as +infections, intoxications, and the like, we can now also attack the +problems of life which can be understood only in terms of plain and +intelligible human relations and activities, and thus we have learned to +meet on concrete ground the real essence of mind and soul--the plain and +intelligible human activities and relations to self and others. There +are in the life records of our patients certain ever-returning +tendencies and situations which a psychiatry of exclusive brain +speculation, auto-intoxications, focal infections, and internal +secretions could never have discovered. + +Much is gained by the frank recognition that man is fundamentally a +social being. There are reactions in us which only contacts and +relations with other human beings can bring out. We must study men as +mutual reagents in personal affections and aversions and their +conflicts; in the desires and satisfactions of the simpler appetites for +food and personal necessities; in the natural interplay of anticipation +and fulfilment of desires and their occasional frustration; in the +selection of companionship which works helpfully or otherwise--for the +moment or more lastingly throughout the many vicissitudes of life. All +through we find situations which create a more or less personal bias and +chances for success or failure, such as simpler types of existence do +not produce. They create new problems, and produce some individuals of +great sensitiveness and others with immunity--and in this great field +nothing will replace a simple study of the life factors and the social +and personal life problems and their working--the study of the real mind +and the real soul--_i.e._, human life itself. Looking back then this +practical turn has changed greatly the general view as to what should be +the chief concern of psychology. One only need take up a book on +psychology to see what a strong desire there always was to contrast a +pure psychology and an applied psychology, and to base a new science +directly on the new acquisitions of the primary sciences such as anatomy +and histology of the nervous system. There was a quest for the elements +of mind and their immediate correlation with the latest discoveries in +the structure of the brain. The centre theory and the cell and neurone +theory seemed obligatory starting-points. To-day we have become shy of +such postulates of one-sided not sufficiently functional materialism. We +now call for an interest in psychobiological facts in terms of critical +common sense and in their own right--largely a product of psychiatry. +There always is a place for elements, but there certainly is also a +place for the large momentous facts of human life just as we find and +live it. + +Thus psychiatry has opened to us new conceptions and understandings of +the relation of child and mother, child and father, the child as a +reagent to the relations between mother and father, brothers and +sisters, companions and community--in the competitions of real concrete +life. It has furnished a concrete setting for the interplay of emotions +and their effects. + +It has led us from a cold dogma of blind heredity and a wholesale +fatalistic asylum scheme, to an understanding of individual, familiar, +and social adjustments, and a grasp on the factors which we can consider +individually and socially modifiable. We have passed from giving mere +wholesale advice to a conscientious study of the problems of each unit, +and at the same time we have developed a new and sensible approach to +mental hygiene and prevention, as expressed in the comprehensive surveys +of State and community work and even more clearly in the development of +helps to individuals in finding themselves, and in the work in schools +to reach those who need a special adaptation of aims and means. To the +terrible emergency of the war it was possible to bring experienced men +and women as physicians and nurses, and how much was done, only those +can appreciate who have seen the liberality with which all the +hospitals, and Bloomingdale among the first, contributed more than their +quota of help, and all the assistance that could possibly be offered to +returning victims for their readjustment. + +It is natural enough that psychiatry should have erred in some respects. +We had forced upon us the herding together of larger numbers of patients +than can possibly be handled by one human working unit or working group. +The consequence was that there arose a narrowing routine and wholesale +classifications and a loss of contact with the concrete needs of the +individual case; that very often progress had to come from one-sided +enthusiasts or even outsiders, who lost the sense of proportion and +magnified points of relative importance until they were supposed to +explain everything and to be cure-alls. We are all inclined to sacrifice +at the altar of excessive simplicity, especially when it suits us; we +become "single-taxers" and favor wholesale legislation and exclusive +State care when our sense for democratic methods has gone astray. Human +society has dealt with the great needs of psychiatry about as it has +dealt with the objects of charity, only in some ways more stingily, with +a shrewd system and unfortunately often with a certain dread of the +workers themselves and of their enthusiasm and demands. Law and +prejudice surrounded a great share of the work with notions of stigma +and hopelessness and weirdness--while to those who see the facts in +terms of life problems there can be but few more inspiring tasks than +watching the unfolding of the problematic personality, seeking and +finding its proper settings, and preventing the clashes and gropings in +maladjustments and flounderings of fancy and the faulty use and +nutrition of the brain and of the entire organism. + +What a difference between the history of a patient reported and studied +and advised by the well-trained psychiatrist of to-day and the account +drawn up by the statistically minded researcher or the physician who +wants to see nothing but infections or chemistry and hypotheses of +internal secretion. What a different chance for the patient in his +treatment, in contrast to what the venerable Galt of Virginia reports as +the conception of treatment recommended by a great leader of a hundred +years ago: "Mania in the first stage, if caused by study, requires +separation from books. Low diet and a few gentle doses of purging +physic; if pulse tense, ten or twelve ounces of blood [not to be given +but to be taken!]. In the high grade, catch the patient's eye and look +him out of countenance. Be always dignified. Never laugh at or with +them. Be truthful. Meet them with respect. Act kindly toward them in +their presence. If these measures fail, coercion if necessary. +Tranquillizing chair. Strait waistcoat. Pour cold water down their +sleeves. The shower bath for fifteen or twenty minutes. Threaten them +with death. Chains seldom and the whip never required. Twenty to forty +ounces of blood, unless fainting occurs previously; ... etc." + +To-day an understanding of the life history, of the patient's somatic +and functional assets and problems, likes and dislikes, the problem +presented by the family, etc.! + +So much for the change within and for psychiatry. How about psychiatry's +contribution beyond its own narrower sphere? It has led us on in +philosophy, it has brought about changes in our attitude to ethics, to +social study, to religion, to law, and to life in general. Psychiatric +work has undoubtedly intensified the hunger for a more objective and yet +melioristic and really idealistic philosophical conception of reality, +such as has been formulated in the modern concept of integration. + +Philosophical tradition, logic, and epistemology alike had all conspired +to make as great a puzzle as possible of the nature of mental life, of +life itself, and of all the fundamental principles, so much so that as +a result anything resembling or suggesting philosophy going beyond the +ordinary traditions has got into poor repute in our colleges and +universities and among those of practical intelligence. The consequence +is that the student and the physician are apt to be hopeless and +indifferent concerning any effort at orderly thinking on these +problems.[3] + +Most of us grew up with the attitude of a fatalistic intellectual +hopelessness. How could we ever be clear on the relation of mind and +body? How could mind and soul ever arise out of matter? How can we +harmonize strict science with what we try to do in our treatment of +patients? How can we, with our mechanistic science, speak of effort, and +of will to do better? How can we meet the invectives against the facts +of matter on the part of the opposing idealistic philosophies and their +uncritical exploitations in "New Thought"--_i.e._, really the revival of +archaic thought? It is not merely medical usefulness that forced these +broad issues on many a thinking physician, but having to face the facts +all the time in dealing with a living human world. The psychopathologist +had to learn to do more than the so-called "elementalist" who always +goes back to the elements and smallest units and then is apt to shirk +the responsibility of making an attempt to solve the concrete problems +of greater complexity. The psychiatrist has to study individuals and +groups as wholes, as complex units, as the "you" or "he" or "she" or +"they" we have to work with. We recognize that throughout nature we have +to face the general principle of unit-formation, and the fact that the +new units need not be like a mere sum of the component parts but can be +an actually new entity not wholly predictable from the component parts +and known only through actual experience with the specific product. +Hydrogen and oxygen, it is true, can form simple mixtures, but when they +make an actual chemical integration we get a new specific type of +substance, water, behaving and dividing according to its own laws and +properties in a way not wholly predictable from just what we know of +hydrogen and oxygen as such. Analogy prompts us to see in plants and +animals products of physics and chemistry and organization, although the +peculiarity of the product makes us recognize certain specificities of +life not contained in the theory of mere physics and chemistry. All the +facts of experience prompt us to see in mentation a biological function, +and we are no longer surprised to find this product of integration so +different from the nature and functions of all the component parts. All +the apparent discontinuities in the intrinsic harmony of facts, on the +one hand, and the apparent impossibility of accounting for new features +and peculiarities of the new units, are shown to be a general feature of +nature and of facts: integration is not mere summation, but a creation +of ever-new types and units, with superficial discontinuities and with +their own new denominators of special peculiarities; hence there is no +reason to think of an insurmountable and unique feature in the origin of +life, nor even of mentally integrated life; no need of special mystical +sparks of life, of a mysterious spirit, etc.; but--and this is the +important point--also no need of denying the existence of all the +evidence there may be of facts which we imply when we use the deeply +felt concepts of mind and soul. In other words, we do not have to be +mind-shy nor body-shy any longer. + +The inevitable problem of having to study other persons as well as +ourselves necessarily leads us on to efforts at solution of other +philosophical problems, the problem of integrating materialism and +idealism, mechanism and relative biological determinism and purpose, +etc. Man has to live with the laws of physics and chemistry unbroken and +in harmony with all that is implied in the laws of heredity and growth +and function of a biological organism. Yet what might look like a +limitation is really his strength and safe foundation and stability. On +this ground, man's biological make-up has a legitimate sphere of growth +and expansion shared by no other type of being. We pass into every new +moment of time with a preparedness shown in adaptive and constructive +activity as well as structure, most plastic and far-reaching in the +greatest feat of man, that of imagination. Imagination is not a mere +duplication of reality in consciousness and subjectivity; it is a +substitute in a way, but actually an amplification, and often a real +addition to what we might otherwise call the "crude world," integrated +in the real activities of life, a new creation, an ever-new growth, seen +in its most characteristic form in choice and in any new volition. Hence +the liberating light which integration and the concepts of growth and +time throw on the time-honored problem of absolute and relative +determinism and on the relation of an ultra-strict "science" with common +sense. + +In logic, too, we are led to special assertions. We are forced to +formulate "open definitions," _i.e._, we have to insist on the open +formulation of tendencies rather than "closed definitions." We deal with +rich potentialities, never completely predictable. + +This background and the demands of work in guiding ourselves and others +thus come to lead us also into practical ethics, with a new conception +of the relation of actual and experimental determinism and of what "free +will" we may want to speak of, with a new emphasis on the meaning of +choice, of effort, and of new creation out of new possibilities +presented by the ever-newly-created opportunities of ever-new time. We +get a right to the type of voluntaristic conception of man which most of +us live by--with a reasonable harmony between our science and our +pragmatic needs and critical common sense. + +The extent to which we can be true to the material foundations and yet +true to a spiritual goal, ultimately measures our health and natural +normality and the value of our morality. _Nature shapes her aims +according to her means._ Would that every man might realize this simple +lesson and maxim--there would be less call for a rank and wanton +hankering for relapses into archaic but evidently not wholly outgrown +tendencies to the assumption of "omnipotence of thought," revived again +from time to time as "New Thought." Psychiatry restores to science and +to the practical mind the right to reinclude rationally and +constructively what a narrower view of science has, for a time at least, +handed over unconditionally to uncritical fancy. But the only way to +make unnecessary astrology and phrenology and playing with mysticism and +with Oliver Lodge's fancies of the revelation of his son Raymond, is to +recognize the true needs and yearnings of man and to show nature's real +ways of granting appetites and satisfactions that are wholesome. + +Hereby we have indeed a contribution to biologically sound idealism: a +clearer understanding of how to blend fact and ambition, nature and +ideal--an ability to think scientifically and practically and yet +idealistically of matters of real life. + +To come back to more concrete problems again, a wider grasp of what +psychiatry may well furnish us helps toward a new ethical goal in our +social conscience. The nineteenth century brought us the boon and the +bane of industrialism. More and more of the pleasures and satisfactions +of creation and production and of the natural rewards of the daily labor +drifted away from the sight and control of the worker, who now rarely +sees the completed result of his work as the farmer or the artisan used +to do. Few workers have the experience of getting satisfaction from +direct pride in the end result; as soon as the product is available, a +set of traders carries it to the markets and a set of financiers +determines, in fact may already have determined, the reward--just as the +reward of the farmer is often settled for him by astounding +speculations long before the crop is at hand. There is a field for a new +conscience heeding the needs of fundamental satisfactions of man so well +depicted by Carlton Parker, and psychiatric study furnishes much +concrete material for this new conscience in industrial relations--with +a better knowledge of the human needs of all the participants in the +great game of economic life. + +Psychiatry gives us also a new appreciation of the religious life and +needs of our race. Man's religion shows in his capacity to feel and +grasp his relations and responsibility toward the largest unit or force +he can conceive, and his capacity for faith and hope in a deeper and +more lasting interdependence of individual and race with the Ruler or +rules of the Universe. Whatever form it may take expresses his capacity +to feel himself in humility and faith, and yet with determination, a +more or less responsible part of the greatest unit he can grasp. The +form this takes is bound to vary individually. As physicians we learn to +respect the religious views of our fellow beings, whatever they may be; +because we are sure that we have the essentials in common; and with this +emphasis on what we have in common, we can help in attaining the +individually highest attainable truth without having to be destructive. +We all recognize relations that go beyond individual existence, lasting +and "more than biological" relations, and it is the realization of these +conceptions intellectually and emotionally true to our individual and +group nature that constitutes our various religions and faiths. +Emphasizing what we have in common, we become tolerant of the idea that +probably the points on which we differ are, after all, another's best +way of expressing truths which our own nature may picture differently +but would not want to miss in, or deny to, the other. One of the +evidences of the great progress of psychiatry is that we have learned to +be more eager to see what is sane and strong and constructively valuable +even in the strange notions of our patients, and less eager to call them +queer and foolish. A delusion may contain another person's attempt at +stating truth. The goal of psychiatry and of sound common sense is truth +free of distortion. Many a strange religious custom and fancy has been +brought nearer our understanding and appreciation since we have learned +to respect the essential truth and individual and group value of fancy +and feeling even in the myths and in the religious conceptions of all +races. + +Among the most interesting formulations and potential contributions of +psychiatry are those reaching out toward jurisprudence. Psychiatry deals +pre-eminently with the variety and differences of human personalities. +To correct or supplement a human system apparently enslaved by concern +about precedent and baffling rules of evidence inherited from the days +of cruel and arbitrary kings, the demand for justice has called for +certain remedies. Psychiatry still plays a disgraceful role in the +so-called expert testimony, largely a prostitution of medical authority +in the service of legal methods. Yet, out of it all there has arisen the +great usefulness of the psychiatrist in the juvenile and other courts. +There it is shown that if psychiatry is to help, it should be taken for +granted that the person indicted on a charge should thereby become +subject to a complete and unreserved study of all the facts, subject to +cross-examination, to be sure, but before all accessible to complete and +unreserved study. This would mean a substantial participation of law in +the promotion of knowledge of facts and constructive activity, and a +conception of indeterminate sentence not merely in the service of +leniency but in the service of the best protection of the public, and, +if necessary, lasting detention of those who cannot be reformed, before +they have had to do their worst. Whoever is clearly indicted for +breaking the laws of social compatibility should not merely invite a +spirit of revenge, but should, through the indictment, surrender +automatically to legalized authority endowed with the right and duty of +an unlimited investigation of the facts as they are. + +Looking back then, you can see how the history of the human thought +about what we call mind and psyche displayed some strange reactions of +the practical man, the scientist, the philosopher, and theologian toward +one of the most important and practical problems. It is difficult to +realize what it means to arrive at ever-more-workable formulations and +methods of approach. We do not have to be mind-shy _or_ body-shy any +longer. To-day we can attack the facts as we find them, without that +disturbing obsession of having to translate them first into something +artificial before we can really study them and work with them. Since we +have reached a sane pluralism with a justifiable conviction of the +fundamental consistency of it all, a satisfaction with what we modestly +call formulation rather than definition and with an appreciation of +relativity, we have at last an orderly and natural field and method from +which nobody need shy. + +The century that has passed since the inspiration of a few men of the +Society of the New York Hospital to provide for the mentally sick has +cleared the atmosphere a great deal. We can start the second century +freer and unhampered in many ways. Much has been added, and more than +ever do we appreciate the position of just such a hospital as that of +Bloomingdale as a centre of healing and as a leader of public opinion +and as a contributor to progress. + +The Bloomingdale Hospital has a remarkable function. It is a more or +less privileged forerunner in standards and policies. Without having to +carry the burdens of the whole State with its sweeping and sometimes +distant power and its forced economy, a semiprivate hospital like +Bloomingdale aims to minister to a slightly select group, especially +those who are in the difficult position of greater sensitiveness but +moderate means in days of sickness. It serves the part of our community +which more than any other sets the pace of the civilization about +us--the intelligent aspiring workers who may not have reached the goal +of absolute financial independence. It creates the standard of which we +may dream that it might become the standard of the whole State. + +When we review the roster of Superintendents--from John Neilson to Pliny +Earle and from Charles Nichols, Tilden Brown, and Samuel Lyon down to +the present head, our highly esteemed friend and coworker William L. +Russell--and the names of the members of the staff, many of whom have +reached the highest places in the profession, and last, but not least, +the names of the Governors of The Society of the New York Hospital, we +cannot help being impressed by the forceful representation of both the +profession and the public, and we recognize the wide range of influence. + +Instead of depending on frequently changing policies regulated from the +outside under the influence of the greater and lesser lights and +exigencies of State and municipal organization, the New York Hospital +has its self-perpetuating body of Governors chosen from the most +public-spirited and thoughtful representatives of our people. +Bloomingdale thus has always had a remarkable Board of Governors, who, +from contact with the General Hospital and with this special division, +are in an unusual position to see the practical aspects of the great +change that is now taking place. You see how the division of psychiatry +has developed from practically a detention-house to an asylum, and +finally to a hospital with all the medical equipment and laboratories of +the General Hospital. And you begin to see psychiatry, with its methods +of study and management of life problems as well as of specific brain +diseases, infections, and gastrointestinal and endocrine conditions, +become more and more helpful, even a necessity, in the wards and +dispensary of the General Hospital on 16th Street. The layman cannot, +perhaps, delve profitably into the details of such a highly and broadly +specialized type of work. But he can readily take a share in the best +appreciation of the general philosophy and policy of it all. + +The shaping of the policy of a semiprivate hospital is not quite as +simple as shaping that of a State Hospital with its well-defined +districts and geographically marked zones of responsibility. +Bloomingdale has its sphere of influence marked by qualitative selection +rather than by a formal consideration. It does not pose as an invidious +contrast to the State Hospital, and yet it is intended to solve in a +somewhat freer and more privileged manner the problem of providing for +the mentally sick of a more or less specific hospital constituency, the +constituency of the New York Hospital; and since it reaches the most +discriminating and thinking part of our population, it has the most +wonderful opportunity to shape public opinion. Like all psychiatrical +institutions, it has to live down the traditional notions of the +half-informed public; it has to make conspicuous the change of spirit +and the better light in which we see our field and responsibilities. +This organization can show that it is not mere insanity but the working +out of life problems that such a hospital as this is concerned with. The +conditions for which it cares are many. Some of them are all that which +tradition and law stamp as insanity. But see what a change. +Seventy-five per cent of the patients are voluntary admissions; and more +and more will be able to use the helps when they begin to feel the need, +not merely when it becomes an enforced necessity. + +By creating for this Hospital a liberal foundation, by completing its +equipment so as to make possible a free exchange of patients and of +workers from the Hospital in the city and this place in the country, +much has been done and more will be done to set a living example of the +very spirit of modern psychopathology and psychiatry. We know now that +from 10 to 40 per cent of the patients of the gynecologist, the +gastroenterologist, and the internist generally would be better treated +if a study of the life problems were added to that of the special organs +and functions. To meet this need it should be possible to have enough +workers in this branch of the Hospital to take their share of the +consulting and co-operation work in the wards and dispensary of the +General Hospital, and perhaps even in the schools provided for the same +type of people from which you draw your patients. The grouping of the +patients can be such that the old prejudices need not reach far into the +second century of the life of the Hospital. With a man of the vision and +practical experience of Dr. Russell, there is no need for an outsider to +conjure up a picture of special practical achievements as I have done +of the more general principles to-day. + +An institution is more than a human life. Many ambitions combine and +become part of a group spirit permeating the organization and reaching +their fulfilment in the succession of leaders. The life and growth and +happy self-realization of an institution is not the bricks and +mortar--it is a living and elastic entity--never too stable, never too +finished, a growing and plastic plant--to use a metaphor that has +slipped in perhaps without arousing all the implications the term plant +might carry and does carry. + +Some years ago my wife celebrated her birthday and told her colored cook +jocosely: "Geneva, I am a hundred years old to-day." The cook's jaw +dropped and then she suddenly remarked: "Lord! you don't look dat ole." +That is the way I feel about Bloomingdale Hospital as we see it to-day +pulsating with ever-fresh life and ever-fresh problems! How different +from a simple human being, after all! The heart and wisdom of many a man +and woman has gone into the perpetuation of what a few thoughtful men +started in 1821 and the result is that it is ever renewing its youth. + +Many a dream has been realized and many a dream has given way to +another. Here and there the past may make itself felt too much. But the +spirit and its growth show in recruiting ever-new lives to meet the +present day and the days to come, and