[Illustration: THE NEW YORK HOSPITAL, DUANE STREET AND BROADWAY

The building to the left was erected in 1808 for the exclusive use ofpatients suffering from mental disorders. ]

A PSYCHIATRIC MILESTONE

BLOOMINGDALE HOSPITAL CENTENARY

1821-1921

 "Cum corpore ut unaCrescere sentimus, pariterque senescere mentem. " --LUCRETIUS

PRIVATELY PRINTED

BY THE SOCIETY OF THE NEW YORK HOSPITAL

1921

ANNIVERSARY COMMITTEE

HOWARD TOWNSENDBRONSON WINTHROPR. HORACE GALLATIN

PREFACE

The opening of Bloomingdale Asylum on June 1, 1821, was an importantevent in the treatment of mental disorders and in the progress ofhumanitarian and scientific work in America. Hospital treatment forpersons suffering from mental disorders had been furnished by the NewYork Hospital since its opening in 1792, and the Governors had givenmuch thought and effort to securing the facilities needed. The treatmentconsisted, however, principally in the administration of drugs and theemployment of such other physical measures as were in vogue at thattime. Little attempt was made to study the minds of the patients or totreat them by measures directed specifically to influencing theirthoughts, feelings, and behavior, and what treatment of this characterthere was had for its object little more than the repression ofexcitement and disordered activity. The value and importance oftreatment directed to the mind had, indeed, been long recognized, but inpractice it had been subordinated to treatment of the actual and assumedphysical disorders to which the mental state of the patient wasattributed, and, in the few hospitals where persons suffering frommental disorders were received, means for its application were almost orquite entirely lacking. The establishment of Bloomingdale Asylum for thepurpose of ascertaining to what extent the recovery of the patientsmight be accomplished by moral as well as by purely medical treatmentmarked, therefore, the very earliest stages of the development inAmerica of the system of study and treatment of mental disorders whichwith increasing amplification and precision is now universally employed. 

A hundred years of growth and activity in the work thus established havenow been accomplished, and it seemed fitting to the Governors of theHospital that the event should be commemorated in a way that would beappropriate to its significance and importance. It was decided that theprincipal place in the celebration should be given to the purely medicaland scientific aspects of the work, with special reference to theprogress which had been made in the direction of the practicalusefulness of psychiatry in the treatment of illness generally, and inthe management of problems of human behavior and welfare. Arrangementswere made for four addresses by physicians of conspicuous eminence intheir particular fields, and invitations to attend the exercises weresent to the leading psychiatrists, psychologists, and neurologists ofAmerica, and to others who were known to be specially interested in thefield of study and practice in which the Hospital is engaged. It wasfelt that, in view of the place which France and England had held in themovement in which Bloomingdale Asylum had its origin, it would addgreatly to the interest and value of the celebration if representativesof these countries were present and made addresses. How fortunate itwas, then, that it became possible to welcome from France Dr. PierreJanet, who stands pre-eminent in the field of psychopathology, and fromEngland Dr. Richard G. Rows, whose contributions to the study andtreatment of the war neuroses and to the relation between psychic andphysical reactions marked him as especially qualified to present themore advanced view-point of British psychiatry. The other two principaladdresses were made by Dr. Adolf Meyer, who, by reason of his scientificcontributions and his wonderfully productive practical work in clinicaland organized psychiatry and in mental hygiene, is the acknowledgedleader of psychiatry in America, and by Dr. Lewellys F. Barker, who, because of his eminence as an internist and of the extent to which hehas advocated and employed psychiatric knowledge and methods in hispractice, has contributed greatly to interesting and informingphysicians concerning the value and importance of psychiatry in generalmedical 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 thecelebration. They were supplemented by an historical review of theorigin 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 astatement concerning the medical development, made by Dr. William L. Russell, the Medical Superintendent. The greetings of the New YorkAcademy 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 thepageant presented on the lawn during the intermission between thesessions, depicting scenes and incidents illustrating the origin anddevelopment of the Hospital, and of psychiatry and mental hygiene. Thetext 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 werepersons who were connected with the Hospital, twenty-two of whom werepatients. 

The celebration was held on May 26, 1921. The weather was exceptionallyclear, with bright sunshine and moderate temperature. The grounds, intheir Spring dress of fresh leaves and flowers, were especiallybeautiful. This added much to the attractiveness of the occasion and thepleasure of those who attended. Luncheon was served on the lawn in frontof the Brown Villa and the pageant was presented on the adjoiningrecreation grounds. The beauty of the day and the surroundings, thecharacter of the addresses and of the speakers, the remarkable felicityand grace with which they were introduced by the President, the dignityand noble idealism of his closing words, and the distinguished characterof the audience, all contributed to make the celebration one ofexceptional interest and value to those who were present, and a notableevent in the history of the Hospital. 

For the purpose of preserving, and of perhaps extending to some who werenot present, the spirit of the occasion, and of placing in permanentform 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

 PagePREFACE 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 PAGEBloomingdale Asylum, 1821 2Bloomingdale Asylum, 1894 80Bloomingdale Hospital, 1921 148The Tableau-Pageant 172Thomas 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 sevenmile stone on the Bloomingdale Road, now 116th Street and Broadway. ]

BLOOMINGDALE HOSPITAL CENTENARY

The One Hundredth Anniversary of the establishment of BloomingdaleHospital as a separate department for mental diseases of The Society ofthe New York Hospital was celebrated at the Hospital at White Plains onThursday, 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 toperfection those powers of Thine which shall more and more make perfectthe beings of Thy creation, we glorify Thee in the gift of Thy DivineSon Jesus Christ, the Great Physician of our souls, the Sun ofRighteousness arising with healing in His wings, who disposeth everygreat and little incident to the glory of God the Father, and to thecomfort of them that love and serve him, we render thanks to Thee andglorify Thy Name, this day, which brings to completion the hundredthanniversary of this noble institution's birthday. Oh, Thou, who didstput it into the hearts and minds of men to dedicate their lives andfortunes to the advancement of science and medicine for the sick andafflicted, we render Thee most high praise and hearty thanks for thegrace and virtue of the founders of this institution--men whose namesare written in the Golden Book of life as those who loved their fellowmen. 

