Chapter IV: Part 4

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

_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

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).

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.