this all the more so if we can +show the younger generation that every effort is likely to have its +reasonable direct support. We all want a man like Dr. William L. Russell +to have the fullest opportunity to bring to its best expression the rich +and well-tried wisdom of over twenty-five years of devoted work in the +field. This is no doubt a time of stress when many personal and general +sacrifices may be needed to bring about the fruition and culmination of +the labors of the present generation. Yet is it not a clear opportunity +and duty, so that those who are growing up in the ranks to-day may +really be encouraged to get a solid training, always animated by the +conviction that one can be sure of the practical reward for toiling +through the many years of preparation in a psychiatric career, whether +it be as a physician or as a nurse or as an administrator? + +I cannot help feeling as I stand here that I am in a way representing +not only my own sentiments and convictions but those of our dear old +friend Hoch. We all wish that he might be with us to express himself the +warm feelings toward the Bloomingdale Hospital and its active +representatives, from the managers to the humblest workers. Hoch in his +modesty could probably not have been brought to state fully and frankly +his own share in the achievements of this Hospital. But I know how much +he would have liked to be here to express especially the warmth of +appreciation we all entertain of what our friend William L. Russell +means to us and has meant to us all through the nearly twenty-five years +of our friendship and of working together. We delight in seeing him +bring to further fruition the admirable work he did at Willard, and +later for all the State hospitals; and that which we see him do at all +times for sanity in the progress of practical psychiatry, and now +especially in the guidance of this institution. We delight in seeing his +master mind given more and more of a master's chance for the practical +expression of his ideals and convictions concerning the duties and +opportunities of such a hospital as Bloomingdale. + +Our thanks and best wishes to those who invited us to stand here to-day +at the cradle of a second century of Bloomingdale Hospital! It is a +noteworthy gathering that joins here in good wishes to those who have +shaped this ever-new Bloomingdale. With a tribute to our thoughtful and +enthusiastic friend in internal medicine, Lewellys F. Barker, to our +English coworker, Richard G. Rows, to the illustrious champion of French +psychopathology, Pierre Janet, to our friend and leader in practical +psychiatry, William L. Russell, to our friends and coworkers of the +Bloomingdale staff, and especially also to the Board of Governors who +shape the policy and control the finances, and exercise the leadership +of public opinion, I herewith express my sincerest thanks and best +wishes. + +FOOTNOTES: + +[Footnote 2: A Guide to the Descriptive Study of the Personality, with +Special Reference to the Taking of Anamneses of Cases with Psychoses, by +Dr. August Hoch and Dr. George S. Amsden.] + +[Footnote 3: See, for instance, Moebius, The Hopelessness of All +Psychology, reviewed in the Psychological Bulletin, vol. IV, 1907, pp. +170-179.] + + + + +ADDRESS BY +DR. LEWELLYS F. BARKER + + +_The Chairman_:--The Johns Hopkins Medical School lends us also to-day +Dr. Lewellys F. Barker, its Professor of Clinical Medicine. Dr. Barker +has done so much to define and settle the contradictions of mind and +matter, and has clarified so much, and in fields so varied, as teacher, +research worker, and practitioner, that we welcome this opportunity of +listening to his discussion of "THE IMPORTANCE OF PSYCHIATRY IN GENERAL +MEDICAL PRACTICE." + + +DR. BARKER + +We have met to-day to celebrate the hundredth anniversary of the +founding of a hospital that, in its simpler beginnings and in its +evolution to the complex and highly organized activities of the present, +has served an eminently practical purpose and has played an important +role in the development of the science and art of psychiatry in America. +I desire, as a representative of general medicine, and, especially, of +internal medicine, to add, on this occasion, my congratulations to those +of the spokesmen of other groups, and, at the same time to express the +hope that this institution, historically so significant for the century +just past, may maintain its relative influence and reputation in the +centuries to come. + +The interest taken in psychiatry by the general practitioner and by the +consulting internist has been growing rapidly of late. Some of the +reasons for this growth of interest and heightening of appreciation I +have drawn attention to on an earlier occasion.[4] Psychiatry as a whole +was for a long time as widely separated from general medicine as +penology is to-day, and for similar reasons. It was a long time before +persons that manifested extraordinary abnormalities of thought, feeling, +and behavior were regarded as deserving medical study and care, and even +when a humanitarian movement led to their transfer from +straight-jackets, chains, and prison cells to "asylums for the insane," +these institutions were, for practical reasons, so divorced from the +homes of the people and from general hospitals that psychiatry had, and +could at the time have, but little intercourse with general medicine or +with general society. Mental disorders were moral and legal problems +rather than biological, social, and medical problems. Their genesis was +wholly misunderstood, and legal, medical, social, religious, and +philosophic prejudices went far toward preventing any rational +scientific mode of approach to the questions involved or any formulation +of investigative procedures that promised to be fruitful. Even to-day +the same prejudices are all too inhibitory; but thanks to the +unprecedented development of the natural sciences during the period +since this hospital was founded, we are witnessing, in our time, a rapid +transformation of thought and opinion concerning both the normal and the +disordered mind, a transformation that is reaching all circles of human +beings, bidding fair to compel the strongholds of tradition and +prejudice to relax, and inviting the whole-hearted co-operation of +workers in all fields in a common task of overcoming some of the +greatest difficulties by which civilization and human progress are +confronted. And though the brunt of this task is borne and must be borne +by the shoulders of medical men, physicians assume the burden +cheerfully, now that they know that they can count upon the intelligent +support and the cordial sympathy of an ever-enlarging extra-medical +aggregate. No better illustration could be given, perhaps, of the change +in the status of psychiatry in this country and in the world than the +contents of the programme of our meeting to-day at which a distinguished +investigator from London tells us of the biological significance of +mental disorders, an eminent authority from Paris explains the +relationship between certain diseases of the nervous system and these +disorders, and a leading psychiatrist of this country speaks upon the +contributions of psychiatry to the understanding of the problems of +life. Psychiatry, like each of the other branches of medicine, has come +to be recognized as one of the subdivisions of the great science of +biology, free to make use of the scientific method, in duty bound to +diffuse the knowledge that it gains, and privileged to contribute +abundantly to the lessening of human suffering and the enhancement of +human joys. General practitioners of medicine and medical +specialists--at least the more enlightened of them--welcome the +developing science of psychiatry, are eager to hasten its progress, and +will gladly share in applying its discoveries to the early diagnosis, +the cure, and the prevention of disease. + +That the majority of medical and surgical specialists and even most of +the widely experienced general practitioners, though constantly coming +in contact with major and minor psychic disturbances, are, however, +still far from realizing the full meaning and value of the principles +and technic of modern psychology and of the newer psychiatry must, I +fear, be frankly admitted.[5] But dare we blame these practitioners for +their ignorance of, apathy regarding, and even antipathy to, the psychic +and especially the psychotic manifestations of their patients? Ought we +not rather to try to understand the reasons for this ignorance, this +apathy, and this aversion, all three of which seem astonishing to many +of our well-trained psychologists and psychopathologists? Are there not +definite conditions that explain and at least partially excuse the +defects in knowledge and interest and the errors in attitude manifested +by those whom we would be glad to see cognizant and enthusiastically +participant? Psychiatrists, who have taught us to understand and rescue +various types of "sinners" and "social offenders" will, I feel sure, +avoid any moralistic attitude when discussing the shortcomings of their +brethren in the general medical profession, and will, instead, seek to +discover and to remove their causes. + +As an internist who values highly the gifts that modern psychology and +psychiatry have been making to medicine, I have given some thought to +the conditions and causes that may be responsible for these professional +delinquencies that you deplore. Though this is not the time nor the +place fully to discuss them, the mere mention of some of the causes and +conditions will, perhaps, contribute to comprehension and pardon, and +may serve to stimulate us all to livelier corrective activity. Let me +enumerate some of them: + +(1) A social stigma still attaches, despite all our efforts to abolish +it, to mental disorders and has, to a certain extent, been transferred +to those that study and treat patients manifesting these disorders. + +(2) The organization of our general education is very defective since it +fails to make clear to each student man's place in the universe and any +orderly view of the world and man; it fails adequately to enlighten the +student regarding the processes of life as adaptations of organisms to +their environment, man, himself, being such an organism reacting +physically and psychically to his surroundings in ways either favorable +or unfavorable to his own preservation and that of his species; it fails +to teach the student that the human organism represents a bundle of +instincts each with its knowing, its feeling, and its striving +component, that what we call "knowledge" and what we call "character" +are gradual developments in each person, and that if we know how they +have developed in a particular person we possess clues to the way that +person will react under a given stimulus, that is to say, what he will +think, how he will feel, and how he will act; and it fails, again, +properly to instruct students regarding the interrelationships of +members of different social groups (familial, civic, economic, +occupational, ethical, national, racial, etc.); in other words, our +general educational organization is as yet far from successful in +inculcating philosophical, biological, psychological, and sociological +conceptions that are adequate symbols of reality. + +(3) Though our medical schools have made phenomenal advances in the +organization and equipment of their institutes and in provision for +teaching and research in a large number of preclinical and clinical +sciences, they have up to now almost wholly ignored normal psychology, +psychiatry, and mental hygiene. The majority of the professors in these +schools are so absorbed by the morphological, physical, and chemical +aspects of their subjects, that students rarely get from them any +inkling of the psychobiological aspect, any adequate knowledge of human +motives, or any satisfactory data regarding human behavior, normal or +abnormal.[6] It is only recently and only in a few schools that +psychiatric clinics have been established as parts of the teaching +hospitals, that medical students have been able to come into direct +contact over an appreciable period of time with the objects of +psychiatric study, that the psychic manifestations of patients have +received any direct and particular attention in the general medical and +surgical wards, and that there has been any free and constant reciprocal +exchange of thought and opinion between students of the somatic on the +one hand and students of the psychic on the other. + +(4) The language of the psychiatrist is unique and formidable. The names +he has applied to motives and impulses, to symptoms and syndromes, are +foreign to the tongue of the general practitioner who is so awed by +them that he withdraws from them and remains humbly reticent in a state +of enomatophobia; or, if he be more tough-minded, he may be amused by, +or contemptuous of, what he refers to as "psychiatric jargon" or +"pseudoscientific gibberish." There is, furthermore, a dearth of +concise, authoritative, well-written text-books on psychiatry, and the +general medical journals rarely print psychiatric papers designed to +interest the average practitioner. The most widely diffused psychiatric +reports of our time are the sensational news items of the daily press. + +(5) The overemphasis of psychogenetic factors to the apparent neglect of +important somatogenic factors by some psychiatrists has tended to arouse +suspicion regarding the soundness of the opinions and methods of +psychiatric workers in the minds of men thoroughly imbued with +mechanistic conceptions and impressed with the results of medical +researches based upon them. The ardor of the psychoanalysts, also, +though in part doubtless justified by experience, has, it is to be +feared, excited a certain amount of antipathy among the uninitiated. + +(6) The fears of insanity prevalent among the laity and the repugnance +of patients to any idea that they may be "psychotic" or "psychoneurotic" +(words that, in their opinion, refer to "imaginary symptoms," or to +symptoms that they could abolish if they would but "buck up" and exert +their "wills") undoubtedly exert a reflex influence upon practitioners +who put the "soft pedal" on the psychobiological reactions and "pull out +the stop" that amplifies the significance of any abnormal physical +findings. + +(7) Psychotherapy, to the mind of the average medical practitioner, is +(or has been) something mysterious or occult. He uses much psychotherapy +himself but it is nearly always applied unconsciously and indirectly +through some form of physical or chemical therapy that he believes will +cure. He is usually quite devoid of insight into the effect of his own +expressed beliefs and bodily attitudes upon the adjusting mechanisms of +his patients. Conscious and direct psychotherapy is left by the average +practitioner to New Thoughters, Christian Scientists, quacks, and +charlatans. If he were to use psychotherapy consciously and were to +receive a professional fee for it he would feel that he was being paid +for a value that the patient had not received. A highly respected +colleague once privately criticised a paper of mine (read before the +Association of American Physicians) on the importance of psychotherapy. +"What you said is true," he remarked; "we all use psychotherapy but we +are a little ashamed of it; and it is better not to talk about it." Even +he did not realize that every psychotherapy is also a physical therapy. + +(8) The rise of specialism, through division of labor and +intensification of interests restricted to limited fields, in practical +medicine, the necessary result and to a large extent also a cause of the +rapid growth of knowledge and technic has brought with it many +advantages, but also some special difficulties, among them (a) the +impossibility any longer of any single practitioner, unaided, to study +and treat a patient as well as he can be studied and treated by a +co-ordinated group whose special analytical studies in single domains +are adequately synthesized by a competent integrator, and (b) in the +absence of such group work, the tendency to one-sided study, partial +diagnosis, and incomplete and unsatisfactory therapy. Through the rise +of specialism, it is true, psychiatry itself has arisen and the +psychiatrist, like the skilled integrating internist, is interested in +the synthesis of the findings in all domains, for only through such +synthetic studies, such integration of the functional activities of the +whole organism, is it possible to gain a global view of the patient as a +person, to make a complete somatic, psychic, and social diagnosis, and +to plan a regimen for him that will ensure the best adjustment possible +of his internal and external relationships.[7] + +Working in a diagnostic group myself as an integrating internist, I have +been much helped by the reports of personality studies made by skilful +psychiatrists; these are linked with the special reports on the several +bodily domains (cardiovascular, respiratory, haemic, dental, digestive, +urogenital, locomotor, neural, metabolic, and endocrine) in order +finally to arrive at an adequately co-ordinated and (subordinated) total +diagnosis from which the clues for an appropriate therapeutic regimen +can safely be drawn. If group practice is to grow and be successful in +this country, as I think likely, groups must see to it that psychiatry, +as well as the other medical and surgical specialties, is properly +represented in their make-up.[8] From now on, too, general practitioners +should, as Southard emphasized, be urged to be at least as familiar +with the general principles and methods of the psychiatrist as they are +with those of the gynecologist, the dermatologist, and the +paediatrist.[9] Well organized group-diagnosis and general will then help +to counteract the inhibiting influence of earlier isolated specialism +upon the appreciation of psychiatry. + +This enumeration of some of the causes of the ignorance and apathy +(existent hitherto) in the general profession regarding psychiatry may +perhaps suffice as explanation. These causes are, fortunately, rapidly +being removed. We are entering upon an era in which psychiatry will be +recognized as one of the most important specialties in medicine, an era +that will demand alliance and close communion among psychiatrists, +internists, and the representatives of the various medical and surgical +specialties. + +The internist and the psychiatrist will ever have a common interest in +the obscure problems of etiology and pathogenesis of diseases and +anomalies that are accompanied by abnormalities of thought, feeling, and +behavior. Progress in this direction is bound to be slow for the studies +are exceptionally complex and there are many impediments to be removed. +Though the problems are deep and difficult, they are doubtless soluble +by the mind of man, and they exert an uncommon fascination upon those +who visualize them. Causes may be internal or external, and are often a +combination of both. The tracing of the direct and indirect +relationships between these causes and the abnormal cerebral functioning +upon which the disturbances of psychobiological adjustment seem to +depend is the task of pathogenesis. The internist who has studied the +infantile cerebropathies with their resulting imbecilities, syphilis +followed by general paresis, typhoid fever and its toxic delirium, +chronic alcoholism with its characteristic psychoses, cerebral +thrombosis with its aphasias, agnosias, and apraxias, thalmic syndromes +due to vascular lesions with their unilateral pathological feeling-tone, +frontal-lobe tumors with joke-making, uncus tumors with hallucinations +of taste and smell, lethargic encephalitis with its disturbance of the +general consciousness and its psychoneurotic sequelae (lesions in the +globus pallidus and their motor consequences), pulmonary tuberculosis +with its euphoria, and endocrinopathies like myxoedema and exophthalmic +goitre with their pathological mental states, is encouraged to proceed +with his clinical-pathological-etiological studies in full assurance +that they will steadily contribute to advances in psychiatry. The +eclectic psychiatrist who is examining mental symptoms and +symptom-complexes ever more critically, who is seeking for parallel +disturbances in physiological processes and who considers both +psychogenesis and somatogenesis in attempting to account for +psychobiological maladjustments will welcome, we can feel sure, any help +that internal medicine and general and special pathology can yield. + +These studies in pathogenesis and etiology are fundamentally necessary +for the development of a rational therapy and prophylaxis. Already much +that is of applicable value in practice has been achieved. The internist +shares with the psychiatrist the desire that knowledge of the facts +regarding care, cure, and prevention of mental disorders may become +widely disseminated among medical men and at least to some extent among +the laity. Experts in psychiatry firmly believe that at least half of +the mental disturbances now prevalent could have been prevented, if, +during the childhood and adolescence of those afflicted, the facts and +principles of existing knowledge and the practical resources now +available could have been applied. + +We have recently had an excellent illustration of the benefits of +applied psychiatry in the remarkable results achieved during the great +war through the activities of the head of the neuropsychiatric division +of the Surgeon General's office and his staff[10] and those of the +senior consultant in neuropsychiatry and his divisional associates in +the American Expeditionary Force. In no other body of recruits and in no +other army than the American was a comparable success arrived at, and +the credit for this is due to American applied psychiatry and its wisely +chosen official representatives. + +The active campaign for the preservation of the mental health of our +people and for a better understanding and care of persons presenting +abnormal mental symptoms carried on during the past decade by the +National Committee for Mental Hygiene marks a new epoch in preventive +medicine.[11] + +The prevention of at least a large proportion of abnormal mental states +through the timely application of the principles of mental hygiene is +now recognized as a practically realizable ideal. Many important reforms +are now in process throughout the United States, no small part of them +directly attributable to the active efforts of our leading psychiatrists +and to our National Committee's [Transcriber's note: original reads +'Committe's'] work. The old "asylums" are being changed into +"hospitals." Psychiatric clinics are becoming attached to teaching +hospitals and psychiatric instruction in the medical schools is being +vastly improved. The mental symptoms of disease now receive attention in +hospitals and in private practice and at a much earlier stage than +formerly. Even the courts, the prisons, and the reformatories are +awakening to the importance of scientific psychiatry; before long +penology may be brought more into accord with our newer and juster +conceptions of the nature and origin of crime, dependency, and +delinquency. That schools of hygiene and the public health services must +soon fall into line and consider mental hygiene seriously is obvious. +The objection sometimes made that the practical problems are too vague, +not sufficiently concrete, to justify attack by public health officials +is no longer valid. In no direction, probably, could money and energy be +more profitably spent during the period just ahead than in the support +of a widely organized campaign for Mental Hygiene.[12] Psychiatrists +can count upon internists and general practitioners to aid them in +educating the public regarding the nature and desirability of this +campaign. + +Man is now consciously participating in the direction of his own +evolution. To cite England's poet laureate, who, you will recall, is a +physician: "The proper work of his (man's) mind is to interpret the +world according to his higher nature, and to conquer the material +aspects of the world so as to bring them into subjection to the spirit." + +FOOTNOTES: + +[Footnote 4: In an address at the seventieth annual meeting of the +American Medico-Psychological Association, 1914, entitled "The Relations +of Internal Medicine to Psychiatry."] + +[Footnote 5: _Cf._ Polon (A.) "The Relation of the General Practitioner +to the Neurotic Patient," Mental Hygiene, New York, 1920, IV, 670-678.] + +[Footnote 6: _Cf._ Paton (S.) Human Behavior in Relation to the Study of +Educational, Social, and Ethical Problems. New York, 1921. Charles +Scribner's Sons, p. 465.] + +[Footnote 7: _Cf._ Meyer (A.), "Progress in Teaching Psychiatry," +Journal A.M.A., Chicago, 1917, LXIX, 861-863; see also his, "Objective +Psychobiology, or Psychobiology with Subordination of the Medically +Useless Contrast of Medical and Physical," Journal A.M.A., Chicago, +1915, LXV, 860-863; and, "Aims and Meanings of Psychiatric Diagnosis," +Am. Journal of Insanity, Baltimore, 1917, LXXIV, 163-168.] + +[Footnote 8: _Cf._ "The General Diagnostic Survey Made by the Internist +Cooperating with Groups of Medical and Surgical Specialists," New York +Medical Journal, 1918, 489,538,577; also, "The Rationale of Clinical +Diagnosis," Oxford Medicine, 1920, vol. I, 619-684; also, "Group +Diagnosis and Group Therapy," Journal Iowa State Medical Society, +113-121, Des Moines, 1921.] + +[Footnote 9: _Cf._ Southard (E.E.), "Insanity Versus Mental Disease"; +the Duty of the General Practitioner in Psychiatric Diagnosis, Journal +American Medical Association, LXXI, 1259-1261, Chicago, 1918.] + +[Footnote 10: _Cf._ Bailey (P.), "The Applicability of Findings of +Neuro-psychiatric Examinations in the Army to Civil Problems," Mental +Hygiene, New York, 1920, IV, 301; also "War and Mental Diseases," Am. J. +Pub. Health, IX, 1, Boston, 1919.] + +[Footnote 11: _Cf._ Salmon (T.W.), "War Neuroses and Their Lesson," New +York Medical Journal, CIX, 993, 1919; also, "The Future of Psychiatry in +the Army," Mil. Surgeon, XLVII, 200, Washington, 1920. + +_Cf._ "Origin, Objects, and Plans of the National Committee for Mental +Hygiene" (Publication No. 1, of the National Committee, New York City); +and, "Some Phases of the Mental Hygiene Movement and the Scope of the +Work of the National Committee for Mental Hygiene," in Trans., XV, +Internal. Congr. for Hygiene and Demography, III, 468-476, (1912), +Washington 1913.] + +[Footnote 12: _Cf._ Russell (W.L.) "Community Responsibilities in the +Treatment of Mental Disorders." Canad. J. Ment. Hygiene, 1919, I 155--. + +Hincks (C.M.), "Mental Hygiene and Departments of Health," Am. J. Pub. +Health, Boston, IX, 352, 1919; Haines (T.H.), "The Mental Hygiene +Requirements of a Community: Suggestions Based upon a Personal Survey," +Mental Hygiene, IV, 920-931, New York, 1920. + +Beers (C.W.), "Organized Work in Mental Hygiene," Mental Hygiene, 567, +New York, 1917, also, Williams (F.E.), "Progress in Mental Hygiene," +Modern Hospital, XIV, 197, Chicago, 1920.] + + + + +_The Chairman_: We had hoped to receive to-day the greetings of our +sole elder sister among American institutions, the Pennsylvania +Hospital, of Philadelphia, which since its foundation in 1751 has +pursued a career much like our own, treating mental cases in the general +hospital from the very beginning, and since 1841 maintaining a separate +department for mental diseases in West Philadelphia. Dr. Owen Copp, the +masterly physician-in-chief and administrator of that department, was to +have been here, but unfortunately has been detained. Our morning +exercises having come to an end, Dr. Russell asks me to say that your +inspection of the occupational buildings and other departments of the +Hospital is cordially invited; a pageant illustrative of the origin and +aspirations of the Hospital will be given on the adjoining lawn; and +that after the pageant our guests are desired to return to the Assembly +Hall, where we shall