We praise Thee for such men as Thomas Eddy, James Macdonald, PlinyEarle, and these endless others, who from age to age have held high thetorch 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 upand enlighten our hearts and minds to a higher perception of all that isnoble, all that is true, all that is merciful. Awaken our dull senses tothe full knowledge of light in Thee, and may all that is said and donebe with the guiding of Thy Holy Spirit. 

We pray for the continued blessing of this institution and hospital, andon all those who are striving to bring out of darkness those unhappysouls, into the pure light of understanding. 

Bless the Governors, physicians, and nurses, direct their judgments, prosper their undertakings, and dispose their ministry that the worldmay feel the blessing and comfort of life in the prevention of diseaseand the preservation of health. And may we all be gathered in thisnation to a more perfect unity of life and purpose in the desire tospend and be spent in the service of our fellow men. 

We ask it all in the name and through the mediation of Thy Son JesusChrist, our Lord. Amen. 

ADDRESS BYMR. EDWARD W. SHELDON

MR. SHELDON

It is with profound gratification that the Governors welcome yourgenerous presence to-day on an occasion which means so much to us andwhich has perhaps some general significance. For we are met in honor ofwhat is almost a unique event in our national history, the centennialanniversary celebration of an exclusively psychopathic hospital. Asummary of its origin and development may be appropriate. 

A hundred and fifty years ago the only institutions on this side of theAtlantic which cared for mental diseases were the Pennsylvania Hospital, chartered in 1751, a private general hospital which had accommodationsfor a few mental cases, and the Eastern State Hospital for the insane, at Williamsburg, Virginia, a public institution incorporated in 1768. Noother one of the thirteen Colonies had a hospital of any kind, generalor special. With a view of remedying this deplorable lack in New York, steps were taken in 1769 to establish an adequate general hospital inthe City of New York. This resulted in the grant, on June 11, 1771, ofthe Royal Charter of The Society of the New York Hospital. Soonafterward the construction of the Hospital buildings began on a spacioustract on lower Broadway opposite Pearl Street, in which provision wasalso to be made for mental cases; but before any patients could beadmitted, an accidental fire, in February, 1775, consumed the interiorof the buildings. Reconstruction was immediately undertaken andcompleted early in the spring of 1776. But by that time theRevolutionary War was in full course, and the buildings were taken overby the Continental authorities as barracks for troops, and weresurrounded by fortifications. When the British captured the city inSeptember, 1776, they made the same use of the buildings for their owntroops, who remained there until 1783. A long period of readjustmentthen ensued, and it was not until January, 1791, that the Hospital wasat last opened to patients. In September, 1792, the Governors directedthe admission of the first mental case, and for the hundred andtwenty-nine years since that time the Society has continuously devoted apart of its effort to the care of the mentally diseased. After a fewyears a separate building for them was deemed desirable, and wasconstructed. The State assisted this expansion of the Hospital byappropriating to the Society $12, 500 a year for fifty years. This newbuilding housed comfortably seventy-five patients, but ten years latereven this proved inadequate in size and undesirable in surroundings. Inthe meanwhile a wave of reform in the care of the insane was rising inEurope under the influence of such benefactors as Philippe Pinel inFrance, and William and Samuel Tuke in England. Thomas Eddy, aphilanthropic Quaker Governor of the Society, who was then its Treasurerand afterward in succession its Vice-President and President, becomingaware of this movement, and having made a special study of the care andcure of mental affections, presented a communication to the Governors inwhich he advocated a change in the medical treatment, and in particularthe adoption of the so-called moral management similar to that pursuedby the Tukes at The Retreat, in Yorkshire, England. This memorablecommunication was printed by the Governors, and constitutes one of thefirst of the systematic attempts made in the United States to put thisimportant medical subject on a humane and scientific basis. To carry outhis plan, Mr. Eddy urged the purchase of a large tract of land near thecity and the erection of suitable buildings. He ventured the moderateestimate that the population of the city, then about 110, 000, might bedoubled by 1836, and quadrupled by 1856. In fact, it was more thandoubled in those first twenty years, and sextupled in the secondtwenty. He was justified, therefore, in believing that the hospitalsite on lower Broadway would soon be surrounded by a dense population, and quite unsuited for the efficient care of mental diseases. TheGovernors gave these recommendations immediate and favorableconsideration. Various tracts of land, containing in all aboutseventy-seven acres, and lying on the historic Harlem Heights betweenwhat are now Riverside Drive and Columbus Avenue, and 107th and 120thStreets, were subsequently bought by the Society for about $31, 000. Toaid in the construction and maintenance of the necessary hospitalbuildings, the Legislature, by an act reciting that there was no otherinstitution in the State where insane patients could be accommodated, and that humanity and the interest of the State required that provisionshould be made for their care and cure, granted an additional annualappropriation of $10, 000 to the Society from 1816 until 1857. The mainHospital, built of brownstone, stood where the massive library ofColumbia University now is, and the brick building still standing at thenortheast corner of Broadway and 116th Street was the residence of theMedical Superintendent. The only access to this site by land was overwhat was known as the Bloomingdale Road, running from Broadway and 23dStreet through the Bloomingdale district on the North River to 116thStreet, and from that fact our institution assumed the name ofBloomingdale Asylum, or, as it is now called, Bloomingdale Hospital. This beautiful elevated site overlooking the Hudson River and the HarlemRiver was admirably fitted for its purpose. The spacious tract of land, laid out in walks and gardens, an extensive grove of trees, generousplaygrounds and ample greenhouses, combined to give the spot unusualbeauty and efficiency. This notable work finished, the Governors of theSociety issued on May 10, 1821, an "Address to the Public"[1] whichmarks so great an advance in psychiatry in our country that it deservesstudy. The national character of the institution was indicated in theopening paragraph, where it announced that the Asylum would be open forthe reception of patients from any part of the United States on thefirst of the following June. Accommodation for 200 patients wasprovided, and to these new surroundings were removed on that day all themental cases then under treatment at the New York Hospital on lowerBroadway. 

In this retired and ideal spot the work of Bloomingdale Hospital wassuccessfully prosecuted for three-quarters of a century. But the sevenmiles that separated it from the old hospital was steadily built over, and before fifty years had gone the growth of the city had passed theasylum grounds. Foreseeing that they could not maintain that verdantoasis intact for many years longer, the Governors, in 1868, bought this300-acre tract on the outskirts of the Village of White Plains. Afterprolonged consideration of the time and method of development of theproperty, final plans were adopted in December, 1891, construction wasbegun May 1, 1892, and two years later, under the direction of ourMedical Superintendent, Dr. Samuel B. Lyon, all the patients were movedfrom the old to this new Bloomingdale. The cost of the new buildings wasabout $1, 500, 000. From time to time the original Bloomingdale site wassold and now supplies room, among other structures, for ColumbiaUniversity, Barnard College, the Cathedral of St. John the Divine, St. Luke's Hospital, the Woman's Hospital, and the National Academy ofDesign. With the proceeds of those sales of the old Bloomingdale, notonly was the cost of the new Bloomingdale met, but the permanentendowment of the Society was substantially increased, and Thomas Eddywas proved to have been both a wise humanitarian and a far-sightedsteward of charitable funds. 

In their "Address to the Public" to which I have referred, issued whenBloomingdale Hospital was opened in 1821, the Governors of the Societyspoke of the new conception of moral treatment of the mentally afflictedwhich had been established in several European hospitals and which wassupplanting the harsh and cruel usage of former days, as "one of thenoblest triumphs of pure and enlightened benevolence. " In that samespirit those founders dedicated themselves to the conduct of thisinstitution. Their devotion to the work was impressive. Looking back onthose early days we see a constant personal attention to the details ofinstitutional life that commands admiration. The standards then set havebecome a tradition that has been preserved unbroken for a hundred years. Humane methods of care, the progressively best that medical science candevise, the utilization of a growingly productive pursuit of research, have consistently marked the administration of this great trust. TheGovernors of to-day are as determined as any of their predecessors tomaintain that ideal of "pure and enlightened benevolence. " New paths areopening and larger resources are becoming available. Under the guidanceof our distinguished Medical Superintendent, with his able and devotedstaff of physicians, a broader and more intensive development isalready under way. Animated by that resolve and cheered by thatprospect, we may thus confidently hope, as we begin the second centuryof Bloomingdale's career, for results not less fruitful and gratifyingthan those which we celebrate to-day. 

FOOTNOTES:

[Footnote 1: Address of the Governors of the New York Hospital, to thePublic, 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 BYDR. ADOLF MEYER

_The Chairman_: In celebrating our centenary we are naturally dealingalso with the larger subject of general psychiatry. Our success in thisdiscussion should be materially promoted by the presence with us of Dr. Adolf Meyer, Professor of Psychiatry in the Medical School of JohnsHopkins University, and Director of the Phipps Psychiatric Clinic, ofBaltimore. Before taking up this important work in that famous medicalcentre, Dr. Meyer was actively engaged for several years in psychopathicwork in New York. He will speak to us on "THE CONTRIBUTIONS OFPSYCHIATRY TO THE UNDERSTANDING OF LIFE PROBLEMS. "

DR. MEYER

When Dr. Russell honored me with the invitation to speak at thiscentenary celebration of the renowned Bloomingdale Hospital, myimmediate impulse was to choose as my topic a phase of psychiatricdevelopment to which this Hospital has especially contributed throughour greatly missed August Hoch and his deeply appreciated coworkerAmsden. I have in mind the great gain in concreteness of the physician'swork with mind and the resulting contribution of psychiatry to a betterknowledge of human life and its problems. The great gain this passingcentury is able to hand on to its successor is the clearer recognitionof just what the psychiatrist actually works with and works on. 

Of all the divisions of medicine, psychiatry has suffered longest fromman's groping for a conception of his own nature. Psychiatry means, literally, the healing of souls. What then do we actually mean by soulor by psyche? This question has too long been treated as a disturbingpuzzle. 

To-day we feel that modern psychiatry has found itself--through thediscovery that, after all, the uncritical common-sense view of mind andsoul is not so far remote from a critical common-sense view of theindividual and its life activity, freed from the forbidding andconfusing assumptions through which the concept of mind and soul hasbeen held in bewildering awe. 

Strange to say, good old Aristotle was nearer an understanding than mostof the wise men and women that have succeeded him for these more thantwo thousand years. He saw in the psyche what he called the form andrealization or fulfilment of the human organism; he would probably nowsay with us, the activity and function as an individual or person. 

Through the disharmonies and inevitable disruption of aself-disorganizing civilization, the Greek and Roman world was plungedinto the dark centuries during which the perils of the soul and thesacrificial attainment of salvation by monastic life and crusadesthreatened to overshadow all other concern. This had some inevitableresults: it favored all those views through which the soul became like aspecial thing or substance, in contrast to and yet a counterpart of thephysical body. As long as there was no objective experimental science, the culminating solution of life problems had to be intrusted to thatremarkable development of religious philosophy which arose from theblending of Hebrew religion and tradition and the loftiest products ofthe Greek mind, in the form which St. Paul and the early Church fathersgave to the teachings of Christ. From being the form and activation, orfunction, of the organism in life, the soul feature of man was given anappearance in which it could neither be grasped nor understood, norshaped, nor guided by man when it got into trouble. From the Middle Agesthere arose an artificial soul and an artificial world of soulspresented as being in eternal conflict with the evil of the flesh--_andthus the house of human nature was divided against itself_. 