have the privilege of listening to addresses by Dr. +Richard G. Rows, of London, and Dr. Pierre Janet, of Paris, who have +come across the Atlantic especially to take part in this anniversary +celebration. + + + + + +ADDRESS BY +DR. GEORGE D. STEWART + +[Illustration: BLOOMINGDALE ASYLUM + +As it appeared in 1894 when it was discontinued and replaced by +Bloomingdale Hospital at White Plains, New York.] + + +AFTERNOON SESSION + +_The Chairman_: For the first seventy-five years of its existence the +New York Hospital was the nearest approach to an academy of medicine +that the city possessed. When the now famous New York Academy of +Medicine was established in 1847, a friendly and cordial co-operation +between the two institutions arose, and while the activity of this +co-operation is not as pronounced as it was, we still cherish in our +hearts a warm regard for that ancient ally in the cause of humanity. Its +President, Dr. George D. Stewart, the distinguished surgeon, has come to +extend the greetings of the medical profession of New York City. + + +DR. STEWART + +The emotions that attend the birthday celebrations of an individual are +often a mixture of joy and sadness, of laughter and of tears. In warm +and imaginative youth there is no sadness and there are no tears, +because that cognizance of the common end which is woven into the very +warp and woof of existence is then buried deep in our subconscious +natures, or if it impresses itself at all, is too volatile and fleeting +to be remembered. But as the years fall away and there is one less +spring to flower and green, the serious man "tangled for the present in +some parcels of fibrin, albumin, and phosphates" looks forward and +backward and takes in both this world and the next. In the case of +institutions, however, the sadness and the tears do not obtain--for a +century of anniversaries may merely mean dignified maturity, as in the +case of Bloomingdale, with no hint of the senility and decay that must +come to the individual who has lived so long. This institution was +founded one hundred years ago to-day; the parent, the New York Hospital, +has a longer history. Bloomingdale, as a separate and independent +concern, had its birthday a century ago. + +It is curious to let the mind travel back, and consider what was +happening about that time. Just two years before the news had flashed on +the philosophical and scientific world that Oersted, a Danish +philosopher, had caused a deflection of the magnetic needle by the +passage near it of an electric current. The relation between the two +forces was then and there confirmed by separate observations all over +the civilized world. This discovery probably created more interest at +that time than Professor Einstein's recent announcement which, if +accepted, may be so disturbing to the principia of Newton and to our +ideas of time and space. There can be no doubt that the practical +significance of Oersted's experiment was much more widely appreciated +than the theory of Einstein, for an understanding of the latter is +confined, we are told, to not many more men than was necessary to save +Sodom and Gomorrah. Its immense practical significance, however, could +have been foreseen by no man, no matter with what vision endowed. Just +two years prior to the founding of this institution the first steamboat +had crossed the Atlantic and in the same year that great conqueror, who +had so disturbed the peace of the world which was even then as now +slowly recovering from the ravages of war, breathed his last in Saint +Helena, yielding to death as utterly as the poorest hind. + +In 1815, Bedlam Hospital in South London was converted into an asylum +for the insane who were at the time called "lunatics." The name Bedlam +is a corruption of the Hebrew "Bethlehem"--meaning the House of +Bread--and while the name popularly came to signify a noisy place it was +the beginning of really scientific treatment for the tragically +afflicted insane. While the treatment of the insane in Europe was being +steadily raised to a higher plane of efficiency, America has also reason +to be proud of her record in this respect. During all the years that +have followed, Bloomingdale has been an important factor in the medical +world of New York. + +There are two phases of its existence which might be emphasized--first, +it was founded by physicians; even then and, of course, long before +doctors had proven that they were in the forefront in the promotion of +humanitarian activities. Medicine has always carried on its banners an +inscription to the Brotherhood of Man. It is worthy of note that when +Pinel and Tuke had begun to regard mental aberration as a disease and to +provide scientific hospital treatment therefor, American physicians, +prepared by study and experimentation, were ready to accept and apply +the new teachings. + +A second phase of great importance is that institutions like +Bloomingdale have promoted the study of psychology far more than any +other factor, particularly because in them the personality stripped of +some of its intricacies, the diseased personality, permits analysis, +which the normal complex has so long defied. That it is high time that +mankind was undertaking this knowledge of himself is particularly +emphasized by the unrest and aberrance of human behavior now startling +and disturbing the whole world. If mankind does not take up this self +study as Trotter has said, Nature may tire of her experiment man, that +complex multicellular gregarious animal who is unable to protect himself +even from a simple unicellular organism, and may sweep him from her +work-table to make room for one more effort of her tireless and patient +curiosity. Psychology should be taught to every doctor and to every +lettered man. + +Digressing for a moment, to every one capable of understanding it, there +should be imparted a knowledge of that simple economic law announced +from the Garden of Eden after the grounds had been cleared and the gates +closed: "By the sweat of thy brow thou shalt earn thy bread." The +economic phase indeed constitutes a highly important aspect of modern +psychology, for abnormal elements are antisocial, and from pickpockets +to anarchists flourish on the soil of pauperism. The key-note of the +future is responsibility. To the educated and enlightened man who still +asks, "Am I my brother's keeper?" Cain has bequeathed a drop of his +fratricidal blood; and he who spurns to do his share of the world's +work, electing instead to fall a burden upon the community, deserves the +fate of the barren fig-tree. + +However, amidst the social unrest, buffeted and perplexed by the cross +currents of our time, we should not be pessimistic but should look +forward with courage, parting reluctantly with whatever of good the past +contained and living hopefully in the present. As Ellis says: "The +present is in every age merely the shifting point at which past and +future meet, and we can have no quarrel with either. There can be no +world without traditions; neither can there be any life without +movement. As Heraclitus knew at the outset of modern philosophy, we +cannot bathe twice in the same stream, though as we know to-day, the +stream still flows in an unending circle. There is never a moment when +the new dawn is not breaking over the earth, and never a moment when the +sunset ceases to die. It is well to greet serenely even the first +glimmer of the dawn when we see it, not hastening toward it with undue +speed, nor leaving the sunset without gratitude for the dying light +that once was dawn." + +So to-day I bring to you from the New York Academy of Medicine +felicitations on your one hundredth anniversary and greetings to your +guests who have come from all over the world to join in your birthday +celebration. + + + + +ADDRESS BY +DR. RICHARD G. ROWS + + +_The Chairman_: Besides the Royal Charter, the New York Hospital is +indebted to Great Britain for invaluable encouragement and financial aid +in our natal struggle in Colonial days. Dr. Rows has added charmingly to +that debt by journeying from London to take part in these exercises. His +subject will be, "THE BIOLOGICAL SIGNIFICANCE OF MENTAL ILLNESS." + +As Director of the British Neurological Hospital for Disabled Soldiers +and Sailors, at Tooting, he is giving the community and the medical +world the benefit of his rich professional experience in the trying +years of war as well as in peace, and gaining fresh laurels as he +marches, like Wordsworth's warrior, "from well to better, daily +self-surpast." + + +DR. ROWS + +I must first express to you my keen appreciation of the high honor you +have conferred on me by inviting me to come from England to address you +on the occasion of the centenary celebration of the opening of this +Hospital. + +It is perhaps difficult for us to realize what resistances lay in the +way of reform at that time, resistances in the form of long-established +but somewhat limited views as to the nature of mental illnesses, as to +whether the sufferer was not reaping what he had sown in angering the +supreme powers and in making himself a fit habitation for demons to +dwell in; in the form of a lack of appreciation of the need of sympathy +for those who, while in a disturbed state, offended against the social +organism or in the form of an exaggerated fear which compelled the +adoption of vigorous methods of protecting the social organism against +those who exhibited such anti-social tendencies. The men and women of +the different countries of the world who recognized this and made it the +chief of their life's duties to spread a wider view of such conditions +and to insist that the unfortunate people should be regarded and +treated as fellow human beings will ever command our admiration. + +By the courtesy of Dr. Russell I have had an opportunity of seeing the +pamphlet in which are recorded the efforts of Mr. Thomas Eddy in the +year 1815 to move his colleagues to consider this matter.[13] The result +of those efforts was the establishment of an institution on Bloomingdale +Road. + +Various changes followed until we arrived at the Bloomingdale Hospital +of to-day with its large and trained staff of medical officers, who, +while still recognizing the difficulties of the task, are imbued with a +hope of success which has arisen on a basis of wider knowledge, but +which was unknown to many of their predecessors. To have the opportunity +of joining with you in celebrating the big advance made a hundred years +ago, of exchanging ideas with you with regard to the difficulties which +still confront us, whether in America or in England, and which demand a +united effort on the part of all who are interested in the scientific +investigation of the subject, cannot fail to afford one the liveliest +satisfaction. + +In the brief history of the Hospital prepared by Dr. Russell we find the +recommendations of another reformer, Dr. Earle, who in 1848 was +evidently still not satisfied with the treatment provided for the +sufferers from mental illness. + +Both Mr. Eddy and Dr. Earle were influenced by their observation that +even in those suffering from mania much of their behavior could not be +described as irrational. If you will allow me I will quote a sentence of +two from each. + +Mr. Eddy said: "It is to be observed that in most cases of insanity, +from whatever cause it may have arisen or to whatever it may have +proceeded, the patient possesses small remains of ratiocination and +self-command; and although they cannot be made sensible of the +irrationality of their conduct or opinions, yet they are generally aware +of those particulars for which the world considers them proper objects +of confinement." With reference to treatment Dr. Earle said: "The +primary object is to treat patients, so far as their condition will +possibly permit, as if they were still in the enjoyment of the healthy +exercise of their mental faculties." + +To superficial observation these suggestions might well have appeared as +the phantasies of dreamers and perhaps at the present day their +importance is not always fully appreciated. Recent advances in +knowledge, however, have led us beyond the moral treatment recommended a +hundred years ago and have enabled us to see that a more important +truth underlay these suggestions. + +We are all familiar with the frequent difficulty we encounter in our +efforts to discover the actual mental disturbance which is supposed to +exist in our patients. It is often a question of wit against wit as +between patient and doctor, and not infrequently a rational and +intelligent conversation may be maintained on an indifferent subject. +The fact too that the disturbance is so frequently only temporary +suggests that the loss of rational control is a less serious phenomenon +than was generally supposed and we know that the control can be +frequently restored by a period of rest or by a helpful stimulus. Quite +recently a patient who in hospital had been confused, undisciplined, +abusive, and threatening, was removed to a house of detention. The shock +of finding himself, as he said, amongst a lot of lunatics, led him to +face reality from a fresh point of view. He admitted that it had taught +him a lesson and when he revisited the hospital, if not entirely +grateful to us for the experience, he evidently bore no ill will. + +But not only is it necessary to recognize what rational powers remain to +the patient, we must also inquire how much in their disturbed mental +activity can be considered a rational reaction to the stimuli which +have operated, and still may be operating, on them. + +In connection with this I would suggest that there are two aspects to be +considered. First, what is the standard according to which we are to +judge them? Secondly, to what extent are the reactions of the patient +abnormal in kind to the driving stimulus? They may perhaps be reckoned +abnormal in degree, but, to what extent, if at all, are they abnormal in +kind? + +It may be readily admitted that the behavior of those suffering from +mental illness offends against conventional usages and is anti-social. +It must also be recognized that amongst human beings living in +aggregates some conventional usages must be evolved and insisted on in +order to insure the greatest good of the greatest number. These usages +are regarded not merely as protective measures for the body corporate, +but they are also supposed to indicate a beneficial standard for the +individual. But such a standard being adopted, observation is liable to +be limited so much to results without sufficient attention being given +to the causes which had led to those results. + +By the recent advances in scientific knowledge and in methods of +investigation we have been led to see that the conditions under +consideration cannot be understood without a study of the mechanisms on +which mental activity depends and without discovering the psychic and +physical causes, arising from without and from within, which have +disturbed the function of these mechanisms. We have learned that these +illnesses do not arise from one cause alone and that they are the result +of influences to which we all may be subject to some degree. + +The originator of these modern methods, Prof. Freud, has stimulated us +to regard the ordinary symptoms of mental illnesses as directing posts +indicating lines to be investigated, and he and others have suggested +various methods which may usefully be employed. + +It is essential that we carefully distinguish what are primary from what +are secondary symptoms. Two thousand years ago a physician, +[Transcriber's note: original reads 'physican'] Areteus, pointed out +that mania frequently commenced as melancholia, and he drew attention to +the extreme frequency of an initial depression in cases of mental +illnesses. But he did not offer any explanation of this initial state. + +Such an initial state may perhaps be, to a certain extent, understood if +we assume that the first evidences of mental disturbance consist in some +difficulty in carrying out ordinary mental processes, some difficulty in +exercise of the function of perceiving, thinking, feeling, judging, and +acting, and that any disturbance of the harmonious activity of these +functions must give rise to an emotional condition of anxiety and +depression. Some such disharmony will, by adequate investigation, be +found in a large number of cases to exist in the early states of the +illness and will be appreciated by the patient before there occur any +obvious signs, any outward manifestations of disability. + +But in any disharmony which may occur it must be recognized that the +mental mechanisms affected are those with which the patient was +originally endowed, which he has gradually trained throughout his past +experience and which he has employed more or less successfully up to the +time the illness commenced. There is no new mechanism introduced to +produce a mental illness, but a putting out of gear of those common to +the race and their disturbance is the result of the action of influences +which may befall any one of us, unbearable ideas with which some intense +emotional state is intimately associated. The normal function of these +mechanisms, simple at first and remaining fundamentally unaltered, +although possibly much modified gradually by added experiences from +within and without, depends on the maintenance of a harmonious balance +between stimuli received and emotional reaction and motor response to +those stimuli so that the feeling of well-being may arise. + +If from any cause there occurs a failure to appreciate the stimuli +clearly, if the emotional reactivity be disturbed, if the sense of value +becomes biassed in one direction or another so that the response is +recognized by the patient as abnormal there will result a disharmony and +a feeling of ill-being of the organism. Under these conditions the +processes of facilitation along certain definite lines and inhibition of +all other lines--processes which are essential to clear +consciousness--will become difficult or perhaps impossible and a mental +illness will develop. In the slighter degrees the disharmony may be +known to the patient without there being any outward manifestation to +betray the conflict going on within. In the severe degrees the mental +activity of the patient may be under the control of some dominant +emotional state so that it may be impossible for him to adapt himself to +his surroundings in a normal manner although his behavior may not appear +so irrational when we know the stimuli affecting him. Within these +extremes we discover all degrees of disturbance, and all varieties of +signs and symptoms may be encountered. + +But the signs which become obvious to superficial observation are, to a +large extent, secondary products. The primary symptoms are felt by the +patient as a disturbance of the capacity to perceive, to think, to feel, +to judge, and to act, and with these disabilities there will be +associated a certain degree of confusion and anxiety which cannot fail +to appear as the result of such alterations of function. + +The obvious signs may represent merely a more intense degree of the +primary affection, disturbed capacity together with some confusion and +anxiety; or they may represent efforts on the part of the patient to +overcome or to escape from the disturbance or to explain it to himself. +And now the total lack of knowledge of the processes on which mental +activity depends, the altered standard of judgment due to some degree of +dissociation, and the necessity of obtaining relief in some way or other +will have much to do with determining the character of the symptoms with +which we are all familiar. So many factors are concerned in the +production of these secondary characters that it is difficult to assign +to the symptoms their true value or to decide whether they possess much +value at all with regard to the fundamental disturbance which +constituted the primary illness. So often they appear to be mere +rationalizations, mere false judgments on the part of the patient; they +thus form subjects for investigation rather than fundamental +constituents of the illness. + +We, therefore, must not accept the outward and visible signs at their +face value but attempt to discover what past experiences in the life of +the patient have led to such disturbance of function, to such a change +in his mental activity. + +It will possibly be of some assistance to provide one or two examples in +order to demonstrate the importance of the past experiences as agents +capable of producing such alterations. + +The first case will illustrate the results produced by the development +of a dominant emotional tendency during early childhood. The patient up +to the fifth year of her life had been an ordinary, normal child, +attached to her mother, fond of her nurse, interested in her toys. +During the next two years she endured much bad treatment at the hands of +a new nurse which produced such an impression on her that she felt she +was a changed child. This nurse, described to me by the patient as a +handsome woman, having met the inevitable man, used frequently to meet +him clandestinely. The child was neglected, was sometimes left alone, on +one occasion in a graveyard, but she was forbidden to mention the +subject to any one under threats of being carried away by a "bogey-man." +The child became very frightened by this, to such an extent that one +night she had a severe nightmare in which a "bogey-man" came to carry +her away. At the end of two years a profound change had taken place in +her which she now describes thus: "I was a changed child; I was +separated from my mother and could no longer confide in her nor did I +wish to do things for her as I had done before; I could not enjoy my +toys; I had no confidence in myself; I was not like other children." And +from that time on, as girl and as woman, she has never felt that she has +been like others of her sex. Such a condition, being started and +confined by repetition, interfered with her free development and it was +remarkable how many incidents occurred in her life to confirm the +disability, but the germ of her serious breakdown thirty years later was +laid in her fifth and sixth years. + +The second case is that of a patient who, as a child, had some +convulsive attacks. She was therefore considered delicate and was +thoroughly spoiled. When nearly thirty she lived through a sexual +experience which caused extreme anxiety; she broke down and was admitted +to an asylum. After admission she looked across the dormitory and saw a +head appearing above the bed-clothes, the hair of which had been cut +short for hygienic reasons. With a memory of her sexual indiscretion +still vivid in her mind she jumped to the conclusion that she was in a +place where men and women were crowded together in the same room. She +got out of bed, refused to return to it, fought against the nurses and +was transferred to a single room, with the mattress on the floor and the +window shuttered. She wondered where she was and came to the conclusion +that she was in a horse-box. Then arose a feeling of terror that she +would be at the disposal of the grooms when they returned from work. The +sound of heavy footsteps of the patients passing along the corridor to +the tea-room suggested that the grooms were returning and that her room +would soon be invaded. The feeling of terror increased and she tried to +hide in the corner, drawing the mattress and clothes over her. And so +on. + +Months later when I had my first interview with her, her sole remark +during the hour was "How can I speak in a place like this?" This was +repeated almost without intermission throughout the hour. It formed a +good example of the origin of the process of perseveration, a process +frequently adopted by the patient to guard against the disclosure of a +troublesome secret. + +If we attempt to trace out some of the mechanisms employed in these two +cases we shall see that in response to definite stimuli each reacted in +a manner which cannot be considered abnormal in kind. It was normal +reaction for the child to be distressed at being separated from her +mother in such a way, to be frightened by being left in the graveyard +alone, or at the threat of her being carried away by a "bogey-man" if +she dared to mention anything of the clandestine meetings to her mother. +It was not very abnormal that after her sexual experience the other +patient while still in a confused state caused by the intense emotional +condition of anxiety, should, on seeing a head with the hair cropped +short, jump to the conclusion that there was a man in a bed in the same +ward with herself, or that she should feel frightened and wish to leave +the room. + +The mental activity in each case depended on mental content, that is, +memory of past experiences with their intense emotional states which +acted as the driving force and also made the recall of the experience go +extremely easy. The further developments after being placed in the +single room with mattresses on the floor and the window shuttered were +rationalizations also based on mental content, _i.e._, on the memory of +rooms somewhat similar to that in which she found herself and of the use +of such rooms. It is interesting to note also in the first case that in +her wildest delirium during an acute attack she lived through episodes +of her past life. One example may be given. In the course of her +delirium she thought that a "blackbird" had flown to her, touched her +left wrist and taken away all her vitality. This depended on an +experience of her going to Germany when a girl and meeting a young +German officer whom she did not like. A few years later she went to +Germany and met the officer again. Without going into full details I may +say that on one occasion when walking with him he seized her left wrist +with his right hand and attempted to kiss her; she struggled fiercely +and ran from him. Here we see that not only is her delirium based on a +past experience, but that the whole memory is symbolized in the +"blackbird" which was the emblem of the German nation in whose army the +officer was then serving. Connected with this there was also another +unpleasant episode which dated from her tenth year. Much of her delirium +was worked out in such a way that most of the details could be traced +back to experiences of her earlier life. + +But however absurd her statement regarding her being touched by a +"blackbird" and all her vitality removed might appear to superficial +observation, it must be admitted that when we know the mental content of +that patient, we cannot but see that at any rate it was not so +irrational. And not only was this recognized by the doctor, but, and +this is much more important, by the patient herself. + +It is, therefore, the mental content which must be discovered before +doctor or patient can understand the disability and before any common +ground between the two can be found. And when the mental content is +known it will be easy to recognize the affective condition of the +patient to be a normal response. It will also be specific and if intense +will dominate the patient. "Why is it I can never feel joy as I used to +do?" was the pathetic inquiry of the patient dominated by a feeling of +misery and fear. Was it not for the reason that being dominated by +misery and fear, joy could find no place? The emotion of misery because +of its intensity could more or less inhibit the feeling of joy, but joy +could not inhibit the misery. + +No repetition of the memory of the unpleasant experiences with their +associated emotion of misery and fear led to the formation of a habit of +mind and feeling. And when once such a habit of mind is established it +is remarkable by what a host of stimuli received in ordinary daily life +the cause of the disturbance can be recalled. + +This question of stimuli deserves further notice. It is not so difficult +to realize the mechanism by which a stimulus which clearly crosses the +threshold of consciousness can lead to a given reaction. But it is +perhaps difficult to imagine how so many stimuli which do