Science of the nineteenth century came nearer bringing mind and bodytogether again. The new astronomical conception of the world and thegrowing objective experimental science gradually began to commandconfidence, 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 soeven with most scientists. Too much had been claimed for the psyche, andbecause of the singling out of a great world of spirit, the world offact had been compromised and left cold and dry and unattractive andunpromising. No doubt it was necessary that the scientist should becomehardened and weaned from all misleading expectation, and shy of all thespurious claims of sordid superstition and of childish fancy. He mayhave been unduly radical in cutting out everything that in any wayrecalled the misleading notions. In the end, we had to go through astage of psychology without a "soul, " and lately even a psychologywithout "consciousness, " so that we might be safe from unscientificpretensions. All the gyrations no doubt tended to retard the wholesomepractical attack upon the problems in the form in which we find them inour common-sense life. 

The first effort at a fresh start tried to explain everything ratherone-sidedly out of the meagre knowledge of the body. Spinoza had said inhis remarkable Ethics (III, Prop. II, Schol. ): "Nobody has thus fardetermined what the body can do, _i. E. _, nobody has as yet shown byexperience and trial what the body can do by the laws of nature alone inso far as nature is considered merely as corporeal and extended, andwhat it cannot do save when determined by mind. "

This challenge of Spinoza's had to be met. With some investigators thisseemed very literally all there was to be done about the study ofman--to show how far the body could explain the activity we call "themind. " The unfortunate feature was that they thought they had to startwith a body not only with mind and soul left out but also withpractical disregard of the whole natural setting. They studied littlemore than corpses and experimental animals, and many a critic wonderedhow such a corpse or a frog could ever show any mind, normal orabnormal. To get things balanced again, the vision of man had to expandto take a sane and practical view of all of human life--not only of itsmachinery. 

The human organism can never exist without its setting in the world. Allwe are and do is of the world and in the world. The great mistake of anoverambitious science has been the desire to study man altogether as amere sum of parts, if possible of atoms, or now of electrons, and as amachine, detached, by itself, because at least some points in thesimpler sciences could be studied to the best advantage with this methodof the so-called elementalist. It was a long time before willingness tosee the large groups of facts, in their broad relations as well as intheir inner structure, finally gave us the concept and vision ofintegration which now fits man as a live unit and transformer of energyinto the world of fact and makes him frankly a consciously integratedpsychobiological individual and member of a social group. 

It is natural enough that man should want to travel on the road he knowsand likes best. The philosopher uses his logic and analysis andsynthesis. The introspectionist wants to get at the riddle of theuniverse 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 afterhim and losing all connection with the objective world. The physicistfollows the reverse course. He gives us the appreciation of theobjective world around and in us. The chemist follows out the analyticand synthetic possibilities of his atoms and elements, and the biologistthe growth and reproduction and multiplication of cells. Each sees anopen world of possibilities and is ready to follow as far as facts willcarry and as far as the imagination will soar. Each branch has createdits rules of the game culminating in the concept of objective science, and the last set of facts to bring itself under the rules of objectivescience, 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 aspurely subjective entity, something that can be studied only byintrospection, or at least only with ultra-accurate instruments--alwayswith 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 whatwas 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 broadrelations, without any special theory but frankly as common sense findsit, viz. , as the activities and behavior of definite individuals--verymuch as Aristotle had put it--"living organisms in their 'form' oractivity and behavior. " Psychology had to wake up to studying otherminds as well as one's own. Common sense has always been willing tostudy other persons besides our own selves, and that exactly as we studysingle organs--viz. , for what they are and do and for the conditions ofsuccess and failure. Nor do we have to start necessarily from so-calledelements. Progress cannot be made merely out of details. It will not domerely to pile up fragments and to expect the aggregates to formthemselves. It also takes a friend of facts with the capacity formustering and unifying them, as the general musters his army. Biologyhad to have evolutionists and its Darwin to get on a broad basis tostart with, and human biology, the life of man, similarly had to beconceived in a new spirit, with a clear recognition of the opportunitiesfor the study of detail about the brain and about the conditions forits working and its proper support, but also with a clear vision of thewhole man and all that his happiness and efficiency depend upon. 

All this evolution is strongly reflected in the actual work ofpsychiatry and medicine. For a time, it looked to the physician as ifthe physiology and pathology of the body had to make it their ambitionto make wholly unnecessary what traditional psychology had accumulated, by turning it all into brain physiology. The "psychological" factsinvolved were undoubtedly more difficult to control, so much so that onetried to cut them out altogether. As if foreshadowing the later academic"psychology without soul and consciousness, " the venerableSuperintendent of Utica, Dr. Gray, was very proud when in 1870 he hadeliminated the "mental and moral causes" from his statistics of theUtica State Hospital, hiding behind the dogma that "mind cannot becomediseased, but only the body. " To-day "mental and moral causes" arerecognized again in truer form--no longer as mere ideas anduninvestigated suppositions taken from uncritical histories, but asconcrete and critically studied life situations and life factors andlife problems. Our patients are not sick merely in an abstract mind, butby actually living in ways which put their mind and the entire organismand its activity in jeopardy, and we are now free to see how thishappens--since we study the biography and life history, the resources ofadaptation and of shaping the life to success or to failure. 

The study of life problems always concerns itself with the interactionof an individual organism with life situations. The first result of arecognition of this fact was a more whole-hearted and practical conceptof personality. 

In 1903 I put together for the first time my analysis of the neuroticpersonality, which was soon followed by a series of studies on theinfluences of the mental factors, and in 1908 a paper on "What DoHistories of Cases of Insanity Teach Us Concerning Preventive MentalHygiene During the Years of School Life?" All this was using forpsychiatry the growing appreciation of a broad biological view-point inits concrete application. It was a reaction against the peculiar fear ofstudying the facts of life simply and directly as we find and experiencethem--scoffed at because it looked as if one was not dealing withdependable and effective data. Many of the factors mentioned as causesdo not have the claimed effects with sufficient regularity. It is quitetrue that not everybody is liable to any serious upset by several of thehandicaps sometimes found to be disastrous during the years ofdevelopment; but we have learned to see more clearly why the one persondoes and the other does not suffer. Evidently, not everybody who isreserved and retiring need be in danger of mental disorder, yet thereare persons of just this type of make-up that are less able than othersto stand the strains of isolation, of inferiority feeling, of exaltedambitions and one-sided longings, intolerable desires, etc. The sameindividual difference of susceptibility holds even for alcohol. Withthis recognition we came to lay stress again on the specific factorswhich make for the deterioration of habits, for tantrums withimaginations, and for drifting into abnormal behavior, and conditionsincompatible with health. 

It was at this point that our great indebtedness to the BloomingdaleHospital began. Dr. August Hoch, then First Assistant of theBloomingdale Hospital, began to swing more and more toward thepsychobiological trend of views, and with his devoted and very ablefriend Amsden he compiled that remarkable outline, [2] which was thefirst attempt to reduce the new ideals of psychobiology to a practicalscheme of personality study--that clear and plain questionnaire goingdirectly at human traits and reactions such as we all know and can seeat work without any special theories or instruments. 

After studying in each patient all the non-mental disorders such asinfections, intoxications, and the like, we can now also attack theproblems of life which can be understood only in terms of plain andintelligible human relations and activities, and thus we have learned tomeet on concrete ground the real essence of mind and soul--the plain andintelligible human activities and relations to self and others. Thereare in the life records of our patients certain ever-returningtendencies and situations which a psychiatry of exclusive brainspeculation, auto-intoxications, focal infections, and internalsecretions could never have discovered. 

Much is gained by the frank recognition that man is fundamentally asocial being. There are reactions in us which only contacts andrelations with other human beings can bring out. We must study men asmutual reagents in personal affections and aversions and theirconflicts; in the desires and satisfactions of the simpler appetites forfood and personal necessities; in the natural interplay of anticipationand fulfilment of desires and their occasional frustration; in theselection of companionship which works helpfully or otherwise--for themoment or more lastingly throughout the many vicissitudes of life. Allthrough we find situations which create a more or less personal bias andchances for success or failure, such as simpler types of existence donot produce. They create new problems, and produce some individuals ofgreat sensitiveness and others with immunity--and in this great fieldnothing will replace a simple study of the life factors and the socialand personal life problems and their working--the study of the real mindand the real soul--_i. E. _, human life itself. Looking back then thispractical turn has changed greatly the general view as to what should bethe chief concern of psychology. One only need take up a book onpsychology to see what a strong desire there always was to contrast apure psychology and an applied psychology, and to base a new sciencedirectly on the new acquisitions of the primary sciences such as anatomyand histology of the nervous system. There was a quest for the elementsof mind and their immediate correlation with the latest discoveries inthe structure of the brain. The centre theory and the cell and neuronetheory seemed obligatory starting-points. To-day we have become shy ofsuch postulates of one-sided not sufficiently functional materialism. Wenow call for an interest in psychobiological facts in terms of criticalcommon sense and in their own right--largely a product of psychiatry. There always is a place for elements, but there certainly is also aplace for the large momentous facts of human life just as we find andlive it. 

Thus psychiatry has opened to us new conceptions and understandings ofthe relation of child and mother, child and father, the child as areagent to the relations between mother and father, brothers andsisters, companions and community--in the competitions of real concretelife. It has furnished a concrete setting for the interplay of emotionsand their effects. 

It has led us from a cold dogma of blind heredity and a wholesalefatalistic asylum scheme, to an understanding of individual, familiar, and social adjustments, and a grasp on the factors which we can considerindividually and socially modifiable. We have passed from giving merewholesale advice to a conscientious study of the problems of each unit, and at the same time we have developed a new and sensible approach tomental hygiene and prevention, as expressed in the comprehensive surveysof State and community work and even more clearly in the development ofhelps to individuals in finding themselves, and in the work in schoolsto reach those who need a special adaptation of aims and means. To theterrible emergency of the war it was possible to bring experienced menand women as physicians and nurses, and how much was done, only thosecan appreciate who have seen the liberality with which all thehospitals, and Bloomingdale among the first, contributed more than theirquota of help, and all the assistance that could possibly be offered toreturning 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 patientsthan can possibly be handled by one human working unit or working group. The consequence was that there arose a narrowing routine and wholesaleclassifications and a loss of contact with the concrete needs of theindividual case; that very often progress had to come from one-sidedenthusiasts or even outsiders, who lost the sense of proportion andmagnified points of relative importance until they were supposed toexplain everything and to be cure-alls. We are all inclined to sacrificeat the altar of excessive simplicity, especially when it suits us; webecome "single-taxers" and favor wholesale legislation and exclusiveState care when our sense for democratic methods has gone astray. Humansociety has dealt with the great needs of psychiatry about as it hasdealt with the objects of charity, only in some ways more stingily, witha shrewd system and unfortunately often with a certain dread of theworkers themselves and of their enthusiasm and demands. Law andprejudice surrounded a great share of the work with notions of stigmaand hopelessness and weirdness--while to those who see the facts interms of life problems there can be but few more inspiring tasks thanwatching the unfolding of the problematic personality, seeking andfinding its proper settings, and preventing the clashes and gropings inmaladjustments and flounderings of fancy and the faulty use andnutrition of the brain and of the entire organism. 

What a difference between the history of a patient reported and studiedand advised by the well-trained psychiatrist of to-day and the accountdrawn up by the statistically minded researcher or the physician whowants to see nothing but infections or chemistry and hypotheses ofinternal secretion. What a different chance for the patient in histreatment, in contrast to what the venerable Galt of Virginia reports asthe conception of treatment recommended by a great leader of a hundredyears ago: "Mania in the first stage, if caused by study, requiresseparation from books. Low diet and a few gentle doses of purgingphysic; if pulse tense, ten or twelve ounces of blood [not to be givenbut to be taken!]. In the high grade, catch the patient's eye and lookhim out of countenance. Be always dignified. Never laugh at or withthem. Be truthful. Meet them with respect. Act kindly toward them intheir presence. If these measures fail, coercion if necessary. Tranquillizing chair. Strait waistcoat. Pour cold water down theirsleeves. The shower bath for fifteen or twenty minutes. Threaten themwith death. Chains seldom and the whip never required. Twenty to fortyounces of blood, unless fainting occurs previously; . .. Etc. "

To-day an understanding of the life history, of the patient's somaticand functional assets and problems, likes and dislikes, the problempresented by the family, etc. !