not cross the +threshold of consciousness or which, if they do, are not recognized by +the patient at the time as having any reference whatever to the special +memory can yet set the memory mechanism into action. The result may not +be seen till after the relapse of some considerable period of time, as +in the case of a man who for years had been disturbed by terrific +nightmares, based on the idea of snakes coming out of the ground and +attacking him. He complained one day that he was much worse, that three +nights before he had had the worst nightmare of his life. On being +questioned as to what could have suggested snakes to him he could not +tell. A few minutes later he said: "I think I know the cause now. I +spent the evening before I had that nightmare with a sergeant who had +returned from the service in India." This friend amongst other things +had mentioned that whenever they were about to bivouac they had to +search every hole under a stone and every tuft of grass to see that +there were no snakes there. This, which had been received as an ordinary +item of information, had been the stimulus which had set his memory +mechanism into action and the nightmare between two and three o'clock in +the morning had been the result. + +The result in many instances is evidenced by an emotional state alone +and the actual memory of the original experience may not come into +consciousness. Many examples of this might be given. The sound of a +trolley wheel on a tram wire in one case gave rise to terror instead of +its normal reaction, viz., that of satisfaction at getting to the +destination quickly and without effort. This terror was produced because +the sound on the wire resembled that of a shell which came over, blew in +a dugout, killed three men, and buried the patient. No memory of this +incident came into consciousness, only a terror similar to that +experienced at the time of the original incident was experienced. Or, +the time four o'clock in the afternoon could act as a stimulus to arouse +an emotional state of misery similar to that experienced at the same +time of day during an illness some years previously. Or, passing the +house of a doctor when on a bus could produce a sudden outburst of +anxiety, giddiness, and confusion; the patient had been taken into that +house at the time of an epileptic attack. Or, showing photographs of the +front could lead to an epileptic attack which was based on the memory of +the time when the patient was wounded in the head; this has occurred on +two separate occasions separated by an interval of some months. Or, +noticing a familiar critical tone in a remark made at a dinner-table +could lead to an acute change of feeling so that the subject who, +before dinner, had felt she would like to play a new composition on the +piano so as to obtain the opinion of the guest who had exhibited the +critical tone, after dinner felt incapable of doing so. Her feelings had +been hurt on many former occasions by critical remarks made by him in +that tone. The critical remarks were not called to memory but there +arose the feeling that under no circumstances could she play that piece +to him. + +Of special importance also are the experiences of childhood. An unhappy +home or unjust treatment as a child may warp the development of the +personality, lead to a lack of self-confidence, to the predominance of +one emotional tendency, and so prevent that balanced equilibrium which +will allow a rapid and suitable emotional reaction such as we may +consider normal. This may lead to a failure of development or a loss of +the sense of value, because the existence of one dominating emotional +tendency so often produces a prejudiced view which may render a just +appreciation of our general experience almost impossible and may +seriously disturb our mental activity. + +And if, as Bianchi suggests, all mental activity depends on a series of +reflex actions, or, as Bechterew and Pavlov have insisted, a series of +conditioned reflexes becomes established, it will assist us to +understand how such stimuli can give rise to mental disturbances, to +mental illnesses. We shall see that there may be something of real +importance underlying such remarks as "I felt I was a changed child"; or +"It is because of the treatment I received from my father that I have +taken life so seriously." "I have never imagined that what I went +through in my childhood could so influence me now"; or "I have never had +confidence in myself and often when I have appeared vivacious and +interested I have had an awful feeling of incapacity and dread within +myself." + +The outward and obvious manifestations, therefore, are not necessarily a +true index of our mental and emotional conditions. This is true of all +mental illnesses, even the most severe. + +One patient who had been in an asylum more than ten years illustrated +this in a most striking manner. His outward manifestations led one to +feel that he thought he possessed the institution in which he was +confined and also the surrounding property and that the authorities were +a set of usurpers and thieves who kept him incarcerated in order that +they might enjoy what was really his money and his property. On one +occasion I said to him, "George, what is that incident in your life +which you cannot forget and which has troubled you so seriously?" The +reply was a flood of abuse. I put the question to him several times +without getting any further answer, but when I came to leave the ward, +George came up behind me and whispered over my shoulder, "Who told you +about it?" No abuse, no shouting as usually occurred, but a whisper, +"Who told you about it?" Was not George running away from a memory with +its emotion which was unbearable to an idea which allowed him to be +angry with others instead of with himself? Many examples of this might +be given and really might be found by us in our own experience. It is +the mental content which is important, a mental content which can be +recalled by various stimuli, and which will be more persistently with us +the more intense is the emotion associated with it. + +But the basis of the condition is not completely understood when we have +apparently arrived at the psychic cause of the disturbance. + +It is recognized that the emotions are accompanied by physical changes, +changes which are specific for each emotional state. The physical +changes which normally are associated with fear differ from those of joy +or anger. This has been appreciated for a long time but recent +researches have recalled other reactions to us. Reactions in the +internal glands which further knowledge will probably prove to be of +great importance, in fact to form an integral part of the sum of +activities, connect with mental processes. The secretions of the glands +exert an influence on the sensibility and reaction of the organs +connected with psychic phenomena and their functions themselves are +affected by reactions occurring in the nervous system. Revival of a +memory may thus affect the functions of these glands, and the changes +produced in them may react on the sensibility and reactivity of the +nervous mechanisms. If this be so, it will be evident that the organism +works as a whole, that a disturbance of one organ may interfere with the +function of another and that in the repetition of all these influences +we may find an explanation of the chronicity of many of these illnesses. +A study of the activities and interactivities of all the organs of the +body is therefore essential and must be made before we shall understand +the biological significance of mental illness. + +FOOTNOTES: + +[Footnote 13: See Appendix III, p. 200.] + + + + +ADDRESS BY +DR. PIERRE JANET + + +_The Chairman_: Our country may be hesitating a little--I hope it will +not be for long--in joining a league of nations to prevent war, but +there can be no doubt of our immediate readiness to co-operate +internationally to prevent and reduce disease. Our distinguished guest +from gallant France, Dr. Pierre Janet, professor in the College of +France, evidently feels confident of our sympathy and willingness to +collaborate in this latter respect, for he has ventured across the +ocean, with Madame Janet, in response to our urgent invitation. His +introduction to an audience of American psychiatrists would be quite out +of place. His fame as a pathological psychologist has circled the world. +In the science of medicine he is a modern Titan. For to-day's address he +has chosen as a subject, "THE RELATION OF THE NEUROSES TO THE +PSYCHOSES." + + +DR. JANET + +Mr. President, my dear colleagues, ladies, and gentlemen: The Americans +and the French have met on the battle-fields and they have faced +together the same sufferings for the defense of their common ideal of +civilization and liberty; it is right that they should meet likewise +where Science stands up for the protection of health and human reason, +and that they should celebrate together the Festivals of Peace. The +President and the organizers of this Congress have greatly honored me in +asking me to represent France at the celebration of the centenary of the +Bloomingdale Hospital; but above all they have procured me a great +pleasure in offering me the opportunity of coming again to this +beautiful land, of meeting once more friends who had welcomed us kindly +in former days; our old friends of past happy days who have become still +dearer to us since they have been tried during the bad days. + +Allow me, in the first place, to present you with the best wishes of the +French Government who have had the kindness to charge me to interpret +the sentiments of sympathy which they feel for all manifestations +tending to render the relations that unite our two countries closer and +more fruitful. The Academy of Moral and Political Sciences has equally +charged me to assure you that it is happy to be represented by one of +its members at the commemoration of the centenary of Bloomingdale +Hospital that has so brilliantly and generously continued the tradition +of Pinel and Esquirol. The Academy takes a lively interest in the +psychological and moral studies of this Congress that seek the cure of +diseases of the mind and the lessening of mental disorders. The +Medico-Psychological Society, the Society of Neurology, the Society of +Psychology, the Society of Psychiatry of Paris are happy to take part in +these festivals and are desirous of associating still more closely their +work to that of the scientific societies of the United States. + +The celebration of the centenary of a lunatic asylum gives birth to-day +to a national festivity in which all civilized nations participate. This +is a fact that would have well astonished the first founders of lunatic +asylums, the Pinels, the Esquirols, the William Tukes, and the first +organizers of Bloomingdale. The public opinion respecting the diseases +of the mind, the care to be given to lunatics, is vastly different to +what it was a century ago. This transformation of ideas has taken place, +in a great measure, as a result of the studies devoted to neuroses and +that is why it seems to me interesting to present you to-day with a few +reflections on the connections which unite neuroses and psychoses; for +it is the discovery of these connections that has shown to the man sound +in mind, or who imagines himself to be so, how near he always was to +being a lunatic and how wise it was always to consider the lunatic as a +brother. + +Formerly a lunatic was considered as a separate being, quite apart from +other members of society. The old prejudices which banished the patient +from the tribe as a useless and dangerous individual had diminished no +doubt with respect to the diseases of the body, which were more and more +regarded as frequent and natural things to which each of us might be +exposed. But these prejudices persisted with respect to some sexual +diseases that were still considered ignominious and chiefly with respect +to diseases of the mind. No doubt some intelligent and charitable +physicians took interest in the lunatic, endeavored to spare him many +sufferings, to defend him, to take care of him. But the people feared +the lunatic and despised him as if he had been struck by some +malediction which excommunicated him. I have seen lately a patient's +parents upset with emotion, as they had to cross the gardens of the +asylum to visit their daughter, at the single thought that they might +catch sight of a lunatic. This individual, in fact, had lost in the eyes +of the public the particular quality of man, reason, which, it appears, +distinguishes us from beasts; he seemed still living, but he was morally +dead; he was no longer a man. + +No doubt it was a dreadful misfortune when some member of a family +became insane, but this terrible calamity, which nothing could make one +anticipate or avoid, was happily exceptional, like thunderbolts. The +other men and even the members of the family presented nothing similar +and regarded themselves with pride as very different to this wretched +being transformed into a beast. This victim of heavenly curse was +pitied, settled comfortably in a nice pavilion at Bloomingdale and never +more spoken of. People still preserve on this point ideas similar to +those they had formerly about tuberculosis, known only under the form of +terrible but exceptional pulmonary consumption. Now it has at last been +understood that there are slight tuberculoses, curable, but tremendously +frequent. It will be the same with mental disorders; one day it will be +recognized that under diverse forms, more or less attenuated they exist +to-day on all sides, among a crowd of individuals that one does not feel +inclined to consider as insane. + +Little by little, in fact, men have had to state with astonishment that +all lunatics were not at Bloomingdale. Outside the hospital, in the +family of the unfortunate lunatic, or even in other groups, one observed +strange complaints, moanings relating to lesions which were not visible, +inability to move notwithstanding the apparent integrity of the organs, +contradictory and incomprehensible affirmations; in one word, abnormal +behaviors, very different to normal behaviors, regularized by the laws +and by reason. + +What was the meaning of these queer behaviors? At first they were very +badly understood; they were supposed to have some connection with being +possessed (with the devil), with miasmata, vapors, unlikely +perturbations of the body and animal spirits that circulated in the +nerves. One spoke, as did still Prof. Pomme at the end of the eighteenth +century, "of the shrivelling up of the nerves."[14] But above all, one +preserved the conviction that these queer disorders were very different +to the mental disorders of lunacy. These peculiar individuals had, it +was said, all their reason; they remained capable of understanding their +fellow creatures and of being understood by them; they were not to be +expelled from society like the poor lunatics; therefore their illness +should be anything but the mental disorders of lunacy. + +Physicians, as it is just, watched their patients and only confirmed +their opinion by fine scientific theories. They christened these new +disorders by the name of neuroses, reserving the name of psychoses for +the mental disorders of lunatics. During the whole of the nineteenth +century the radical division of neuroses and psychoses was accepted as a +dogma; on the one side, one described epilepsies, hysterias, +neurasthenias; on the other, one studied manias, melancholias, +paranoias, dementias, without preoccupying oneself in the least with the +connections those very ill-defined disorders might have the ones with +the others. This division was accentuated by the organization of the +studies and the treatment of the patients. The houses that received the +neurotic patients and the insane were absolutely distinct. The +physicians who attended the ones and the others were different, and even +supplied by different competitions. In France, even now, the recruiting +of asylum house pupils and hospital house pupils, the recruiting of +asylum doctors and that of hospital doctors, give an opportunity for +different competitions. One might almost say that these two categories +of house pupils and doctors have quite a different education. The result +was that the examination of the patients, the study thereof, and even +their treatment, were for the most part often conceived in quite a +different manner. For example, neuroses were studied publicly; the +examination was on elementary sensibilities, the movements of the limbs, +and especially reflexes; the insane were more closely examined in the +mental point of view, in conversations held with them by the physician +alone. Their arguments, their ideas were noted more than their +elementary movements. Strange to say, just when the psycho-therapeutic +treatments by reasoning and moralizing with the patients were being +developed, they stood out the contrary of what one might have +supposed--that this treatment should be applied to neurotic patients +alone. It was admitted that lunatics were probably not able to feel this +moral and rational influence; they were treated by isolation, +shower-baths, and purgatives. + +This complete division did not fail to bring about singular and +unfortunate consequences. In a hospital such as La Salpetriere the tic +sufferers, the impulsive, those beset with obsessions, the hysterical +with fits and delirium were placed near the organic hemiplegics and the +tabetics who did not resemble them in the least, and completely +separated from the melancholic, the confused, the systematical raving, +notwithstanding evident analogies. If Charcot who, moreover, has brought +about so much progress in these studies, committed some serious errors +in the interpretation of certain phenomena of hysteria, is it not +greatly due to his having studied these neurotic patients with the +neurology methods without ever applying psychiatry methods? Is it not +strange to refuse psychological treatment precisely to those who present +psychological disorders to the highest degree, and to place the insane +who thinks and suffers altogether outside of psychology? + +In fine, this distinction between the neurotic sufferer and the mental +sufferer was mostly arbitrary and depended more than was believed on the +patient's social position and fortune. Important and rich families could +not be resigned to see one of their members blemished by the name of +lunatic, and the physician very often qualified him as neurasthenic to +please the family. A few years ago this distinction of the patients and +of the physicians gave rise to a very amusing controversy in the +newspapers. The professor of the clinic for diseases of the nervous +system asserted that neurotic sufferers should be patients set apart for +neurologist physicians alone, whereas the alienist should content +himself with real lunatics. The professor of the clinic for mental +diseases protested with much wit and claimed the right of attending +equally the neurotic patients. All this proved a great confusion in the +ideas. + +Notwithstanding these difficulties, Charcot's studies themselves on +hysterical accidents began to make people's minds uneasy and to modify +conceptions of neuroses. They showed that neurotic sufferers presented +disorders in their thoughts, that many of their accidents, in all +appearance physical, were in connection with ideas, with the +_conviction_ of paralysis, of illness, with the remembrance of such or +such an event which had determined some great emotion. Without doubt, +this interpretation of hysteria, which I have myself contributed to +extend, must never be exaggerated, and it must not be concluded from +this that every neuropathic accident always and solely depends on some +remembrance or some emotion. In my opinion, this is only exact in a very +limited number of cases; and then it only explains the particular form +of such or such an accident and not the entire disease. Without doubt it +seems to me exaggerated to-day to see in neuroses those psychological +disorders alone, whereas the disorders of the circulation, the disorders +of internal secretions, the disorders of the functions of the +sympathetic which will be spoken of just here must also have a great +importance. But, however, this observation proved very useful at that +moment. A remembrance, an emotion, are evidently psychological +phenomena, and to connect neuropathic disorders with facts of the kind +is to include the study thereof with that of mental disorders. At this +time, in fact, they began to repeat on all sides a notion that had +already been indicated in a more vague manner; it is that neuroses were +at the root, were in reality diseases of the mind. + +If such is the case, what becomes of the classical distinction between +neuroses and psychoses? No one can deny that the latter are above all +diseases of the mind and we have here to review the reasons which seem +to justify their complete separation. Will it be said that with +psychoses the disorders of the mind last very much longer? But some +patients who enter the asylum with a certificate of insanity are very +frequently cured in a few months and some neuropathic disorders may last +years. I could name you patients who since thirty years keep the same +obsessions, and who at the age of fifty still ask themselves questions +upon their pact with heaven, as they did at the age of twenty. Shall we +speak of the consciousness the patient has of his state? But this +consciousness may be complete in certain melancholies and very +incomplete in certain impulsions. + +Is it necessary to insist on the presence or absence of anatomical +lesions which one tries to ascertain at the post-mortem examination? +Shall we say with Sandras, Axenfeld, Huchard, Hack, Tuke, that neuroses +are diseases without lesions? One finds lesions in general paralysis +which is ranged with insanity and we find some also in epilepsies which +are considered as neuroses; one no more finds lesions in melancholic +conditions than in conditions of obsessions. Besides, as I have often +repeated, this absence of lesions is of no importance; it is quite in +keeping with our ignorance. Every one admits that organic alterations +more or less momentary, but actually not suspected, must exist in +neuroses as in other diseases. Neuroses as well as psychoses are much +more likely to be diseases with unknown lesions than diseases without +lesions, and it is impossible to take this characteristic into account +to distinguish the ones from the others. + +In reality, the notion of lunatic has lost its former superstitious +signification and it has taken no precise medical signification. That +word is now the term of the police language. It indicates only an +embarrassment felt by the police before certain persons' conduct. When +an individual shows himself to be dangerous for others, the public +administration has the habit of defending us against him by the system +of threats and punishments. As a rule, in fact, when a normal mind is in +question, threats can stop him before the execution of crime, and +punishments, when crime has been committed, can prevent him from +beginning again; that is the psychological fact which has given birth to +the idea of responsibility. But in certain disorders it becomes evident +that neither threats nor punishments have a favorable effect, for the +individual seems to have lost the phenomenon of responsibility. When an +individual shows himself to be dangerous for others or for himself, and +that he has lost his responsibility, we can no longer employ the +ordinary means of defense; we are obliged to defend ourselves against +him, and defend him against himself by special means which it is useless +to apply to other men; we are obliged to modify legal conduct toward +him. All disorders of the mind oblige us to modify our social conduct +toward the patient, but only in a few cases are we obliged to modify at +the same time our legal conduct; and these are the sort of cases that +constitute lunacy. + +This important difference in the police point of view is of no great +importance in the psychological point of view nor in the medical point +of view, for the danger created by the patient is extremely varied. It +is impossible to say that such or such a disorder defined by medicine +leaves always the patient inoffensive and that such another always +renders him dangerous. There are melancholies, general paralytics, +insane who are inoffensive, and whom one should not call lunatics; there +are impulsive psychasthenics who are dangerous and whom one shall have +to call lunatics. The danger created by a patient depends a great deal +more upon the social circumstances in which he lives than upon the +nature of his psychological disorders. If he is rich, if he has no need +to earn his living, if he is surrounded by devoted watchfulness, if he +lives in the country, if his surroundings are simple, the very serious +mental disorders he may have do not constitute a danger. If he is poor, +if he has to earn his living, if he lives alone in a large town and his +position is delicate and complex, the same mental disorders, exactly at +the same degree, will soon constitute a danger, and the physician will +be forced to place him in an asylum with a good certificate. This is a +practical distinction, necessary for order in towns, which has no +importance in the point of view of medical science.[15] If we put these +accidental and slightly important differences on one side, we certainly +see a common ground in neuroses and psychoses. The question is always an +alteration in the conduct, and, above all, in the social conduct, an +alteration which tends, if I am not mistaken, toward the same part of +the conduct. + +The conduct of living beings is a special form of reaction by which the +living being adapts himself to the society to which he belongs. The +primitive adaptations of life are characterized by the organization of +internal physiological functions. Later on they consist in external +reactions, in displacements, in uniform movements of the body which +either keep him from or draw him near to the surrounding bodies. The +first of these movements are the reflex movements, then are developed +those combinations of movements which we called perceptive or suspensive +actions in keeping with perceptions. Later came the social acts, the +elementary intellectual acts which gave birth to language, the primitive +voluntary acts, the immediate beliefs, then the reflected acts, the +rational acts, experimental, etc. As I said formerly, there is, in each +function, quite a superior part which consists in its adaptation to the +particular circumstance existing at the present moment. The function of +alimentation, for instance, has to exercise itself at this moment when I +am to take aliments on this table in the midst of new people, that is to +say, among whom I have not yet found myself in this circumstance, +wearing a special dress and submitting my body and my mind to very +particular social rites. In reality it is nevertheless the function of +alimentation, but it must be noted that the act of dining, when wearing +a dress suit and talking to a neighbor, is not quite the same +physiological phenomenon as the simple secretion of the pancreas. +Certain patients lose only the superior part of this function of +alimentation which consists in eating in society, in eating in new and +complex circumstances, in eating while being conscious of what one is +doing, and in submitting to rules. Although the physiologist does not +imagine that these functions are connected with the exercise of sexual +functions in humanity, there is a pathology of the betrothal and of the +wedding-tour. + +It is just on this superior part of the functions, on their adaptation +to present circumstances, that the disorders of conduct +(self-government) which occupy us to-day bear. If one is willing to +understand by the word "evolution" the fact that a living being is +continually transforming himself to adapt himself to new circumstances, +neuroses and psychoses are disorders or halts in the evolution of +functions, in the development of their highest and latest part.