So much for the change within and for psychiatry. How about psychiatry'scontribution beyond its own narrower sphere? It has led us on inphilosophy, it has brought about changes in our attitude to ethics, tosocial study, to religion, to law, and to life in general. Psychiatricwork has undoubtedly intensified the hunger for a more objective and yetmelioristic 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 conspiredto make as great a puzzle as possible of the nature of mental life, oflife itself, and of all the fundamental principles, so much so that asa result anything resembling or suggesting philosophy going beyond theordinary traditions has got into poor repute in our colleges anduniversities and among those of practical intelligence. The consequenceis that the student and the physician are apt to be hopeless andindifferent concerning any effort at orderly thinking on theseproblems. [3]

Most of us grew up with the attitude of a fatalistic intellectualhopelessness. How could we ever be clear on the relation of mind andbody? How could mind and soul ever arise out of matter? How can weharmonize strict science with what we try to do in our treatment ofpatients? How can we, with our mechanistic science, speak of effort, andof will to do better? How can we meet the invectives against the factsof matter on the part of the opposing idealistic philosophies and theiruncritical exploitations in "New Thought"--_i. E. _, really the revival ofarchaic thought? It is not merely medical usefulness that forced thesebroad issues on many a thinking physician, but having to face the factsall the time in dealing with a living human world. The psychopathologisthad to learn to do more than the so-called "elementalist" who alwaysgoes back to the elements and smallest units and then is apt to shirkthe responsibility of making an attempt to solve the concrete problemsof greater complexity. The psychiatrist has to study individuals andgroups 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 haveto face the general principle of unit-formation, and the fact that thenew units need not be like a mere sum of the component parts but can bean actually new entity not wholly predictable from the component partsand known only through actual experience with the specific product. Hydrogen and oxygen, it is true, can form simple mixtures, but when theymake an actual chemical integration we get a new specific type ofsubstance, water, behaving and dividing according to its own laws andproperties in a way not wholly predictable from just what we know ofhydrogen and oxygen as such. Analogy prompts us to see in plants andanimals products of physics and chemistry and organization, although thepeculiarity of the product makes us recognize certain specificities oflife not contained in the theory of mere physics and chemistry. All thefacts of experience prompt us to see in mentation a biological function, and we are no longer surprised to find this product of integration sodifferent from the nature and functions of all the component parts. Allthe apparent discontinuities in the intrinsic harmony of facts, on theone hand, and the apparent impossibility of accounting for new featuresand peculiarities of the new units, are shown to be a general feature ofnature and of facts: integration is not mere summation, but a creationof ever-new types and units, with superficial discontinuities and withtheir own new denominators of special peculiarities; hence there is noreason to think of an insurmountable and unique feature in the origin oflife, nor even of mentally integrated life; no need of special mysticalsparks of life, of a mysterious spirit, etc. ; but--and this is theimportant point--also no need of denying the existence of all theevidence there may be of facts which we imply when we use the deeplyfelt concepts of mind and soul. In other words, we do not have to bemind-shy nor body-shy any longer. 

The inevitable problem of having to study other persons as well asourselves necessarily leads us on to efforts at solution of otherphilosophical problems, the problem of integrating materialism andidealism, mechanism and relative biological determinism and purpose, etc. Man has to live with the laws of physics and chemistry unbroken andin harmony with all that is implied in the laws of heredity and growthand function of a biological organism. Yet what might look like alimitation is really his strength and safe foundation and stability. Onthis ground, man's biological make-up has a legitimate sphere of growthand expansion shared by no other type of being. We pass into every newmoment of time with a preparedness shown in adaptive and constructiveactivity as well as structure, most plastic and far-reaching in thegreatest feat of man, that of imagination. Imagination is not a mereduplication of reality in consciousness and subjectivity; it is asubstitute in a way, but actually an amplification, and often a realaddition to what we might otherwise call the "crude world, " integratedin the real activities of life, a new creation, an ever-new growth, seenin its most characteristic form in choice and in any new volition. Hencethe liberating light which integration and the concepts of growth andtime throw on the time-honored problem of absolute and relativedeterminism and on the relation of an ultra-strict "science" with commonsense. 

In logic, too, we are led to special assertions. We are forced toformulate "open definitions, " _i. E. _, we have to insist on the openformulation of tendencies rather than "closed definitions. " We deal withrich potentialities, never completely predictable. 

This background and the demands of work in guiding ourselves and othersthus come to lead us also into practical ethics, with a new conceptionof the relation of actual and experimental determinism and of what "freewill" we may want to speak of, with a new emphasis on the meaning ofchoice, of effort, and of new creation out of new possibilitiespresented by the ever-newly-created opportunities of ever-new time. Weget a right to the type of voluntaristic conception of man which most ofus live by--with a reasonable harmony between our science and ourpragmatic needs and critical common sense. 

The extent to which we can be true to the material foundations and yettrue to a spiritual goal, ultimately measures our health and naturalnormality and the value of our morality. _Nature shapes her aimsaccording to her means. _ Would that every man might realize this simplelesson and maxim--there would be less call for a rank and wantonhankering for relapses into archaic but evidently not wholly outgrowntendencies to the assumption of "omnipotence of thought, " revived againfrom time to time as "New Thought. " Psychiatry restores to science andto the practical mind the right to reinclude rationally andconstructively what a narrower view of science has, for a time at least, handed over unconditionally to uncritical fancy. But the only way tomake unnecessary astrology and phrenology and playing with mysticism andwith Oliver Lodge's fancies of the revelation of his son Raymond, is torecognize the true needs and yearnings of man and to show nature's realways of granting appetites and satisfactions that are wholesome. 