[16] + +This halt in evolution can be connected with different physiological +causes, hereditary weaknesses of origin, infections, intoxications, +disorders of internal secretions, disorders of the sympathetic system. +These diverse etiologies will most likely be of use later to distinguish +between forms of these diseases; but to-day the common character of +neuroses and psychoses is that this diminution of vitality bears upon +the highest functions of self-government. + +Whatever be the disorders you may consider, aboulias, hysterical +accidents, psychasthenic obsessions, periodical depressions, +melancholics, systematized deliriums, asthenic insanity, you will always +find a number of facts resulting from this general perturbation. + +In plenty of cases, the acts, far from being diminished, appear +exaggerated; the patient moves about a great deal, he accomplishes acts +of defense, of escape, of attack, he speaks enormously, he seems to +evoke many remembrances and combine all sorts of stories during +interminable reveries. But pray examine the value and the level of all +these acts; they are mere gestures, shocks of limbs, laughter, sobs, +reactions simply reflex or perceptive, in connection with immediate +stimulation, with inhibition, without choice, without adaptation by +reflection. The thoughts that fill these ruminations are childish and +stupid, just as the acts are vulgar and awkward; there is a manifest +return to childhood and barbarism. The behavior of the agitated +individual is well below that which he should show normally. It is easy +to explain these facts in the language we have adopted. The agitation +consists in an activity, more less complete, in inferior tendencies very +much below those the subject should normally utilize. + +It is that in reality the agitation never exists alone, it is +accompanied by another very important phenomenon which it dissimulates +sometimes, I mean the depression characterized by the diminution or the +disappearance of superior actions, appertaining to the highest level of +our hierarchy. It is always observed that with these patients certain +actions have disappeared, that certain acts executed formerly with +rapidity and facility can no longer be accomplished. The patients seem +to have lost their delicacy of feeling, their altruism, their +intelligent critique. The stopping of tendencies by stimulation, the +transformation of tendencies into ideas, the deliberation, the endeavor, +the reflection; in one word, both the moral effort and the call upon +reserves for executing painful acts are suppressed. There exists visibly +a lowering of level, and it is right to say that these patients are +below themselves. + +The two phenomena, agitation and depression, are almost always +associated in neuroses as well as in psychoses. It is likely that their +union depends upon some very general law, relating to the exhaustion of +psychological forces. It is probable that the superior phenomena exact +under a form of concentration, of particular tension, much more power +than acts of an inferior order, although the latter seem more violent +and more noisy. "When the force primitively destined to be spent for the +production of a certain superior phenomenon has become impossible, +derivations happen, that is to say, that this force is spent in +producing other useless and especially inferior phenomena."[17] + +A very great number of phenomena observed in neuroses and psychoses are +in connection with depression and agitation. Convulsive attacks, diverse +fits of agitation, prove to us that before the fit there existed +disproportion between the quantity and the tension of the psychological +forces, and that the spending of forces during the fit re-establishes +the equilibrium. But at the same time, after this spending, one observes +a notable lowering of the mental level, a real psycholepsy. It is very +likely that studies of this kind will produce some day the key of the +epilepsy problem, for vertigos and certain epileptic fits are certainly +phenomena of relaxation, the meaning of which we do not comprehend +because we do not study sufficiently the state of psychological tension +before and after the accidents. + +The difficulty of accomplishing superior acts, the exhaustion resulting +from their accomplishment, renders them fearful to the patient who has +the fear, the phobia of these acts, just as he has the terror of that +depression which gives the feeling of the diminution of life. The +shrinking of activity and conscience, phobias, negativisms, generally +take their starting point in this fear of exhaustion caused by some +difficult action. In other cases the patient feels incapable of +accomplishing correctly the reflected acts necessary to social and moral +life, and feeling no longer protected by reflection, he is afraid of +willing or believing something, as one is afraid of walking in a +dangerous path, when one cannot see. The vertigo of life produces itself +like the vertigo of heights, when one is not sure of oneself. + +Depressed patients have felt, wrongly or rightly, a certain excitation +after a certain action. Through some curious mechanism, certain acts, +instead of exhausting them, have raised their psychological tension. The +need, the desire to raise themselves inspires them with the wish to +renew such acts, and we behold the impulsions to absorb poisons, +impulsions to command, to theft, to aggression, to extraordinary acts, +varied impulsions which play a great part in psychoses as well as in +neuroses. + +I shall not insist any more on a very interesting phenomenon in +connection with the oscillations of the mind and which still plays a +great part in these diseases. I am speaking of the change of feeling +which may accompany the same action in the course of the oscillations of +the mind. At the level with the reflected action, more or less complete, +the thought of an action which appears important and of which one often +thinks, determines interrogations, doubts, scruples. If the individual +descends one degree, if he becomes quite incapable of reflecting and +therefore of doubting, the same action he continues to think about may +present itself under the form of an impulsion more or less irresistible. + +There are patients who in the first stage have the fear and horror of +committing an act and who in the second stage are driven to accomplish +it. In other cases a subject may make use of an action as a means of +exciting and raising himself; he seeks it, and the thought of this +action is accompanied by love and desire. Let him become depressed and +he will no longer be able to accomplish this same action without +exhausting himself; he is then reduced to dread it and take an aversion +to it. That which was an object of love becomes an object of hatred. +Thence these turnings of mind that are so often to be observed in the +course of neuroses and psychoses. In a score of my observations the +frenzy of persecution and hatred presents itself as an evolution of +those obsessions of love and domination. + +These are very curious facts that one observes in the oscillations of +the mind, in particular when the psychasthenic depression becomes more +serious and transforms itself in psychasthenic delirium, which is more +frequent than one generally imagines. As a rule the properly so-called +psychasthenic has only disorders of the reflection; he doubts but he +does not rave. But under different influences, his depression may +augment, and when he drops below reflection he has no longer the doubts, +the hesitations, he no longer shows manias of love and of direction, he +transforms his obsessions into deliriums and often his loves into +hatreds. + +These are a few examples of the perturbations of conduct common to +neurotic sufferers and the diseased in mind. One perceives that the same +laws relating to the diminution of force and the lowering of the +psychological tension intervene in the same way with the one as with the +others. The distinctions, which have been established for social reasons +and practical conveniences, no longer exist when one tries to find, by +analysis of the symptoms, the nature of neuroses and psychoses. + +The latter reflection shows us, however, that in certain cases, at +least, there is a certain difference in degree between neuroses and +psychoses. The evolution of the human mind has been formed by degrees, +by successive stages, and we possess in ourselves a series of superposed +layers which correspond to diverse stages of the psychological +development; when our forces diminish we lose successively these diverse +layers commencing with the highest. It is the superior floors of the +buildings that are reached first by the bombardments of the war and the +cellars are not destroyed at first; they acquire even more importance, +as people are beginning to inhabit them. Well, according as the +depression descends more or less deeply, the disorders which result from +the loss of the superior functions and the exaggerated action of the +inferior ones become more and more serious and are appreciated +differently. The superior psychological functions are, in my opinion, +experimental tendencies and rational tendencies. They are tendencies to +special actions in which man takes in account remembrances of former +acts and of their results, in which he enforces on himself by a special +effort obedience to logical and moral laws. A little fatigue and a +slight degree of exhaustion are sufficient for such an action to become +difficult and impossible to prolong for a long time. Furthermore, the +disorders of the experimental conduct or of the rational conduct are +very frequent. These disorders only reach the superior actions which are +not absolutely necessary to the conservation of social order. They can +be easily repaired by inferior acts: if the man does not obey pure moral +principles, at least he can conduct himself in appearance in an +analogous manner through fear of the prison. Also, these disorders of +the superior functions are considered as slight; they are called errors, +or faults, and it is admitted that the subjects remain normal beings. + +At the other extremity of the hierarchical series of tendencies the acts +are simply reflex. When the disease descends to this level, when the +elementary acts can no longer be executed correctly, we do not hesitate +either, and we consider these disorders (related with known lesions) as +organic diseases of the nervous system. But between these two terms we +note disorders in behavior which are more difficult to interpret. These +disorders are too grave and too difficult to modify by our usual +processes of education and punishment for us to consider them as mere +errors or as moral faults; they are variable; they are not accompanied +by actually visible lesions and we have trouble in classing them among +the acknowledged deteriorations of the organism. There is the province +of neuroses and psychoses, intermedium between that of rational errors +and that of organic diseases of the nervous system. It corresponds to +the disorders of medium psychological functions, to the group of these +operations which establish a union more or less solid between the +language and the movements of limbs and which give birth to our wills +and beliefs. + +Can one establish, in this group, a distinction between neuroses and +psychoses that rests on some more precise notion and that is not limited +to distinguishing them in a legal point of view? A more profound +knowledge of the mechanisms of the will and belief would perhaps permit +us to do so. We are capable of wills and beliefs of a superior order +when we reach decision after reflection. The operation of reflection +which hinders tendencies and maintains them in the shape of ideas, which +compares ideas and which only decides after this deliberation, +constitutes the highest form of the medium operations of the human mind. +Lower, still, there exists will and belief, but they are formed without +reflection, without stoppage of ideas, without deliberation; they are +the result of an immediate assent which transforms verbal formulas into +wills and beliefs as soon as they strike the attention, as soon as they +are accompanied by a powerful sentiment. The immediate assent is the +inferior form of these tendencies. + +If one wished to establish a scientific distinction between neuroses and +psychoses, I should say, in a summary fashion, that in neuroses the +reflection alone is disturbed, that in psychoses the immediate assent +itself is affected. The shrinkage of the conscience, doubts, aboulias, +obsessions, scruples are always disorders of the reflected will and +belief. On the contrary, irresistible impulsions, deliriums, +indifferences which suppress desires and only allow elementary +agitations to subsist, show alterations in the immediate assent, in the +will, and the primitive belief and must be considered as psychoses. +Below could be placed the disorders of elementary intelligence, the +disorder of the perceptive and social functions which characterize the +mental deficiencies of imbeciles and idiots. One might also distinguish +these disorders according to the degree of depth the destruction of the +edifice has reached, according to the more or less distant state of +evolution to which the patient goes back. But these psychological +classifications are purely theoretical, and in practice many other +factors intervene which oblige us to consider such a patient as +incapable of doing any harm and such another as dangerous; this is the +only difference to-day between neuroses and psychoses. Later on, without +doubt, we shall be able to substitute for these simply symptomatical and +psychological diagnostics, some etiological and physiological +diagnostics. We shall be able from the very outset to recognize that a +disorder, in all appearance slight and which is not deeply set, presents +a bad prognosis, and we shall be able to foresee a serious and deep +psychosis in the future. To-day, without doubt, one can often +distinguish from the outset the future general paralytic from the simple +neurasthenic. But in the actual state of science this ability to +distinguish is not frequent and the future evolution of a depressed +state can scarcely be foreseen with precision. + +Certain individuals pass in a few years from psychasthenic depression +with doubts and obsessions to psychasthenic deliriums with stubbornness +and negativism, then to asthenic insanity with irremediable and complete +want of power. Is it necessary to say that we made a mistake in our +diagnostic and that from the first demential psychosis should have been +recognized? I am not convinced of this: these diseases, excepting a few +cases with rapid evolution, are not characterized from the outset. +Without doubt we must note that these depressions which disturb the +reflective tendencies of young patients in full period of formation, +are dangerous and can bring on still deeper depressions of the +psychological tension. But that evolution is rarely fatal; it can very +often be checked, and it seems to me fair to preserve the distinction +between neuroses and psychoses considered as different degrees of +psychological decadence. + +Neuroses are, therefore, the intermedium between the errors and the +faults which appeared to us almost normal, and alienation which seemed +exceptional and distant from us. The first appearances of that +depression which in a continuous manner descends to alienation are to be +found already in the disorders of character which seemed to be quite +insignificant. The miser, the misanthrope, the hypocrite are described +by the writer before they are claimed by the physician. A great number +of neuropathic disorders which I have described are related to the +popular type of mother-in-law. This type is not necessarily that of a +woman whose daughter has married, but the type of a depressed woman of +about fifty, aboulic, discontented with herself and others, domineering, +and jealous, because she suffers from the mania of being loved though +she is incapable of acquiring any one's affection. All exhaustions, all +moral failings have the closest connection with neuroses and psychoses. + +These reflections prove to us that the alienist physician should +interest himself more and more in the treatment of neuroses even slight, +to rectifying the disorders of temper, to the education of the young, to +the direction of the moral hygiene of his country. On many of these +points America leads the way; your works of social hygiene, the good +battle you are righting against alcoholism, are examples for us. You are +the new world, younger, not rendered so inactive by secular habits. You +can act more easily than we. We may have the advantage, in the old +world, of the experience of old people and the habit of observation, but +we are slack in reform and action. "If youth had experience and old age +ability," says one of our proverbs. We must remain united and join your +strength to our experience for the greater progress of the studies which +are dear to us and for the greater good benefit of our two countries. + +FOOTNOTES: + +[Footnote 14: _Cf._ Janet, P., Les nevroses, 1909, p. 370.] + +[Footnote 15: _Cf._ Les Medications psychologiques, 1920, I, p. 112.] + +[Footnote 16: "Les Nevroses," 1909, p. 384.] + +[Footnote 17: _Cf._ Janet, P., "Obsessions et Psychestenic," 1903, vol. +I, p. 997.] + + + + +ADDRESS BY +DR. WILLIAM L. RUSSELL + +[Illustration: BLOOMINGDALE HOSPITAL, WHITE PLAINS, NEW YORK, 1921] + + +_The Chairman_: The year 1921 is rich in anniversaries for the New +York Hospital. Next October we plan to celebrate the one hundred and +fiftieth anniversary of the granting of our charter. To-day we are +occupied with the Bloomingdale Centenary. A fortnight ago the +twenty-fifth annual graduating exercises of our Training School for +Nurses were held in this room. This year also marks the decennial of Dr. +Russell's term of office as Medical Superintendent. When his devoted +predecessor, Dr. Samuel B. Lyon, asked in 1911 to be relieved from +active duty and became our first Medical Superintendent Emeritus, we +were most fortunate in securing as his successor Dr. Russell. Coming to +this institution after a broad psychiatric and administrative +experience, he has taken up our special problems with deep insight and +gratifying success. He has selected for his subject this afternoon "THE +MEDICAL DEVELOPMENT OF BLOOMINGDALE HOSPITAL." No one can speak with +greater authority on a theme of which it may be said _quorum magna +pars_--fortunately not only _fuit_--but _est_ and _erit_ as well. + + +DR. RUSSELL + +The object of this celebration is not merely to glorify the past and +least of all is it to laud the present. What we hope from it is that it +will establish a milestone, not only to mark the progress thus far made +but to point the way to a path of greater usefulness. The advances in +medical science and practice and in the specialty of psychiatry during +the past hundred years fill one with wonder and hope. It is worth while +to review them merely to obtain this help. The outlook for the century +to come is, however, so far as can be anticipated, still brighter. + +To review the past is, at a time like this, not unprofitable. It may +prevent us, in our zeal for the new, from discarding what is valuable in +the old, and from overvaluing some things which may have outlived their +usefulness. We must be careful that we do not fall into errors similar +to those from which the medical profession was rescued by the movement +of which Bloomingdale Asylum was an offspring. It should be recalled +that the establishment of the asylum was due to the initiative of the +Governors of the New York Hospital, especially Mr. Eddy, rather than to +the active interest and direction of physicians. The object of the +establishment was, according to Mr. Eddy, to afford an opportunity of +ascertaining how far insanity may be relieved by moral treatment alone, +which, he says, "it is believed, will, in many instances, be more +effective in controlling the maniacs than medical treatment." The moral +management he referred to, though advocated by Pinel and a few others, +some of whom were benevolent and intelligent laymen, had not been +accepted by physicians as a distinct form of medical treatment. Few +physicians of the period had accepted management of the mind as +described and practised by Pinel as being a distinct medical procedure, +as having the same value in overcoming mental disorders as the drastic +medical remedies which they were accustomed to employ, or as having any +exclusive healing power. This is clearly shown by the case records of +the mental department of the New York Hospital which have been preserved +since 1817, and of those of Bloomingdale Asylum for some years after its +opening in 1821. It is plainly set forth in Dr. Rush's book on diseases +of the mind, which was first published in 1810 and again in a fourth +edition in 1830. Rush was physician to the Pennsylvania Hospital and his +book was the principal, if not the only, one of the period by an +American author. American physicians like their European brothers, had, +as Pinel observes, "allowed themselves to be confined within the fairy +circle of antiphlogisticism, and by that means to be deviated from the +more important management of the mind." Rush believed that madness was a +disease of the blood-vessels of the brain of the same nature as fever, +of which it was a chronic form. "There is," he says, "not a single +symptom that takes place in an ordinary fever, except a hot skin, that +does not occur in an acute attack of madness." He found in his autopsy +observations confirmation of this view and concludes that "madness is to +phrenitis what pulmonary consumption is to pneumony, that is, a chronic +state of an acute disease." The reason for believing that madness was a +disease of the blood-vessels, which seemed to him most conclusive, was +"from the remedies which most speedily and certainly cure it being +exactly the same as those which cure fever or disease in the +blood-vessels from other causes and in other parts of the body." The +treatment he recommended and which was generally employed was copious +blood-letting, blisters, purges, emetics, and other severe depleting +measures. When Bloomingdale Asylum was established, therefore, the +provision for moral treatment did not contemplate that this should be +applied by the physician or that he should have full control of the +resources by means of which it could be applied. The records do not +indicate that either the physicians or the Governors realized that this +might be necessary or advantageous. The present system of administration +in which the chief physician is also the chief executive officer of the +institution was a result of an evolution which took many years to reach +its full consummation. + +Pinel, many years before Bloomingdale Asylum was opened, had shown by +the most careful observation and practice that the management and +discipline of the hospital was a most powerful agent in the treatment of +the patients. The manner in which he was led to this conclusion is a +remarkable example of the scientific method. When he became physician to +the Bicetre he found that the methods of classification and treatment +recommended in the books seemed to be inadequate, and, desiring further +information, he says: "I resolved to examine myself the facts which were +presented to my attention; and, forgetting the empty honor of my titular +distinction as a physician, I viewed the scene that opened to me with +the eye of common sense and unprejudiced observation.... From systems of +nosology, I had little assistance to expect; since the arbitrary +distributions of Sauvages and Cullen were better calculated to impress +the conviction of their insufficiency than to simplify my labor. I, +therefore, resolved to adopt that method of investigation which has +invariably succeeded in all the departments of natural history, viz., to +notice successively every fact, without any other object than that of +collecting materials for future use; and to endeavor, as far as +possible, to divest myself of the influence, both of my own +prepossessions and the authority of others. With this view, I first of +all took a general statement of the symptoms of my patients. To +ascertain their characteristic peculiarities, the above survey was +followed by cautious and repeated examinations into the condition of +individuals. All our new cases were entered at great length upon the +journals of the house." Having thus studied carefully the course of the +disease in a number of patients who were subjected only to the guidance +and control made possible by the management of the hospital under the +direction of a remarkably highly qualified Governor, it came to him with +the force of a new discovery that this man who was not a physician was +doing more for the patients than he was, and that insanity was curable +in many instances by mildness of treatment and attention to the state of +mind exclusively. "I saw with wonder," he says, "the resources of nature +when left to herself, or skilfully assisted in her efforts. My faith in +pharmaceutic preparations was gradually lessened, and my scepticism +went at length so far as to induce me never to have recourse to them, +until moral remedies had completely failed." So convinced did he become +of the significance and importance of the management and discipline of +the hospital in the treatment of the patients, that, when a few years +later, he wrote his "Treatise on Insanity," he states that one of the +objects of his writing it was, "to furnish precise rules for the +internal police and management of charitable establishments and asylums; +to urge the necessity of providing for the insulation of the different +classes of patients at houses intended for their confinement; and to +place first, in point of consequence, the duties of a humane and +enlightened superintendency and the maintenance of order in the services +of the Hospitals." + +Pinel's views had apparently not been fully understood or adopted by the +physicians of America at the time Bloomingdale Asylum was planned and +established. Dr. Rush did not mention him in his book, and Mr. Eddy, in +his communication to the Governors of the New York Hospital, referred +only to the writings of Drs. Creighton, Arnold, and Rush and the Account +of the York Retreat by Samuel Tuke. + +When Bloomingdale Asylum was opened, the form of organization +introduced was that under which the department at the New York Hospital +had been conducted. Mr. Laban Gardner was made Superintendent or Warden +with two men and three women keepers to aid him in the control and +management of the seventy-five patients. There was an Attending +Physician who visited once a week and a Resident Physician, neither of +whom received salaries. There is nothing in the records to indicate that +in the beginning, the Governors of the Hospital looked upon the moral +treatment of the patients, which was the object for which the +institution was established, as the task of the Physicians. The aim was +to furnish employment, diversion, discipline, and social enjoyment, +without much attempt at precision or close medical direction and +control. For a time the results were considered to be satisfactory. In +1824, however, a joint Committee of the Board reported that they were +impressed by the necessity of improving the moral treatment, and +recommended that two discreet persons be appointed to take charge of +such of the patients as might from time to time be in a condition to be +amused or employed on the farm or in walking exercises in the open or in +classes to be designated by the Resident Physician "with," however, "the +approbation of the Superintendent," who you will recall was not a +physician. These patients were, the report recommends, to be +particularly under the charge of the Resident Physician when thus +employed or amused "out of the Asylum." At this time, the Attending