Hereby we have indeed a contribution to biologically sound idealism: aclearer understanding of how to blend fact and ambition, nature andideal--an ability to think scientifically and practically and yetidealistically of matters of real life. 

To come back to more concrete problems again, a wider grasp of whatpsychiatry may well furnish us helps toward a new ethical goal in oursocial conscience. The nineteenth century brought us the boon and thebane of industrialism. More and more of the pleasures and satisfactionsof creation and production and of the natural rewards of the daily labordrifted away from the sight and control of the worker, who now rarelysees the completed result of his work as the farmer or the artisan usedto do. Few workers have the experience of getting satisfaction fromdirect pride in the end result; as soon as the product is available, aset of traders carries it to the markets and a set of financiersdetermines, in fact may already have determined, the reward--just as thereward of the farmer is often settled for him by astoundingspeculations long before the crop is at hand. There is a field for a newconscience heeding the needs of fundamental satisfactions of man so welldepicted by Carlton Parker, and psychiatric study furnishes muchconcrete material for this new conscience in industrial relations--witha better knowledge of the human needs of all the participants in thegreat game of economic life. 

Psychiatry gives us also a new appreciation of the religious life andneeds of our race. Man's religion shows in his capacity to feel andgrasp his relations and responsibility toward the largest unit or forcehe can conceive, and his capacity for faith and hope in a deeper andmore lasting interdependence of individual and race with the Ruler orrules of the Universe. Whatever form it may take expresses his capacityto feel himself in humility and faith, and yet with determination, amore or less responsible part of the greatest unit he can grasp. Theform this takes is bound to vary individually. As physicians we learn torespect the religious views of our fellow beings, whatever they may be;because we are sure that we have the essentials in common; and with thisemphasis on what we have in common, we can help in attaining theindividually highest attainable truth without having to be destructive. We all recognize relations that go beyond individual existence, lastingand "more than biological" relations, and it is the realization of theseconceptions intellectually and emotionally true to our individual andgroup nature that constitutes our various religions and faiths. Emphasizing what we have in common, we become tolerant of the idea thatprobably the points on which we differ are, after all, another's bestway of expressing truths which our own nature may picture differentlybut would not want to miss in, or deny to, the other. One of theevidences of the great progress of psychiatry is that we have learned tobe more eager to see what is sane and strong and constructively valuableeven in the strange notions of our patients, and less eager to call themqueer and foolish. A delusion may contain another person's attempt atstating truth. The goal of psychiatry and of sound common sense is truthfree of distortion. Many a strange religious custom and fancy has beenbrought nearer our understanding and appreciation since we have learnedto respect the essential truth and individual and group value of fancyand feeling even in the myths and in the religious conceptions of allraces. 

Among the most interesting formulations and potential contributions ofpsychiatry are those reaching out toward jurisprudence. Psychiatry dealspre-eminently with the variety and differences of human personalities. To correct or supplement a human system apparently enslaved by concernabout precedent and baffling rules of evidence inherited from the daysof cruel and arbitrary kings, the demand for justice has called forcertain remedies. Psychiatry still plays a disgraceful rôle in theso-called expert testimony, largely a prostitution of medical authorityin the service of legal methods. Yet, out of it all there has arisen thegreat usefulness of the psychiatrist in the juvenile and other courts. There it is shown that if psychiatry is to help, it should be taken forgranted that the person indicted on a charge should thereby becomesubject to a complete and unreserved study of all the facts, subject tocross-examination, to be sure, but before all accessible to complete andunreserved study. This would mean a substantial participation of law inthe promotion of knowledge of facts and constructive activity, and aconception of indeterminate sentence not merely in the service ofleniency but in the service of the best protection of the public, and, if necessary, lasting detention of those who cannot be reformed, beforethey have had to do their worst. Whoever is clearly indicted forbreaking the laws of social compatibility should not merely invite aspirit of revenge, but should, through the indictment, surrenderautomatically to legalized authority endowed with the right and duty ofan unlimited investigation of the facts as they are. 

Looking back then, you can see how the history of the human thoughtabout what we call mind and psyche displayed some strange reactions ofthe practical man, the scientist, the philosopher, and theologian towardone of the most important and practical problems. It is difficult torealize what it means to arrive at ever-more-workable formulations andmethods of approach. We do not have to be mind-shy _or_ body-shy anylonger. To-day we can attack the facts as we find them, without thatdisturbing obsession of having to translate them first into somethingartificial before we can really study them and work with them. Since wehave reached a sane pluralism with a justifiable conviction of thefundamental consistency of it all, a satisfaction with what we modestlycall formulation rather than definition and with an appreciation ofrelativity, we have at last an orderly and natural field and method fromwhich nobody need shy. 

The century that has passed since the inspiration of a few men of theSociety of the New York Hospital to provide for the mentally sick hascleared the atmosphere a great deal. We can start the second centuryfreer and unhampered in many ways. Much has been added, and more thanever do we appreciate the position of just such a hospital as that ofBloomingdale as a centre of healing and as a leader of public opinionand as a contributor to progress. 

The Bloomingdale Hospital has a remarkable function. It is a more orless privileged forerunner in standards and policies. Without having tocarry the burdens of the whole State with its sweeping and sometimesdistant power and its forced economy, a semiprivate hospital likeBloomingdale aims to minister to a slightly select group, especiallythose who are in the difficult position of greater sensitiveness butmoderate means in days of sickness. It serves the part of our communitywhich more than any other sets the pace of the civilization aboutus--the intelligent aspiring workers who may not have reached the goalof absolute financial independence. It creates the standard of which wemay dream that it might become the standard of the whole State. 

When we review the roster of Superintendents--from John Neilson to PlinyEarle and from Charles Nichols, Tilden Brown, and Samuel Lyon down tothe present head, our highly esteemed friend and coworker William L. Russell--and the names of the members of the staff, many of whom havereached the highest places in the profession, and last, but not least, the names of the Governors of The Society of the New York Hospital, wecannot help being impressed by the forceful representation of both theprofession and the public, and we recognize the wide range of influence. 