and +Resident Physicians were placed on a small salary, and the Resident +Physician was instructed to "devote a greater portion of his time and +attention to the moral part of the establishment and to communicate to +the Committee such improvements as his experience shall suggest to be +useful and necessary in carrying into more complete effect the system of +moral treatment and to report from time to time to the Committee the +effect of the measure adopted." This seems to have been the beginning of +a realization that the moral management of the patients was inseparable +from medical treatment and must necessarily be the task of the +physician. Seven years after this, in 1831, the Committee found it +advisable to spread upon the minutes an "interpretation and +regulations," relating to the Superintendent and Matron of the Asylum +and to the Asylum physicians, to the effect that the Committee +understood that the regulations "placed the moral treatment on the +physician alone, under the direction of the Asylum Committee, and that +the responsibility remains with him alone, that this treatment commenced +with the reception of the patient, the ward where he shall be placed, +his exercises, amusement, admission of friends, the time of discharge +from the house.... And that all orders to nurses and keepers which the +physicians may think necessary to carry these orders into effect _shall +be communicated through the Superintendent_" (or Warden). In 1832, the +Resident Physician, Dr. James Macdonald, who had just returned from +Europe after having spent a year in visiting the institutions for mental +disorders there, made a report in which he rather significantly referred +to the impracticability of making a sharp distinction between the +medical and moral treatment of the patients, it being difficult to say +where the one ended and the other began, or to put one into successful +operation without bringing in the other. At this time the position of +Attending Physician was abolished and the Resident Physician was made +the Chief Medical Officer of the Asylum. It was not until 1837 that an +amendment to the by-laws regulating the powers of the physician and the +Warden was adopted which gave to the physician the power of appointing +and discharging at pleasure all the attendants on the patients, while to +the Warden was reserved the power of appointing and dismissing all other +employees. Fourteen years had thus elapsed since the opening of the +Asylum before the physician was given control of even the nursing +service. The first Annual Report of the Resident Physician of the +Asylum to be published appeared in 1842. In this, Dr. William Wilson +makes a general statement in regard to the beneficial effects of the +moral as well as the medical treatment pursued in the institution, and +refers particularly to occupations, exercise in the open air, amusement, +religious services, and he asks that a workshop be erected for the men. +It is evident that by this time the authority of the physician in the +management of the institution had been extended and it is perhaps +significant that in his report of the following year Dr. Wilson refers +to a plan for distribution of food which had been evolved in +co-operation with the Warden. Under the direction of Dr. Pliny Earle, +who was appointed physician to the Asylum in 1844, treatment directed to +the mind was further elaborated and systematized, and the place of the +physician in the management of the hospital was more firmly established. + +This brief survey indicates how, in the development of the work of the +institution, it required years of practical experience to show to the +Governors that, in order to secure for the patients the treatment which +the Asylum had been established to furnish, it was necessary to extend +the powers and duties of the physician so that he could control and +direct the internal management and discipline, and all the resources +for social as well as individual treatment. This extension was continued +until finally the present form of organization was adopted in which the +chief physician is also the chief executive officer of the institution. +This was, however, not fully accomplished until 1877. It is now +universally recognized that the physician must be the supreme head of +the organization, and all American institutions and most, if not all, of +those in other countries are now similarly organized. + +In the early development of Bloomingdale Asylum, this extension of the +influence and authority of the physician is the outstanding medical +fact. It did away with division of responsibility and removed from +discussion the question of moral as distinct from medical treatment. +Thereafter a harmonious and effective application of all the resources +of the institution to the problems of the patients became more easily +and certainly possible. Since then, the resources for treatment directed +to the mind have been developed as steadily and fully as those required +for the treatment of physical conditions. The use of the organized +agencies which were regarded by the founders as the main reliance in +moral treatment, namely occupations, physical exercises and games, +diversion, social contacts, and enjoyment, and management of behavior +has been greatly extended, and specialized departments have been +created for their application with system and growing precision. Great +advances have also been made in the methods of examining the minds of +the patients and of determining the mental factors in their disorders +and the means of restoring their capacity for adjustment to healthy +thinking and acting. Psychiatry has been furnished with a body of +well-arranged facts, and with a technic which is not inferior in system +and precision to that of many other branches of medicine. In the study +and management of the minds of the patients the physician is thus +enabled to apply himself to the task as he does to any other medical +problem. + +The advances in general medical science and practice have also +necessitated great elaboration of the resources for the study and +treatment of the physical condition of the patients. Instruments of +precision, laboratories, x-ray departments, dental and surgical +operating rooms, massage and hydrotherapy departments, facilities for +eye, throat, nose, and ear examinations and treatment, and all the other +means of determining disease processes and applying proper treatment +have been supplied and the methods and standards of modern clinical +medicine and surgery are utilized. It can now be clearly seen that it is +necessary to direct attention to the whole personality of the patient, +including his original physical and mental constitution, the physical as +well as the mental factors which may be operating to produce his +disorder, and the environmental conditions to which he has been and may +again be exposed. In the treatment of mental disorders it is necessary +to beware of what Pinel found to be the fault of the physicians and +medical authors of his time, who he says were more concerned with the +recommendation of a favorite remedy than with the natural history of the +disease, "as if," he says, "the treatment of every disease without +accurate knowledge of its symptoms involved in it neither danger nor +uncertainty," and he quotes the following maxim of Dr. Gault: "We cannot +cure diseases by the resources of art, if not previously acquainted with +their terminations, when left to the unassisted efforts of nature." +Exclusive attention to the physical condition and factors, or to the +mental condition and factors, or concentration on one theory or one form +of treatment to the exclusion of all others is sure to lead to neglect +of that careful general inquiry into the whole personality of the +patient, into the conditions out of which his disorder arose, and into +all the manageable factors in the situation which is so essential to +intelligent and effective treatment. Notwithstanding the great benefit +which has been derived from physical measures in the study and +treatment of mental disorders, and the well-founded hopes of greater +advances in this direction, the main task still continues to be what +Pinel calls the management of the mind. Experience and increasing +knowledge show that this is a task which can only be successfully +performed by the physician and by means of organized resources which are +under medical direction and control. The hospital for mental disorders +furnishes the means of providing social as well as individual treatment. +It is a medical mechanism and for its proper management and use it is +required of physicians that they accept the burden of much executive +work and give their attention to many subjects and activities that may +interfere seriously with what they have been taught to regard as more +strictly professional interests. Like Pinel, one must be willing to +forget the empty honor of one's titular distinction as a physician, and +do whatever may be necessary to make the institution a truly medical +agency for the healing of the sick. Considerable progress has been made +in developing executive assistants to relieve the physicians of much of +the administrative work which requires little or no medical supervision +and direction. Special provision for the training of such executives +has, however, received insufficient attention. This question might, with +great advantage, be taken up by the hospitals and colleges. Nothing +would add more to the quality of the service which the hospitals render +than to supplement the work of the physicians by that of well educated +and highly trained executive assistants who would themselves find an +extremely interesting and productive field for their efforts. + +A period has now been reached in this field of work when what amounts to +a movement not inferior in significance and importance to that of a +hundred years ago, seems to be in active operation. The character and +scope of this movement and the lines of its progress have, to some +extent, been indicated in the illuminating formulations which have been +presented here to-day. The medical study and treatment of the mind is no +longer so exclusively confined within the walls of institutions nor to +the type or degree of disorder which necessitates compulsory seclusion. +Psychiatry is extending out from the institutions into the communities +by means of out-patient clinics and social workers, through newly +created organized agencies, through informed individuals, physicians, +nurses, and lay workers, and through the general spread of psychiatric +knowledge. This process is being expedited by the efforts of organized +bodies such as the National and State Committees and Societies for +Mental Hygiene, and the public is rapidly learning what can properly be +expected of institutions, officials, physicians, nurses, and other +responsible individuals in whom special knowledge and ability are +supposed to be found. As in the prevention of tuberculosis, so, in the +prevention of mental disorders, the informed public is likely to start a +campaign which the medical profession may have to make haste to follow +in order to maintain its needed leadership. Although much is yet +required to improve the facilities necessary in carrying on the present +work, it seems to us that at such a time a further extension of the +activities of an institution such as Bloomingdale Hospital may be +necessary to enable it to fulfil its possibilities for greater +usefulness. To extend the work our experience indicates that a +department in the city at the General Hospital would be of great +advantage. During the past few years the oversight of discharged +patients has grown to such an extent that it seems as though some +organized method of carrying it on may soon become necessary. This and +out-patient work generally could be best attended to in a city +department. Much emergency work and preliminary observation and the +treatment of certain types of cases now frequently subjected to +unfortunate delays, neglect, and unskilful treatment would also be thus +provided for. It can be seen too that developments in construction and +organization which would furnish organized treatment for types of +disorders which are not so incapacitating as the pronounced psychoses +might be of advantage in the treatment of both adults and children. The +property on which the Hospital is located is large enough to permit of +further extensions and developments which could be as closely connected +with, or as widely separated and distinguished from, the present +provision as circumstances required. In this way much needed provision +for the treatment of persons suffering from the psychoneuroses and minor +psychoses could be furnished. Better provision for a further period of +readjustment after a patient is ready to leave the Hospital but not yet +ready to face the risk of ordinary conditions in the community is a felt +want. A group of supervised homes or an occupational colony might best +serve this purpose. The more extensive use of the Hospital as a teaching +centre is also a subject for consideration. A School for Nurses is now +conducted, and much instruction is given in the occupational +departments. More, however, could be done, especially in medical +teaching, which could be best carried on in a department in the city and +would tend to advance the standard of medical service throughout the +Hospital. + +The lines of further development are, perhaps, not yet perfectly clear +in all directions. It seems certain, however, that they will lead toward +a broader field of usefulness, in which the hospital will be regarded as +a responsible agency for dealing with psychiatric problems in the +community which it serves and will take part with other agencies in +extending psychiatric knowledge and in applying it to prevention, and to +the management of mental disorders as an individual and social problem +beyond the walls of the institution. We hope that this meeting will +prove a real starting point for this development. We are greatly +indebted to those who have taken part in it both as speakers and as +audience. We are especially indebted to those who came across the sea to +be with us. It is peculiarly fitting that representatives of France and +of England should have been here, for to Pinel, the Frenchman, and to +Tuke, the Englishman, are due more than to any others whose names we +know the foundations of the modern institutional treatment of mental +disorders. + + + + +_The Chairman:_ This, ladies and gentlemen, concludes our exercises. As +the representative of the Governors, I find it quite impracticable, in +supplementing what Dr. Russell has just said, to express adequately our +admiration of and gratitude to these eminent scientists and apostles of +light for their presence here and for their inspiring addresses. These, +if I may be permitted to appraise them, seem to make a notable addition +to medical literature, and, with the permission of their authors, we +purpose, for our own gratification and for the benefit of the +profession, to have all of the addresses preserved in a volume recording +this centenary celebration. In due course a copy of this volume will be +sent to each of our guests. The celebration itself, I think you will all +agree with me, has been a moving one, with an underlying note of +philanthropic endeavor as high as the stars. You heard its refrain in +the pageant on the lawn this afternoon. As I have listened to-day to +these words of profound wisdom, uttered in so noble a spirit of human +ministry, my mind has gone back to the sentence from Cicero's plea for +Ligarius,[18] which formed the text for Dr. Samuel Bard's eloquent +appeal in 1769, mentioned this morning, for the establishment of the New +York Hospital, and which may be freely rendered, "In no act performed by +man does he approach so closely to the Gods as when he is restoring the +sick to the blessings of health." And surely when that restoration to +health consists in "razing out the written trouble of the brain" and +reviving in the patient the conscious exercise of divine reason, it is +difficult to imagine a more Godlike act. + +FOOTNOTES: + +[Footnote 18: Homines enim ad Deos nulla re proprius accedunt, quam +salutem hominibus dando.] + + + + +THE TABLEAU-PAGEANT + +[Illustration: SCENE FROM THE TABLEAU PAGEANT PRESENTED ON THE GROUNDS +OF BLOOMINGDALE HOSPITAL, MAY 26, 1921] + + +SYNOPSIS + +While the Symbolic Father Time bears witness, the Muse of History, as +the Narrator, after alluding to the remote past, briefly summarizes the +incidents leading up to the establishment of the Society of the New York +Hospital by Royal Charter in 1771. The succeeding scenes are +self-revealing. The familiar picture of Pinel at Salpetriere depicts +conditions in that period. Several portraits of personalities intimately +associated with the early history of Bloomingdale Hospital follow. +These, together with an episode from the life of Dorothy Dix, stimulate +our imagination with reference to the revival of interest in the care of +the mentally ill in the first half of the last century. The closing +scenes suggest the great advance which has taken place during the +century, and the part that work and play take to-day in re-establishing +and maintaining life's balances. Finally, in symbolic processional, +tribute is paid to Hygeia, the goddess of Health and Happiness. + + +CHARACTERS AND SCENES IN TABLEAU-PAGEANT + +Music: Orchestra + Overture + +_Prologue_ + +The Muse of History (Narrator): Adelyn Wesley +Spirit of the Past (Time): Dr. D. Austin Sniffen + +Music: Orchestra + "Amaryllis" + + +SCENE I + +COURT OF KING GEORGE III.--GRANTING OF THE CHARTER + +Characters: + King George III + Queen Charlotte + Prince of Wales + Court Chamberlain + Court Ladies + Emissaries + Cherokee Chief + Gavot + +Minuet + + Through dramatic license, this scene takes place in the Court of + King George III. Colonial emissaries, accompanied by a North + American Indian, attend, and are graciously granted by the King a + Royal Charter establishing the Society of the New York Hospital, + along with a seal, insignia, and a money gift. A bit of color and + romance attaches to the Cherokee's appearance in the scene. + +Music: Orchestra + "God Save the King" + "Minuet Don Juan" + "Largo" + "Amaryllis" + + +SCENE II + +PINEL A LA SALPETRIERE [Transcriber's note: original reads +'SALPTERIERE'] + +Characters: + Pinel + Patients + Aides and Attendants + + A courtyard scene in Salpetriere in 1792. Hopelessness and chained + despair are pictured. Pinel enters, is saddened and indignant at + the sight of so much unnecessary suffering, and instantly orders + the chains to be struck off. The historic episode closes in a + graphic tableau depicting the gratitude of the released. + +Music: Orchestra + "Kammenoi Ostrow" + + +SCENE III + +PORTRAITS--PERSONALITIES OF THE PAST + + +Thomas Eddy, of the Board of Governors, 1815-1827. + +Dr. James Macdonald, First Resident Physician, 1825-1837. + +Dr. Pliny Earle,[Transcriber's note: original reads 'Early'] Organizer, + 1844-1849. + +Miss Eliza Macdonald, daughter of Dr. Macdonald, unveils the portrait of +her father. + +Music: Orchestra + "Long, Long Ago" + + +SCENE IV + +DOROTHY LYNDE DIX BEFORE A LEGISLATIVE COMMITTEE + +Characters: [This instance of 'Characters:' added by transcriber] + Dorothy L. Dix + Members of the Committee + Chairman + + Miss Dix appears before a Committee of the Legislature and is heard + in an impassioned appeal on behalf of adequate provision and care + for the mentally ill. The scene closes with the Committee + indicating their approval and congratulating Miss Dix on her + successful effort. + +Music: Orchestra + "Maryland, My Maryland" + "Columbia, the Gem of the Ocean" + + +SCENE V + +OCCUPATIONAL-RECREATIONAL ACTIVITIES + +Men's Crafts +Women's Crafts +Men's Sports +Women's Sports + +Maypole Dance + + Supplementing the general medical work, the therapeutic value of + organized occupational and recreational activities is gaining + increasing recognition. Those arts and crafts lending themselves to + graphic presentation are here selected: dyeing, weaving, spinning, + basketry, caning, modelling, painting, pottery, metal work, net + making, gardening, etc.: and similarly, in the recreative + activities, tennis, golf, hockey, baseball, croquet, bowling, + skiing, and skating. A Maypole dance closes the scene. + +Music: Orchestra + "Boccherina" + "Henry VIII, Maypole Dance" + + +SCENE VI + +INSPIRATIONS + +Characters: + Hygeia + La Belle France + Britannia + Columbia + + The closing scene is in the nature of a processional symbolizing + international unity of purpose and a determination to pursue, until + finally attained, the goal of Health and Happiness, personified by + the goddess Hygeia. + +Music: Orchestra + "Marseillaise" + "God Save the King" + "Battle Hymn of the Republic" + "The Star Spangled Banner" + "Tammany" + + + + +NAMES OF THOSE WHO ATTENDED THE EXERCISES[19] + +E. Stanley Abbot, M.D. Philadelphia, Pa. +Louise Acton White Plains, N.Y. +Elizabeth I. Adamson, M.D. White Plains, N.Y. +William H. Allee, M.D. Ridgefield, Conn. +Thaddeus H. Ames, M.D. New York City. +Mrs. George S. Amsden White Plains, N.Y. +Mrs. Isadora Anschutz White Plains, N.Y. +Grosvenor Atterbury New York City. + +Pearce Bailey, M.D. New York City. +Amos T. Baker, M.D. Bedford Hills, N.Y. +Mrs. Amos T. Baker Bedford Hills, N.Y. +Lewellys F. Barker, M.D. Baltimore, Md. +Clifford W. Beers New York City. +Christopher C. Beling, M.D. Newark, N.J. +Harrison Betts, M.D. Yonkers, N.Y. +Anna T. Bingham, M.D. New York City. +Mrs. Martha Bird Middletown, N.Y. +Charles E. Birch, M.D. White Plains, N.Y. +J. Fielding Black, M.D. White Plains, N.Y. +Mrs. J. Fielding Black White Plains, N.Y. +G. Alder Blumer, M.D. Providence, R.I. +Leonard Blumgart, M.D. New York City. +J. Arthur Booth, M.D. New York City. +Miss Helen Booth New York City. +S.M. Boyd Scarsdale, N.Y. +Mrs. S.M. Boyd Scarsdale, N.Y. +Mrs. Sidney C. Borg New York City. +Rose Bell Bradley New York City. +V.C. Branham, M.D. New York City. +Holly Brown White Plains, N.Y. +Helen Brown, M.D. New York City. +Sanger Brown, 2d, M.D. New York City. +Miss Elizabeth O. Buckingham Chicago, Ill. +Alfred C. Buckley, M.D. Frankford, Philadelphia, Pa. +Alice Gates Bugbee, M.D. White Plains, N.Y. +Jesse C.M. Bullowa, M.D. New York City. +William Browning, M.D. Brooklyn, N.Y. +Marie von H. Byers New York City. +Karl M. Bowman, M.D. White Plains, N.Y. +Mrs. Karl M. Bowman White Plains, N.Y. +Edna L. Byington White Plains, N.Y. + +C.N.B. Camac, M.D. New York City. +C. Macfie Campbell, M.D. Boston, Mass. +Mrs. C. Macfie Campbell, M.D. Boston, Mass. +Robert Carroll, M.D. Asheville, N.C. +Mrs. Robert Carroll Asheville, N.C. +Louis Casamajor, M.D. New York City. +Ross McC. Chapman, M.D. Towson, Md. +Helen Childs White Plains, N.Y. +Mrs. Anne Choate Pleasantville, N.Y. +E.H. Clarke New York City. +Miss Marjory Clark, R.N. New York City. +Joseph Collins, M.D. New York City. +Michael Collins White Plains, N.Y. +Arthur S. Corwin, M.D. Rye, N.Y. +Mrs. Margaret Cornwell New Rochelle, N.Y. +Henry A. Cotton, M.D. Trenton, N.J. +Edith Cox White Plains, N.Y. +C. Burns Craig, M.D. New York City. +Henry W. Crane New York City. +Raymond S. Crispell, M.D. New York City. +Mrs. Seymour Cromwell Mendham, N.Y. +Hugh S. Cummings, M.D., + Surgeon-General U.S. + Public Health Service Washington, D.C. + +Charles L. Dana, M.D. New York City. +Thomas K. Davis, M.D. New York City. +Henderson Brooke Deady, M.D. New York City. +John W. Dean White Plains, N.Y. +Mrs. Aline S. Devin Eliot, Maine. +Allen Ross Diefendorf, M.D. New Haven, Conn. +William Elliott Dold, M.D. Astoria, L.I., N.Y. +George Drake White Plains, N.Y. +John W. Draper, M.D. New York City. +Nataline Dullas White Plains, N.Y. +Charles S. Dunlap, M.D. New York City. +Mrs. Alfred F. DeNike White Plains, N.Y. + +R. Condit Eddy, M.D. New Rochelle, N.Y. +Joseph P. Eidson, M.D. White Plains, N.Y. +Mrs. Emma Eldridge Tuckahoe, N.Y. +Charles A. Elsberg, M.D. New York City. +William Else, M.D. New York City. +Everett S. Elwood, + Secretary State + Hospital Commission Albany, New York. + +Mrs. Ezra H. Fitch New York City. +Ralph P. Folsom, M.D. New York City. +Harold E. Foster, M.D. Boston, Mass. +Diana Fowler White Plains, N.Y. +Florence Fuller White Plains, N.Y. +Isaac J. Furman, M.D. New York City. + +Leslie Gager, M.D. New York City. +William C. Garvin, M.D. Kings Park, N.Y. +Arnold Gesell, M.D. New Haven, Conn. +Bernard Glueck, M.D. New York City. +J. Riddle Goffe, M.D. New York City. +S. Philip Goodhart, M.D. New York City. +Miss Annie W. Goodrich, R.N. New York City. +Phyllis Greenacre, M.D. Baltimore, Md. +Menas S. Gregory, M.D. New York City. +Miss Pauline P. Gunderson White Plains, N.Y. + +Louis J. Haas White Plains, N.Y. +Thomas H. Haines, M.D. New York City. +Miss Dorothy Hale New York City. +Miss Natalie Hall White Plains, N.Y. +Robert B. Hammond, M.D. White Plains, N.Y. +Miss Elisa Hansen White Plains, N.Y. +Milton A. Harrington, M.D. Alfred, N.Y. +Isham G. Harris, M.D. Brooklyn, N.Y. +George A. Hastings New York City. +Winifred Hathaway New York City. +Edna Haverstock White Plains, N.Y. +C. Floyd Haviland, M.D. Middletown, Conn. +F. Ross Haviland, M.D. Brooklyn, N.Y. +Charles E. Haynes, M.D. New York City. +Eunice W. Haydon New York City. +Miss Katherine F. Hearn, R.N. White Plains, N.Y. +Edna Hemingson White Plains, N.Y. +George W. Henry, M.D. White Plains, N.Y. +Mrs. George W. Henry White Plains, N.Y. +Marcus B. Heyman, M.D. New York City. +Beatrice M. Hinkle, M.D. New York City. +L.E. Hinsie, M.D. New York City. +P.F. Hoffman, M.D. White Plains, N.Y. +John F. Holden, M.D. White Plains, N.Y. +Hubert S. Howe, M.D. New York City. +Thomas Howell, M.D. New York City. +J. Ramsay Hunt, M.D. New York City. +Helen Hunt White Plains, N.Y. +Miss Augusta M. Huppuch New York City. +Richard H. Hutchings, M.D. Utica, N.Y. + +Frank N. Irwin, M.D. New York City. + +Martha Joffe White Plains, N.Y. +Walter B. James, M.D. New York City. +Mrs. Walter James White Plains, N.Y. +Professor Pierre Janet, M.D. Paris, France. +Madame Pierre Janet Paris, France. +M.E. Jarvis, M.D. New York City. +Rev. Oscar Jarvis White Plains, N.Y. +Walter Jennings Cold Spring Harbor, L.I., N.Y. +Miss Gudron Johannessen, R.N. White Plains, N.Y. +Miss Marguerite Jewell White Plains, N.Y. +Miss Florence M. Johnson. New York City. +Kenneth B. Jones, M.D. Thiells, N.Y. +Miss Minnie Jordan, R.N. New York City. + +Mrs. De Lancey A. Kane New Rochelle, N.Y. +Lilian A. Kelm New York City. +James P. Kelleher, M.D. New York City. +Foster Kennedy, M.D. New York City. +Marion E. Kenworthy, M.D. New York City. +John Joseph Kindred, M.D. Astoria, L.I., N.Y. +George W. King, M.D. Secaucus, N.J. +Hermann G. Klotz, M.D. White Plains, N.Y. +George W. Kline, M.D. Boston, Mass. +George H. Kirby, M.D. New York City. +Henry Klopp, M.D. Allentown, Pa. +Augustus S. Knight, M.D. New York City. +Frank Henry Knight, M.D. White Plains, N.Y. +Mary S. Kirkbride Albany, N.Y. +Walter M. Kraus, M.D. New York City. +Edward J. Kempf, M.D. New York City. + +Alexander Lambert, M.D. New York City. +Charles I. Lambert, M.D. White Plains, N.Y. +Mrs. Charles I. Lambert White Plains, N.Y. +Arthur G. Lane, M.D. Greystone Park, N.J. +G. Alfred Lawrence, M.D. New York City. +W.A. Lawrence, M.D. White Plains, N.Y. +Ruth W. Lawton White Plains, N.Y. +Helen Letson White Plains, N.Y. +Samuel Leopold, M.D. Philadelphia, Pa. +Maurice J. Lewi, M.D. New York City. +Mrs. Maurice J. Lewi New York City. +Miss Ella H. Lowe White Plains, N.Y. +Walter E. Lowthian, M.D. White Plains, N.Y. +F.R. Lyman, M.D. Hastings-on-Hudson, N.Y. +Samuel B. Lyon, M.D. New York City. +Winslow Lyon New York City. + +William H. McCastline, M.D. New York City. +John T. McCurdy, M.D. New York City. +Carlos F. MacDonald, M.D. New York City. +D.W. McFarland, M.D. Greens Farms, Conn. +Miss Eliza Macdonald Flushing, L.I., N.Y. +John W. Mackintosh White Plains, N.Y. +Daniel W. Maloney White Plains, N.Y. +Grace F. Marcus, M.D. White Plains, N.Y. +L. Markham, M.D. Amityville, N.Y. +Miss Anna Maxwell, R.N. New York City. +John F.W. Meagher, M.D. Brooklyn, N.Y. +Adolf Meyer, M.D. Baltimore, Md. +Carlos J. Miller, M.D. White Plains, N.Y. +Henry W. Miller, M.D. Brewster, N.Y. +Mrs. R. Van C. Miller New York City. +George W. Mills, M.D. Central Islip, N.Y. +Henry Moffett, M.D. Yonkers, N.Y. +Mrs. Maude G. Moody New York City. +Miss Madeline Moore White Plains, N.Y. +Joseph W. Moore, M.D. Beacon, N.Y. +Eugene T. Morrison, M.D. New Rochelle, N.Y. +Miss Cecil Morrison White Plains, N.Y. +Richard W. Moriarty, M.D. White Plains, N.Y. +Herman Mortensen, R.N. White Plains, N.Y. +Walter W. Mott, M.D. White Plains, N.Y. +Florence Munn White Plains, N.Y. + +Theodore W. Neumann, M.D. Central Valley, N.Y. +Ethan A. Nevin, M.D. Newark, N.J. +Miss Christine M. Nuno New York City. + +George O'Hanlon, M.D. New York City. +James M. O'Neill Harrison, N.Y. +Herman Ostrander, M.D. Kalamazoo, Mich. +Mary F. O'Grady White Plains, N.Y. + +Flavius Packer, M.D. Riverdale, N.Y. +Mrs. Flavius Packer Riverdale, N.Y. +Irving H. Pardee, M.D. New York City. +Jason S. Parker, M.D. White Plains, N.Y. +Frederick W. Parsons, M.D. Buffalo, N.Y. +Miss Margaret Patin White Plains, N.Y. +Stewart Paton, M.D. Princeton, N.J. +Christopher J. Patterson, M.D. Troy, N.Y. +Guy Payne, M.D. Cedar Grove, N.J. +Arthur M. Phillips, M.D. New York City. +Charles W. Pilgrim, M.D., Chairman, + State Hospital Commission, N.Y. Central Valley, N.Y. +Mason Pitman, M.D. Riverdale-on-Hudson, N.Y. +Miss Leah Pitman White Plains, N.Y. +Miss Adele S. Poston, R.N. White Plains, N.Y. +Howard W. Potter, M.D. Thiells, N.Y. +Wilson M. Powell New York City. +Mrs. Margaret J. Powers New York City. +Miss Nina Prey New York City. +W.B. Pritchard, M.D. New York City. +Morton Prince, M.D. Boston, Mass. +Rose Pringle, M.D. White Plains, N.Y. +Sylvanus Purdy, M.D. White Plains, N.Y. + +Paul R. Radosvljevich, M.D. New York City. +E. Benjamin Ramsdell, M.D. New York City. +Edwin G. Ramsdell, M.D. White Plains, N.Y. +Mortimer W. Raynor, M.D. New York City. +Lawrence F. Rainsford, M.D. Rye, N.Y. +Mrs. Lawrence F. Rainsford Rye, N.Y. +Henry A. Riley, M.D. New York City. +Miss Elise Reilly White Plains, N.Y. +Frank W. Robertson, M.D. New York City. +M.A. Robinson, M.D. New York City. +William C. Roden, R.N. White Plains, N.Y. +A.J. Rosanoff, M.D. Kings Park, N.Y. +Miss Catherine Ross, R.N. White Plains, N.Y. +John T.W. Rowe, M.D. New York City. +Richard G. Rows, M.D. London, England. +Frederick D. Ruland, M.D. Westport, Conn. +William L. Russell, M.D. White Plains, N.Y. +Mrs. William L. Russell White Plains, N.Y. +Earnest F. Russell, M.D. New York City. +Paul L. Russell White Plains, N.Y. +Mrs. Paul L. Russell White Plains, N.Y. +Walter G. Ryon, M.D. Poughkeepsie, N.Y. +Miss Helen K. Ryce Poughkeepsie, N.Y. + +Miss Helen Sayre White Plains, N.Y. +Thomas W. Salmon, M.D. New York City. +Mrs. Thomas W. Salmon New York City. +Irving J. Sands, M.D. Brooklyn, N.Y. +James P. Sands, M.D. Philadelphia, Pa. +William C. Sandy, M.D. New York City. +Miss E. Saul New York City. +William G. Schauffler, M.D. Princeton, N.J. +Paul Schlegman, M.D. White Plains, N.Y. +H. Ernest Schmid, M.D. White Plains, N.Y. +Miss Gertrude Schmid White Plains, N.Y. +Augusta Scott, M.D. New York City. +Major Louis L. Seaman, M.D. New York City. +Edward W. Sheldon New York City. +George Sherrill, M.D. Stamford, Conn. +Miss Eloise Shields, R.N. White Plains, N.Y. +Lewis M. Silver, M.D. New York City. +Mrs. A. Slesingle New York City. +Mrs. Anna C. Schermerhorn New York City. +Rev. Frank H. Simmonds White Plains, N.Y. +Clarence J. Slocum, M.D. Beacon, N.Y. +Mrs. Clarence J. Slocum Beacon, N.Y. +Augustine J. Smith New York City. +Miss M. Smith, R.N. Titusville, Pa. +Philip Smith, M.D. New York City. +Rev. George H. Smyth Scarsdale, N.Y. +D. Austin Sniffen, D.D. White Plains, N.Y. +John D. Southworth, M.D. New York City. +Edith E. Spaulding, M.D. New York City. +M. Allen Starr, M.D. New York City. +Samuel A. Steele White Plains, N.Y. +William Steinach, M.D. New York City. +George S. Stevenson, M.D. New York City. +Adolf Stern, M.D. New York City. +Emil Strateman White Plains, N.Y. +Israel Strauss, M.D. New York City. +Frank K. Sturgis New York City. +Miss Mary Ruth Swann, R.N. Washington, D.C. +C.C. Sweet, M.D. Ossining, N.Y. +Sarah Swift White Plains, N.Y. + +William B. Terhune, M.D. New Haven, Conn. +William J. Tiffany, M.D. New York City. +Walter Clark Tilden, M.D. Hartsdale, N.Y. +Frederick Tilney, M.D. New York City. +Walter Timme, M.D. New York City. +Howard Townsend New York City. +E. Clark Tracy, M.D. White Plains, N.Y. +Walter L. Treadway, M.D. Washington, D.C. +Miss Gertrude Trefrey, R.N. White Plains, N.Y. + +Miss Mary G. Urquhart White Plains, N.Y. + +J.L. Van deMark, M.D. Albany, N.Y. +T.J. Vosburgh, M.D. White Plains, N.Y. +Henry J. Vier, M.D. White Plains, N.Y. + +Emory M. Wadsworth, M.D. Brooklyn, N.Y. +Miss Lillian D. Wald, R.N. New York City. +Professor Howard C. Warren Princeton, N.J. +Mrs. Caroline E. Washburn White Plains, N.Y. +Miss Martha Washburn White Plains, N.Y. +G.F. Washburne, M.D. Hastings-on-Hudson, N.Y. +Chester Waterman, M.D. New York City. +James J. Waygood, M.D. White Plains, N.Y. +Mrs. James J. Waygood White Plains, N.Y. +R.G. Wearne, M.D. New York City. +Edward W. Weber, M.D. White Plains, N.Y. +Israel S. Wechsler, M.D. New York City. +Miss Kathryn I. Wellman. White Plains, N.Y. +Mrs. Adelyn Wesley New York City. +Lt. Col. Arthur W. Whaley, M.D. New York City. +Mrs. Arthur W. Whaley New York City. +Miss Margaret Wheeler Short Hills, N.J. +Payne Whitney New York City. +Frankwood E. Williams, M.D. New York City. +Rodney R. Williams, M.D. Poughkeepsie, N.Y. +O.J. Wilsey, M.D. Amityville, N.Y. +John E. Wilson, M.D. New York City. +Miss A. Wilson New York City. +J.M. Winfield, M.D. Brooklyn, N.Y. +G. Howard Wise New York City. +Miss Frances E. Wood White Plains, N.Y. +Robert C. Woodman, M.D. Middletown, N.Y. +Robert S. Woodworth, Ph.D. New York City. + +Rev. John C. York Brooklyn, N.Y. + +Edwin G. Zabriskie, M.D. New York City. +Charles C. Zacharie, M.D. White Plains, N.Y. + +FOOTNOTES: + +[Footnote 19: If any names are omitted it is because these names and +addresses were not obtained.] + + + + +APPENDICES + + + + +APPENDIX I + +COMMUNICATIONS FROM DR. BEDFORD PIERCE, MEDICAL SUPERINTENDENT OF THE +RETREAT, YORK, ENGLAND + + +May 5th, 1921. + +DEAR DR. RUSSELL: + +I have read with much pleasure your pamphlet giving the history of +Bloomingdale Hospital. The reproduction in facsimile of Thomas Eddy's +communication[20] is especially interesting and it will be placed with +the records of the early days of the Retreat. + +We have looked through the Minutes, which are complete from the opening +of the Retreat in 1796, and also examined a large number of original +letters of William and Samuel Tuke respecting the Institution, but have +not succeeded in tracing the letter from S. Tuke to William Eddy, to +which you refer. As you are probably aware, S. Tuke was the grandson of +William Tuke, the founder, and when he published the History of the +Retreat in 1812 he was but twenty-eight years of age. This book had a +far-reaching influence on the treatment of the insane, and it is +remarkable that a man untrained in medicine and without university +education should have been able to write it. The book is now very rare, +but as we have three duplicate copies, I am authorized by the Directors +of the Retreat to present your Hospital with one of them. I have already +sent you a copy of an address of my own dealing with Psychiatry in +England at about the time your Hospital was instituted. + +The use of the term "moral treatment" as opposed to treatment of +physical disease has in recent years become especially interesting. It +is clear that Tuke and Pinel foresaw that psychotherapeutic treatment is +necessary, and their efforts were directed towards providing effective +"sublimation" of misdirected psychical energy. + +One is pleased to see in your report the extent to which organized +occupations are developed at Bloomingdale--a pleasure not unmixed with +envy at seeing the picture of the men's occupational pavilion, and the +prospective erection of a similar building for women. + +In the early days of the Retreat large numbers of visitors came from all +parts of the world. There is a gap in the Visitors' Book between +1800-1815, and the list of visitors is not complete. + +We have copied out the names of the American Visitors, together with an +entry by John W. Francis, M.D., in 1815. It is interesting to note that +an American woman Friend, Hannah Field, was accompanied to the Retreat +by Elizabeth Fry. In 1818 a party of North American Indians visited the +Retreat and signed the Visitors' Book with pictorial representations of +their names. These we have had photographed and I send the prints +herewith. + +May I congratulate you on the centenary of your Hospital and also +congratulate you and the Governors on its remarkable development and +progress. Here at the Retreat we carry on using the original buildings +still, striving to give our patients modern treatment in premises now +almost ancient, but which do not appear so out of date in this City of +York. York congratulates New York upon its wonderful prosperity, and we +gladly recognize its development in the practice of psychiatry fully +corresponds with its development in other directions. + +I remain, + +Yours sincerely, + +BEDFORD PIERCE. + + +EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE RETREAT + +The Retreat, York + +Meeting of Directors held on April the 30th, 1921 + +Copy of Minute No. 8 + +At this Meeting of the Directors and Agents of York Retreat we hear with +pleasure that the Bloomingdale Hospital, the section of the Society of +the New York Hospital devoted to the Treatment of Mental Diseases, is to +celebrate next month the centenary of its foundation. The facsimile +reproduction of the letter of Thomas Eddy which has been presented to +the Retreat Library is specially interesting to us as it acknowledges +the pioneer work at the Retreat and specially refers to correspondence +with Samuel Tuke. We have pleasure in sending to the Governors of the +Bloomingdale Hospital a copy of Samuel Tuke's classical work "The +Description of the Retreat" in the belief that the principles therein +set forth are of lasting importance. We send our hearty congratulations +to the Bloomingdale Hospital on its century of good work and wish it +every success in the future. + +Signed, + +CHARLES WEOMANS, _Chairman_. + +OSCAR F. RUMLEN, _Treasurer_. + + * * * * * + +TRANSCRIPT FROM THE VISITORS BOOK OF THE RETREAT + +EARLY AMERICAN VISITORS + + +1803. 3 mon 11th. _Abrm. Barker_, New Bedford, Massachusits, a young man + (a Friend) on a tour; has been in Russia, Denmark, Sweden & + Holland. (In William Tuke's writing) + +1815. Nov. 30. _John W. Francis_, M.D. of N. York. J.W. Francis is not + wholly ignorant of the State of the Lunatic Asylums in North + America, and he has visited almost all the institutions for the + Insane that are established in England. He now embraces this + opportunity of stating that after an examination of the Retreat + for some hours, he should do injustice to his feelings were he + not to declare that this establishment far surpasses anything of + the kind he has elsewhere seen, and that it reflects equal credit + on the wisdom and humanity of its conductors. + + Perhaps it is no inconsiderable honour to add that institutions + of a similar nature and on the same plan are organizing in + different parts of the United States. The New World cannot do + better than imitate the old so far as concerns the management of + those who labour under mental infirmities. J.W.F. + +1816. 1 Mon 4. _Sharon Carter_, Philadelphia. + +1816. 1 mon. _Wm. S. Warder_, from Philadelphia. + +1816. 2 mon 21. Rev. Thomas H. Gallaudet, who visits Europe for the + purpose of qualifying himself to superintend an Asylum for the + Deaf and Dumb, proposed to be established in Hartford, + Connecticut, of the United States of America. + +1816. 4 mon 8th. _Archibald Gracie_, Junr., New York. + +1816. April 29th. _George F. Randolph_, Philadelphia. _John Hastings_, + Baltimore. + +1816. 6 mon 19th. _Charles Longstreth_, from Philadelphia. + +1816. 6 mon 19th. _Jacob Smedley_, from Philadelphia. + +1817. 7 mon. _Henry Kollock_, of Savannah, Georgia. + _Dr. Wm. Parker_, Savannah. + _G.C. Versslanchi_, of New York. + +1817. 11/24. _Hannah Field_, North America, with Elizabeth Fry. + +1817. 12 Mo. _G.J. Browne_, United States of America (Cincinnati). + +[Illustration: [*HANDWRITING: Thy Assured Friend, Thomas Eddy*] + +In 1815 Thomas Eddy, one of the Governors of the Society of the New York +Hospital, presented a communication in which he advocated the +establishment in the country of a branch for the moral treatment of the +insane. This led to the establishment of Bloomingdale Asylum.] + +FOOTNOTES: + +[Footnote 20: Bloomingdale Hospital Press.] + + + + +APPENDIX II + +A LETTER ON PAUPER LUNATIC ASYLUMS[21] + + +The Governors of the New York Hospital, conceiving that the very +judicious remarks and sentiments contained in the following letter, +might be highly useful to the community, as well as to the institution +with which they are connected, have requested the same to be published. +The work alluded to in the letter, called, "Practical hints on the +construction and economy of Pauper Asylums," is believed to be one of +the most valuable and interesting works of the kind ever published. This +work was sent by the author to one of the Governors, and is now +deposited in the Hospital library. It is very desirable that it should +be republished in this country; but as such republication would be +expensive, on account of the few copies that would be wanted, the +Governors have directed, that if any person, or trustees of any public +institution, in any part of the United States, should be desirous of +obtaining a copy of this very valuable work, with a view to aid them in +erecting a similar Asylum, or the improvement of any already +established, that a manuscript copy shall be furnished them, upon an +application to the subscriber, + +THOMAS EDDY. + +New-York, 12th month, 30th, 1815. + + +YORK, 7mo. 17th, 1815. + +To Thomas Eddy, + +Our mutual friend, L. Murray, has put into my hands a letter and +pamphlet, lately received from thee, respecting the erection of an +asylum for lunatics near New-York.[22] He has wished me to make any +remarks which may occur to me on the perusal; but, having just +published a few hints on the construction and economy of Pauper Lunatic +Asylums, which contain much of the information thou requests, I shall +have but little to add. Those hints, however, relating to institutions +for the poorest class of society, must be applied with some +modifications to establishments for persons of different pervious +habits, and for whom a greater portion of attendance can be afforded. +The great objects, however, which are stated in the hints to be so +important for the comfort of lunatics, apply equally to those of all +ranks and classes. + +From the sum you propose to receive from the patients, intended to +occupy the new building, I conclude you are providing for patients of +the middle ranks of life, a class hardly less to be commiserated, when +thus afflicted, than the very poorest, since the expense and difficulty +of private management, may bring to ruin a respectable family, as well +as expose it to great personal dangers. There would, I think, be +considerable objection to the accumulation of 40 patients of this class, +in three contiguous rooms, as proposed in the hints for pauper lunatics. +You purpose building for 50 patients, and as you probably intend to +accommodate both sexes, the number of each sex may be very suitable for +the accommodation of three contiguous rooms, which, of course, need not +be so large as those in the Wakefield Asylum. It would be difficult to +offer a detailed plan, without knowing more than we do of your local +circumstances, and the classes of patients you purpose to admit. I +doubt, however, whether you can do better than to adopt the general form +of the Wakefield Asylum, and as you are providing for only a small +number, it deserves consideration whether all the rooms might not be +advantageously placed on the ground floor. This plan affords great +facilities to easy inspection, and safe communication with airing +grounds, and the roof might project so far over the building, as to form +an excellent collonnade for the patients; which seems peculiarly +desirable under an American Sun. + +With these views, I send a sketch drawn by the Architect whose plan is +to be adopted at Wakefield; and though it may not be, in many respects, +adapted to your particular wants, yet I hope it will not be altogether +useless. Should it be thought too expensive, I think the rooms, 1, 2, +and 3, might be dispensed with, and rooms marked "attendants, sick and +bath," might be appropriated to the patients during the day. The +attendants room is not a requisite, though it has been thought that it +would be more agreeable to patients of superior rank, not to have the +society of a servant. This, however, chiefly applies to the +convalescents, and these might occupy the room marked 'sick', whilst the +middle class, and the attendants, would be in the centre, marked +"attendants." A sick and bath room might probably be obtained in the +galleries: if you are inclined for the sake of appearance, to make the +centre building two stories high, you might bring the wings nearer to +the centre, and accommodate most of the convalescent patients with bed +rooms in the upper story. In this case, perhaps it would be desirable to +give the wings a radiating form. You will however be best able to modify +the sketch to your particular wants, if the general idea should meet +your approbation. + +I observe with pleasure, that one leading feature of your new +institution, is the introduction of employment amongst the patients, an +object which I am persuaded is of the utmost importance in the moral +treatment of insanity. It is related of an institution in Spain, which +accommodated all ranks, and in which the lower class were generally +employed, that a great proportion of these recovered, whilst the number +of the Grandees was exceedingly small. It will however, require great +address to induce patients to engage in manual labour, who have not been +accustomed to it previously to their indisposition, and it must be +admitted, that where the reluctance on the part of the patient is great, +the irritation which compulsory means are likely to excite, will +probably be more injurious to the patient, than the exercise will be +beneficial. The employment of insane persons should, as far as it is +practicable, be adapted to their previous habits, inclinations and +capacities, and, though horticultural pursuits may be most desirable, +the greatest benefit will, I believe, be found to result from the +patient being engaged in that employment in which he can most easily +excel, whether it be an active or a sedentary one. If it be the latter, +of course sufficient time should be allotted to recreation in the air. +Some persons imagine, that exercises of diversion, are equally +beneficial with those that are useful. The latter appear to me to +possess a decided preference, by imparting to the mind that calm feeling +of satisfaction, which the mere arts of amusement, though not to be +neglected, can never afford. To the melancholy class, this is an +important distinction between amusing and useful employments, and labour +is to be prefered for the maniacal class as less calculated to stimulate +the already too much excited spirits. + +It is proposed that the new asylum should be placed a few miles from the +city. The visitors to it, (I do not mean the medical ones) will, I +presume, be residents in New-York, and from what I have seen of the zeal +of persons under such appointments in this country, it appears +desirable, to render the performance of this duty, so important for the +welfare of asylums, as easy as it can be with propriety. One mile +perhaps would not be objectionable, and might probably afford as good +air and retirement, as a greater distance. + +I need hardly say, I was much gratified to find by the pamphlet, that +the importance of moral treatment in the cure of insanity, was duly +appreciated in America. When we consider, as Lord Bacon observes, +speaking of common diseases, that "all wise physicians in the +prescription, of their regimen to their patients, do ever consider +accidentia animi, as of great force to further or hinder remedies or +recoveries;" it is difficult to account for the general neglect of moral +considerations in the treatment of deranged mind. I hope, however, +though in many instances medicine may not be employed with advantage, +and its indiscriminate use has been seriously injurious, that we shall +not abandon it as altogether useless, in what we term disease of the +mind. All the varieties, included under this general term, have been +produced by physical causes: by external accidents, by intoxication, the +improper use of medicines, repelled eruptions, obstructed secretions, +&c. In some instances, dissection has discovered, after death, the cause +of the mental affection, and though, in many instances, no physical +cause can be detected, yet, when it is considered, how limited are the +investigations of the anatomist, and that the art is so imperfect, that +diseases occasioning instant death, cannot always be discovered on the +most minute dissection, it is not unreasonable to suppose, that the body +is in all cases the true seat of the disease. + +All I would infer from this speculation is, the importance of having +judicious medical attendants, to watch the progress of the disorder, to +be ready to apply their art as bodily symptoms may arise, and to +ascertain, with greater precision than has hitherto been done, "how and +how far the humours and effects of the body, do alter and work upon the +mind; and how far the passions and apprehensions of the mind, do alter +and work upon the body." Even if the disease is not confined to the +corporal organs of mind, but extends to the pure and eternal +intelligence, medical aid may still be useful from the well known +reciprocal action of the two parts of our system upon each other. + +I hope my unknown friend will excuse the length and freedom of this +letter: its length has much exceeded my intentions, yet I may have +omitted information which the experience of the Retreat might afford, +and which would have been useful to promoters of the New-York Asylum, +Should this be the case, I shall be glad to answer, as well as I am +able, any questions which they may propose; and, with the best wishes +for the success of their benevolent and important undertaking, + +I remain, respectfully, + +Thy friend, + +SAMUEL TUKE. + +FOOTNOTES: + +[Footnote 21: A letter on Pauper Lunatic Asylums, by Samuel Tuke, New +York, 1815. Reprinted Bloomingdale Hospital Press, June 3, 1919.] + +[Footnote 22: Appendix III.] + + + + +APPENDIX III + +THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815[23] + + +Of the numerous topics of discussion on subjects relating to the cause +of humanity, there is none which has stronger claims to our attention, +than that which relates to the treatment of the insane. + +Though we may reasonably presume, this subject was by no means +overlooked by the ancients, we may fairly conclude, it is deservedly the +boast of modern times, to have treated it with any degree of success. + +It would have been an undertaking singularly interesting and +instructive, to trace the different methods of cure which have been +pursued in different ages, in the treatment of those labouring under +mental derangement: and to mark the various results with which they were +attended. The radical defect, in all the different modes of cure that +have been pursued, appears to be, that of considering mania a _physical_ +or _bodily_ disease, and adopting for its removal merely physical +remedies. Very lately, however, a spirit of inquiry has been excited, +which has given birth to a new system of treatment of the insane; and +former modes of medical discipline have now given place to that which is +generally denominated _moral management_. + +This interesting subject has closely engaged my attention for some +years, and I conceive that the further investigation of it may prove +highly beneficial to the cause of humanity, as well as to science, and +excite us to a minute inquiry, how far we may contribute to the relief +and comfort of the maniacs placed under our care. In pursuing this +subject, my views have been much extended, and my mind considerably +enlightened, by perusing the writings of Doctors Creighton, Arnold, and +Rush; but, more particularly, the account of the Retreat near York, in +England. Under these impressions I feel extremely desirous of submitting +to the consideration of the Governors, a plan to be adopted by them, for +introducing a system of moral treatment for the lunatics in the Asylum, +to a greater extent than has hitherto been in use in this country. The +great utility of confining ourselves almost exclusively to a course of +moral treatment, is plain and simple, and incalculably interesting to +the cause of humanity; and perhaps no work contains so many excellent +and appropriate observations on the subject, as that entitled, _The +Account of the Retreat_. The author, Samuel Tuke, was an active manager +of that establishment, and appears to have detailed, with scrupulous +care and minuteness, the effects of the system pursued toward the +patients. I have, therefore, in the course of the following remarks, +with a view of illustrating the subject with more clearness, often +adopted the language and opinions of Tuke, but having frequently mixed +my own observations with his, and his manner of expression not being +always adapted to our circumstances and situation, I have attempted to +vary the language, so as to apply it to our own institution; this will +account for many of the subsequent remarks not being noticed as taken +from Tuke's work. + +It is, in the first place, to be observed, that in most cases of +insanity, from whatever cause it may have arisen, or to whatever extent +it may have proceeded, the patient possesses some small remains of +ratiocination and self-command; and although many cannot be made +sensible of the irrationality of their conduct or opinions, yet they are +generally aware of those particulars for which the world considers them +proper objects of confinement. Thus it frequently happens, that a +patient, on his first introduction into the asylum, will conceal all +marks of mental aberration; and, in some instances, those who before +have been ungovernable, have so far deceived their new friends, as to +make them doubt their being insane. + +It is a generally received opinion, that the insane who are violent, +may be reduced to more calmness and quiet, by exciting the principle of +_fear_, and by the use of chains or corporal punishments. There cannot +be a doubt that the principle of fear in the human mind, when moderately +and judiciously excited, as it is by the operation of just and equal +laws, has a salutary effect on Society. It is of great use in the +education of children, whose imperfect knowledge and judgment, occasion +them to be less influenced by other motives. But where fear is _too +much_ excited, and especially, when it becomes the chief motive of +action, it certainly tends to contract the understanding, weaken the +benevolent affection, and to debase the mind. It is, therefore, highly +desirable, and more wise, to call into action, as much as possible, the +operation of superior motives. Fear ought never to be induced, except +when an object absolutely necessary cannot be otherwise obtained. +Maniacs are often extremely irritable; every care, therefore, should be +taken, to avoid that kind of treatment that may have any tendency +towards exciting the passions. Persuasion and kind treatment, will most +generally supersede the necessity of coercive means. There is +considerable analogy between the judicious treatment of children and +that of insane persons. Locke has observed "the great secret of +education is in finding out the way to keep the Child's Spirit easy, +active and free; and yet, at the same time, to restrain him from many +things he has a mind to, and to draw him to things which are uneasy to +him." Even with the more violent and vociferous maniacs, it will be +found best to approach them with mild and soft persuasion. Every pains +should be taken to excite in the patient's mind a desire of esteem. +Though this may not be sufficiently powerful to enable them to resist +the strong irregular tendency of their disease; yet, _when properly +cultivated_, it may lead many to struggle to overcome and conceal their +morbid propensities, or at least, to confine their deviations within +such bounds as do not make them obnoxious to those about them. This +struggle is highly beneficial to the patient; by strengthening his mind, +and conducing to a salutary habit of self-restraint, an object, no +doubt, of the greatest importance to the care of insanity by _moral +means_. + +It frequently occurs, that one mark of insanity is a fixed false +conception, and a total incapacity of reasoning. In _such_ cases, it is +generally advisable to avoid reasoning[24] with them, as it irritates +and rivets their false perception more strongly on the mind. On this +account, every means ought to be taken to seduce the mind from unhappy +and favourite musings; and particularly with melancholic patients; they +should freely partake of bodily exercises, walking, riding, +conversations, innocent sports, and a variety of other amusements; they +should be gratified with birds, deer, rabbits, etc. Of all the modes by +which maniacs may be induced to restrain themselves, regular employment +is perhaps the most efficacious; and those kind of employments are to be +preferred, both on a moral and physical account, which are accompanied +by considerable bodily action, most agreeable to the patient, and most +opposite to the illusions of his disease. + +In short the patient should be always treated as much like a rational +being as the state of his mind will possibly allow. In order that he may +display his knowledge to the best advantage, such topics should be +introduced as will be most likely to interest him; if he is a mechanic +or an agriculturalist, he should be asked questions relating to his art, +and consulted upon any occasion in which his knowledge may be useful. +These considerations are undoubtedly very material, as they regard the +comforts of insane persons; but they are of far greater importance as +they relate to the cure of the disorder. The patient, feeling himself of +some consequence, is induced to support it by the exertion of his +reason, and by restraining those dispositions, which, if indulged, would +lessen the respectful treatment he wishes to receive, or lower his +character in the eyes of his companions and attendants. + +Even when it is absolutely necessary to employ coercion, if on its +removal the patient promises to control himself, great reliance may +frequently be placed upon his word, and under this engagement, he will +be apt to hold a successful struggle with the violent propensities of +his disorder. Great advantages may also be derived, in the moral +management of maniacs, from an acquaintance with the previous +employment, habits, manners, and prejudices of the individual: this may +truly be considered as indispensably necessary to be known, as far as +can be obtained; and, as it may apply to each case, should be registered +in a book for the inspection of the Committee of the Asylum, and the +physician; the requisite information should be procured immediately on +the admission of each patient; the mode of procuring it will be spoken +of hereafter. + +Nor must we forget to call to our aid, in endeavouring to promote +self-restraint, the mild but powerful influence of the precepts of our +holy religion. Where these have been strongly imbued in early life, they +become little less than principles of our nature; and their restraining +power is frequently felt, even under the delirious excitement of +insanity. To encourage the influence of religious principles over the +mind of the insane, may be considered of great consequence, as a means +of cure, provided it be done _with great care and circumspection_. For +this purpose, as well as for reasons still more important, it would +certainly be right to promote in the patient, _as far as circumstances +would permit_, an attention to his accustomed modes of paying homage to +his Maker. + +In pursuing the desirable objects above enumerated, we ought not to +expect too suddenly to reap the good effects of our endeavours; nor +should we too readily be disheartened by occasional disappointments. It +is necessary to call into action, as much as possible, every remaining +power and principle of the mind, and to remember, that, "in the wreck of +the intellect, the affections very frequently survive." Hence the +necessity of considering _the degree_ in which the patient may be +influenced by moral and rational inducements. + +The contradictory features in their characters, frequently render it +exceedingly difficult to insure the proper treatment of insane persons; +to pursue this with any hopes of succeeding, so that we may in any +degree ameliorate their distressed condition, renders it indispensably +necessary that attendants only should be chosen who are possessed of +good sense, and of amiable dispositions, clothed, as much as possible, +with philosophical reflexion, and above all, with that love and charity +that mark the humble Christian. + +Agreeably to these principles, I beg leave to suggest the following +regulations to be adopted, in accomplishing the objects in view. + +1st. No patient shall hereafter be confined by chains. + +2nd. In the most violent states of mania, the patient should be confined +in a room with the windows, etc., closed, so as nearly to exclude the +light, and kept confined if necessary, in a straight jacket, so as to +walk about the room or lie down on the bed at pleasure; or by strops, +etc., he may, particularly if there appears in the patient a strong +determination to self-destruction, be confined on the bed, and the +apparatus so fixed as to allow him to turn and otherwise change his +positions. + +3rd. The power of judicious kindness to be generally exercised, may +often be blessed with good effects, and it is not till after other moral +remedies are exercised, that recourse should be had to restraint, or the +power of fear on the mind of the patient; yet it may be proper +sometimes, by way of punishment, to use the shower bath. + +4th. The common attendants shall not apply any extraordinary coercion by +way of punishment, or change in any degree the mode of treatment +prescribed by the physician; on the contrary, it is considered as their +indispensable duty, to seek by acts of kindness the good opinion of the +patients, so as to govern them by the influence of esteem rather than of +severity. + +5th. On the first day of the week, the Superintendent, or the principal +keeper of the Asylum, shall collect as many of the patients as may +appear to them suitable, and read some chapters in the Bible. + +6th. When it is deemed necessary to apply the strait-jacket, or any +other mode of coercion, by way of punishment or restraint, such an ample +force should be employed as will preclude the idea of resistance from +entering the mind of the patient. + +7th. It shall be the duty of the deputy-keeper, immediately on a patient +being admitted, to obtain his name, age, where born, what has been his +employment or occupation, his general disposition and habits, when first +attacked with mania; if it has been violent or otherwise, the cause of +his disease, if occasioned by religious melancholy, or a fondness for +ardent spirits, if owing to an injury received on any part of the body, +or supposed to arise from any other known cause, hereditary or +adventitious, and the name of the physician who may have attended him, +and his manner of treating the patient while under his direction. + +8th. Such of the patients as may be selected by the physician, or the +Committee of the Asylum, shall be occasionally taken out to walk or ride +under the care of the deputy-keeper; and it shall be also his duty to +employ the patients in such manner, and to provide them with such kinds +of amusements and books as may be approved and directed by the +Committee. + +9th. The female keeper shall endeavour to have the female patients +Constantly employed at suitable work; to provide proper amusements, +books, etc., to take them out to walk as may be directed by the +Committee. + +10th. It shall be the indispensable duty of the keepers, to have all the +patients as clean as possible in their persons, and to preserve great +order and decorum when they sit down to their respective meals. + +11th. It shall be the duty of the physician to keep a book, in which +shall be entered an historical account of each patient, stating his +situation, and the medical and moral treatment used; which book shall be +laid before the Committee, at their weekly meetings. + +The sentiments and improvements proposed in the preceding remarks, for +the consideration of the Governors, are adapted to our present situation +and circumstances; but a further and more extensive improvement has +occurred to my mind, which I conceive, would very considerably conduce +towards affecting the cure, and materially ameliorate the condition, and +add to the comfort of the insane; at the same time that it would afford +an ample opportunity [Transcriber's note: original reads 'apportunity'] +of ascertaining how far that disease may be removed by moral management +alone, which it is believed, will, in many instances, be more effectual +in controlling the maniac, than medical treatment especially, in those +cases where the disease has proceeded from causes operating directly on +the mind. + +I would propose, that a lot, not less than ten acres, should be +purchased by the Governors, conveniently situated, within a few miles of +the city, and to erect a substantial building, on a plan calculated for +the accommodation of fifty lunatic patients; the ground to be improved +in such a manner as to serve for agreeable walks, gardens, etc., for the +exercise and amusement of the patients: this establishment might be +placed under the care and superintendence of the Asylum Committee, and +be visited by them once every week: a particular description of patients +to remain at this Rural Retreat; and such others as might appear +suitable objects might be occasionally removed there from the Asylum. + +The cost and annual expense of supporting this establishment, are +matters of small consideration, when we duly consider the important +advantages it would offer to a portion of our fellow-creatures, who have +such strong claims on our sympathy and commiseration. + +But, it is a fact that can be satisfactorily demonstrated, that such an +establishment would not increase our expenses; and, moreover, would +repay us even the interest of the money that might be necessary to be +advanced, for the purchase of the ground and erecting the buildings. The +board of patients (supposing fifty) would yield two hundred dollars per +week, or ten thousand four hundred dollars per annum. + +Supposing the ground, building, etc., to cost $50,000, the interest on +this sum at 6 per cent. would be $3,000, there would yet remain $7,400, +for the maintenance and support of the establishment; a sum larger than +would be required for that purpose. + +We had lately in the Asylum, more than ninety patients; and, at that +time, had repeated applications to receive an additional number; the +Committee however, concluded, that as the building was not calculated to +accommodate more than seventy-five, it would be an act of injustice to +take in any more; they, therefore, concluded to reduce the number of +seventy-five, and strictly to refuse receiving any beyond that number. +This may serve clearly to show, that we might safely calculate, that we +should readily have applications to accommodate one hundred and +twenty-five patients. + +This succinct view of the subject may suffice, at this time, as outlines +of my plan; and which is respectfully submitted to the Governors, for +their Consideration. + +FOOTNOTES: + +[Footnote 23: "Hints for Introducing an Improved Mode of Treating the +Insane in the Asylum"; read before the Governors of the New York +Hospital on the 4th of Fourth-month, 1815. By Thomas Eddy, one of the +Asylum Committee. New York, 1815. Reprinted Bloomingdale Hospital Press, +1916.] + +[Footnote 24: The following anecdotes illustrate the observation before +made, that maniacs frequently retain the power of reasoning to a certain +extent; and that the discerning physician may oftimes successfully avail +himself of the remains of this faculty in controlling the aberrations of +his patient:--A patient in the Pennsylvania Hospital, who called his +physician his father, once lifted his hand to strike him. "What!" said +his physician, (Dr. Rush), with a plaintive tone of voice, "Strike your +father?" The madman dropped his arm, and instantly showed marks of +contrition for his conduct. The following was related to me by Samuel +Coates, President of the Pennsylvania Hospital:--maniac had made several +attempts to set fire to the Hospital: upon being remonstrated with, he +said, "I am a salamander"; "but recollect," said my friend Coates, "all +the patients in the house are not salamanders;" "That is true," said the +maniac, and never afterwards attempted to set fire to the Hospital.] + + + + +APPENDIX IV + +EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TO +ACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED APRIL, 1815 + + +_April 4, 1815._ + +A communication was received from Thos. Eddy suggesting several +improvements in the mode of treating Insane persons, which is referred +to Dr. Hugh Williamson, George Newbold, William Johnson, Peter A. Jay, +and John R. Murray--Resolved that the Treasurer have fifty copies of the +report printed for use of the Governors. + + +_July 3, 1815._ + +The Committee on the communication from Thos. Eddy, relative to the +treatment of Insane patients, report attention to the subject and that +in their opinion it is advisable to have a few acres of land purchased +in the vicinity of the City for the better accommodation of this unhappy +class of our fellow creatures--the Committee are continued. + +On motion Resolved that Thomas Eddy, John A. Murray, and John Aspinwall, +be a Committee to look out for a suitable spot of land, and to make a +purchase, if in their opinion it shall become necessary. + + +_8th Month (August) 1st, 1815._ + +The Committee on the communication from Thomas Eddy, made the following +Report, which was intended to have been laid before the last meeting of +the Board; which was now accepted, and ordered to be inserted in the +minutes. + +"The Committee appointed to consider the expediency of erecting another +Building for the accommodation of Insane Persons Report: + +That another building for the use of those unfortunate persons who have +lost the use of their reason, is not only advisable, but seems to be +absolutely necessary. + +That though there are at present more patients in the Asylum, by nearly +one third, than can with perfect Safety, and the best hopes of recovery, +be lodged there; many more insane persons, perhaps twenty within a few +months, have by their friends been soliciting a place in that +Building--In speaking of the want of safety, the Committee only mean to +express an opinion, that when two or more insane persons, from the want +of room are lodged together in one cell, the life of the weaker must be +somewhat endangered by the stronger, who in a high Paroxysm of insanity +might strangle him in his sleep, or otherwise destroy him. + +That such additional Building, from the want of room, cannot possibly be +erected near the hospital, in this city. + +That there are many reasons for believing that the recovery from a state +of insanity would be greatly promoted, by having a considerable space of +ground adjoining the Asylum or Public Building, in which many of the +patients might have the privilege of walking, or taking other kinds of +exercise. + +That considering the various kinds of insanity, your Committee, are +clearly of the opinion, that two buildings should be erected at the +distance of at least one hundred yards from each other. The sedate or +melancholy madman should not have his slumbers broken by living under +the same roof with disorderly persons, who by singing, or other noisy +proceedings, will not suffer their neighbours to sleep. + +That for the above and similar considerations, it would be advisable, +to purchase, within a few miles of this City, at least twenty acres of +land, detached from private buildings, in a healthy and pleasant +situation, where the water is good and where materials for buildings may +be obtained on easy terms: and the portage of fuel not expensive. + +Your Committee are aware that a smaller lot of ground might suffice for +all the buildings that are now required, or all this Corporation may, in +a short time, be enabled to complete. But they count it advisable to +prepare for a period that must certainly come; a period in which such a +lot will be needed, and not easily obtained, for it is evident from the +topography, and geographical position of this City, that the time must +come, when New York will be not only the greatest City in the United +States, or in America; but must rival the most distinguished City's in +the old Continent. + +Wherefore it is recommended, that a Committee be appointed, who shall +examine the sundry places, corresponding with the above description, +that may be purchased. And that they report the means of making the +purchase, and of erecting such Buildings, as seem at this time to be +required." + +The Committee to whom was referred, to purchase a suitable Lot of Land +for the erection of a House for the accommodation of maniacs, Report +that they have purchased 38 acres of Land, being part of the Estate +belonging to Gerard Depeyster at Bloomingdale, at the rate of $246. per +acre, payable 25 per cent down, 371/2 per cent on 1st November and 373/4 per +cent on 1st February next, with interest. + +THOMAS EDDY, Chairman + + +August 1st, 1815 + +Whereupon Resolved that the Report of the Committee be accepted, and +they are instructed to take the Titles, after P.A. Jay shall have +examined the Records, and be satisfied that the property is free of +incumbrance. + + + + +APPENDIX V + +ADDRESS TO THE PUBLIC BY THE GOVERNORS 1821[25] + + +The Governors of the New-York Hospital have the satisfaction to announce +to the public, the completion of the Asylum for the insane; and that it +will be open for the reception of patients, from any part of the United +States, on the first day of June. + +This Asylum is situated on the Bloomingdale road, about seven miles from +the City Hall of the city of New-York, and about three hundred yards +from the Hudson River. The building is of hewn free-stone, 211 feet in +length, and sixty-feet deep, and is calculated for the accommodation of +about two hundred patients. Its site [Transcriber's note: original reads +'scite'] is elevated, commanding an extensive and delightful view of the +Hudson, the East River, and the Bay and Harbour of New-York, and the +adjacent country, and is one of the most beautiful and healthy spots on +New-York Island. Attached to the building are about seventy acres of +land, a great part of which has been laid out in walks, ornamental +grounds, and extensive gardens. + +This institution has been established by the bounty of the Legislature +of the state of New-York, on the most liberal and enlarged plan, and +with the express design to carry into effect that system of management +of the insane, happily termed _moral treatment_, the superior efficacy +of which has been demonstrated in several of the Hospitals of Europe, +and especially in that admirable establishment of the Society of +Friends, called "THE RETREAT," near York, in England. This mild and +humane mode of treatment, when contrasted with the harsh and cruel +usage, and the severe and unnecessary restraint, which have formerly +disgraced even the most celebrated lunatic asylums, may be considered as +one of the noblest triumphs of pure and enlightened benevolence. But it +is by no means the intention of the governors to rely on moral, to the +exclusion of medical treatment. It is from a judicious combination of +both, that the greatest success is to be expected in every attempt to +cure or mitigate the disease of insanity. + +In the construction of the edifice and in its interior arrangements, it +has been considered important to avoid, as far as practicable, +consistently with a due regard to the safety of the patients, whatever +might impress their minds with the idea of a prison, or a place of +punishment, and to make every thing conduce to their health and to their +ease and comfort. The self-respect and complacency which may thus be +produced in the insane, must have a salutary influence in restoring the +mind to its wonted serenity. In the disposition of the grounds attached +to the Asylum, everything has been done with reference to the amusement, +agreeable occupation, and salutary exercise of the patients. + +Agricultural, horticultural, and mechanical employments, may be resorted +to, whenever the inclination of the patient, or their probable +beneficial effects may render them desirable. To dispel gloomy images, +to break morbid associations, to lead the feelings into their proper +current, and to restore the mind to its natural poise, various +[Transcriber's note: original reads 'varius'] less active amusements +will be provided. Reading, writing, drawing, innocent sports, tending +and feeding domestic animals, &c. will be encouraged as they may be +found conducive to the recovery of the patients. A large garden has been +laid out, orchards have been planted, and yards, containing more than +two acres, have been inclosed for the daily walks of those whose +disorder will not allow more extended indulgence. The plants of the +Elgin Botanic garden, presented to this institution by the Trustees of +Columbia College, have been arranged in a handsome green-house, prepared +for their reception. + +The apartments of the house are adapted to the accommodation of the +patients, according to their sex, degree of disease, habits of life, and +the wishes of their friends. The male and female apartments are entirely +separated, so as to be completely secluded from the view of each other. + +Care has been taken to appoint a Superintendent and Matron, of good +moral and religious characters, possessing cheerful tempers, and kind +dispositions, united with firmness, vigilance and discretion. A +Physician will reside in the house, and one or more Physicians, of +established character and experience, will attend regularly, and afford +medical aid in all cases where the general health, or the particular +cause of the patient's insanity, may require it. The relations or +friends of patients will be at liberty, if they prefer it, to employ +their own physicians, who will be allowed to attend patients, subject to +the general regulations of the house. + +The institution will be regularly visited and inspected by a committee +of the Governors of the Hospital, who will, as often as they may think +it advantageous, be attended by some of the physicians of the city of +high character and respectability. + +The charges for board and the other advantages of the institution, will +be moderate, and proportioned to the different circumstances of the +patients, and the extent of the accommodations desired for them. + +Patients at the expense of the different towns of the state, will be +received at the lowest rate. + +Application for the admission of patients into the Asylum, must be made, +at the New York Hospital, in Broadway, where temporary accommodation +will be provided for such patients as may require it, previously to +their being carried to the Asylum out of town. A committee of the +Governors will, when necessary, attend at the Hospital in Broadway, for +the purpose of admitting patients into the Asylum, and to agree on the +terms and security for payment to be given. + +_By order of the board of Governors._ + +MATTHEW CLARKSON, _President._ + +THOMAS BUCKLEY, _Secretary._ + +_New-York, 10th May, 1821._ + +N.B. The friends of the patients are requested to send with them an +account of their cases, stating the probable causes of their insanity, +the commencement and peculiar character of the disorder. It is desirable +that this statement, where it is practicable, should be drawn up by a +physician. + +Applications from abroad, for information relative to the admission of +patients, may be made by letters addressed to THOMAS BUCKLEY, Secretary +of the New-York Hospital. + +FOOTNOTES: + +[Footnote 25: Address of the Governors of the New York Hospital to the +Public, Relative to the Asylum for the Insane at Bloomingdale. New York, +May 10th, 1821. Reprinted Bloomingdale Hospital Press, May 1921.] + + + + +APPENDIX VI + +BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL + +1821 AND 1921 + + +1821 + +Matthew Clarkson, President +Thomas Eddy, Vice President +Thomas Franklin +Jonathan Little +Thomas Buckley +William Johnson +Andrew Morris +John R. Murray +John B. Lawrence +George Newbold +Ebenezer Stevens +Peter A. Jay +Najah Taylor +Cadwallader D. Colden +Robert H. Bowne +Robert I. Murray +Thomas C. Taylor +John Adams, Treasurer +John McComb +Benjamin W. Rogers, Assistant Treasurer +William Bayard +Nathan Comstock +Duncan P. Campbell +Rev. F.C. Schaeffer +John Clark, Jr. +William Edgar, Jr. + + +1921 + +Hermann H. Cammann +Henry W. deForest +Richard Trimble +Howard Townsend +George F. Baker +Augustine J. Smith +Charles S. Brown +Edward W. Sheldon, President +Bronson Winthrop +Frank K. Sturgis +David B. Ogden +Joseph H. Choate, Jr. +Henry G. Barbey +Cornelius B. Bliss, Jr. +Paul Tuckerman, Treasurer +William Woodward +Arthur Iselin +Payne Whitney, Vice President +G. Beekman Hoppin +Lewis Cass Ledyard, Jr. +Henry R. Taylor +R. Horace Gallatin +Walter Jennings + + +BLOOMINGDALE COMMITTEE + +1821 + +Thomas Eddy +Cadwallader D. Colden +Thomas C. Taylor +John Adams +Thomas Buckley +John B. Lawrence + + +1921 + +Frank K. Sturgis +Augustine J. Smith +Henry R. Taylor +Henry G. Barbey +Walter Jennings +Howard Townsend + + + + +APPENDIX VII + +ORGANIZATION OF BLOOMINGDALE HOSPITAL + +1821 AND 1921 + + +1821 + +Superintendent or Warden 1 +Housekeeper 1 +Keepers, Men 3 +Keepers, Women 2 +Chambermaids 1 +Cooks 3 +Baker 1 +Assistant Baker 1 +Dairymaid 1 +Washerwoman 1 +Assistant washerwoman 1 +Yard Keeper 1 +Waitresses 2 +Gardener 1 +Farmer 1 +Assistant farmer 1 + + Total 22 + +Number of patients 75 + + +1921 + +Officers and employees: + +Men 217 +Women 195 + --- +Total 412 + +Patients: + +Men 132 +Women 156 + --- +Total 288 + +_General Administration_: + Medical Superintendent 1 + Steward 1-2 + +_Clinical and Laboratory Service:_ + Physicians: + Resident 9 + Consultants 3 + Dentist 1 + Assistant 1 + Apothecary 1 + Technicians 2 + Stenographers 5-22 + +_Nursing Service_: + Director, Assistant, and Instructor 3 + Nurses, attendants, and pupils 135 + Maids and porters 46-184 + +_Occupational Therapy_ 13 +_Physical Training_ 7 +_Hydrotherapy and Massage_ 5 +_Dietary Department_ 25 +_Housekeeping and Laundry Departments_ 60 +_Financial, Purchasing, and Supplies_ 10 +_Engineering Department_ 18 +_Building Department_ 20 +_Industrial Department_ 5 +_Farm and Grounds_ 38 +_Miscellaneous_ 8 +Chaplain, Librarian, Watchmen, Telephonists, Postal Clerk, Barber. + + +STATISTICS: 1821-1921 + +Number of cases admitted 1821 to 1921 13,411 +Number discharged recovered 1821 to 1921 4,651 +Number discharged improved 1821 to 1921 3,873 + + + + + + + + + + + + +End of the Project Gutenberg EBook of A Psychiatric Milestone +by Howard Townsend, Bronson Winthrop and R. 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