Instead of depending on frequently changing policies regulated from theoutside under the influence of the greater and lesser lights andexigencies of State and municipal organization, the New York Hospitalhas its self-perpetuating body of Governors chosen from the mostpublic-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 greatchange that is now taking place. You see how the division of psychiatryhas developed from practically a detention-house to an asylum, andfinally to a hospital with all the medical equipment and laboratories ofthe General Hospital. And you begin to see psychiatry, with its methodsof study and management of life problems as well as of specific braindiseases, infections, and gastrointestinal and endocrine conditions, become more and more helpful, even a necessity, in the wards anddispensary of the General Hospital on 16th Street. The layman cannot, perhaps, delve profitably into the details of such a highly and broadlyspecialized type of work. But he can readily take a share in the bestappreciation of the general philosophy and policy of it all. 

The shaping of the policy of a semiprivate hospital is not quite assimple as shaping that of a State Hospital with its well-defineddistricts and geographically marked zones of responsibility. Bloomingdale has its sphere of influence marked by qualitative selectionrather than by a formal consideration. It does not pose as an invidiouscontrast to the State Hospital, and yet it is intended to solve in asomewhat freer and more privileged manner the problem of providing forthe mentally sick of a more or less specific hospital constituency, theconstituency of the New York Hospital; and since it reaches the mostdiscriminating and thinking part of our population, it has the mostwonderful opportunity to shape public opinion. Like all psychiatricalinstitutions, it has to live down the traditional notions of thehalf-informed public; it has to make conspicuous the change of spiritand the better light in which we see our field and responsibilities. This organization can show that it is not mere insanity but the workingout of life problems that such a hospital as this is concerned with. Theconditions for which it cares are many. Some of them are all that whichtradition and law stamp as insanity. But see what a change. Seventy-five per cent of the patients are voluntary admissions; and moreand 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 itsequipment so as to make possible a free exchange of patients and ofworkers 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 thevery spirit of modern psychopathology and psychiatry. We know now thatfrom 10 to 40 per cent of the patients of the gynecologist, thegastroenterologist, and the internist generally would be better treatedif a study of the life problems were added to that of the special organsand functions. To meet this need it should be possible to have enoughworkers in this branch of the Hospital to take their share of theconsulting and co-operation work in the wards and dispensary of theGeneral Hospital, and perhaps even in the schools provided for the sametype of people from which you draw your patients. The grouping of thepatients can be such that the old prejudices need not reach far into thesecond century of the life of the Hospital. With a man of the vision andpractical experience of Dr. Russell, there is no need for an outsider toconjure up a picture of special practical achievements as I have doneof the more general principles to-day. 

An institution is more than a human life. Many ambitions combine andbecome part of a group spirit permeating the organization and reachingtheir fulfilment in the succession of leaders. The life and growth andhappy self-realization of an institution is not the bricks andmortar--it is a living and elastic entity--never too stable, never toofinished, a growing and plastic plant--to use a metaphor that hasslipped in perhaps without arousing all the implications the term plantmight carry and does carry. 

Some years ago my wife celebrated her birthday and told her colored cookjocosely: "Geneva, I am a hundred years old to-day. " The cook's jawdropped 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-daypulsating with ever-fresh life and ever-fresh problems! How differentfrom a simple human being, after all! The heart and wisdom of many a manand woman has gone into the perpetuation of what a few thoughtful menstarted 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 toanother. Here and there the past may make itself felt too much. But thespirit and its growth show in recruiting ever-new lives to meet thepresent day and the days to come, and this all the more so if we canshow the younger generation that every effort is likely to have itsreasonable direct support. We all want a man like Dr. William L. Russellto have the fullest opportunity to bring to its best expression the richand well-tried wisdom of over twenty-five years of devoted work in thefield. This is no doubt a time of stress when many personal and generalsacrifices may be needed to bring about the fruition and culmination ofthe labors of the present generation. Yet is it not a clear opportunityand duty, so that those who are growing up in the ranks to-day mayreally be encouraged to get a solid training, always animated by theconviction that one can be sure of the practical reward for toilingthrough the many years of preparation in a psychiatric career, whetherit 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 representingnot only my own sentiments and convictions but those of our dear oldfriend Hoch. We all wish that he might be with us to express himself thewarm feelings toward the Bloomingdale Hospital and its activerepresentatives, from the managers to the humblest workers. Hoch in hismodesty could probably not have been brought to state fully and franklyhis own share in the achievements of this Hospital. But I know how muchhe would have liked to be here to express especially the warmth ofappreciation we all entertain of what our friend William L. Russellmeans to us and has meant to us all through the nearly twenty-five yearsof our friendship and of working together. We delight in seeing himbring to further fruition the admirable work he did at Willard, andlater for all the State hospitals; and that which we see him do at alltimes for sanity in the progress of practical psychiatry, and nowespecially in the guidance of this institution. We delight in seeing hismaster mind given more and more of a master's chance for the practicalexpression of his ideals and convictions concerning the duties andopportunities of such a hospital as Bloomingdale. 

Our thanks and best wishes to those who invited us to stand here to-dayat the cradle of a second century of Bloomingdale Hospital! It is anoteworthy gathering that joins here in good wishes to those who haveshaped this ever-new Bloomingdale. With a tribute to our thoughtful andenthusiastic friend in internal medicine, Lewellys F. Barker, to ourEnglish coworker, Richard G. Rows, to the illustrious champion of Frenchpsychopathology, Pierre Janet, to our friend and leader in practicalpsychiatry, William L. Russell, to our friends and coworkers of theBloomingdale staff, and especially also to the Board of Governors whoshape the policy and control the finances, and exercise the leadershipof public opinion, I herewith express my sincerest thanks and bestwishes. 

FOOTNOTES:

[Footnote 2: A Guide to the Descriptive Study of the Personality, withSpecial Reference to the Taking of Anamneses of Cases with Psychoses, byDr. August Hoch and Dr. George S. Amsden. ]

[Footnote 3: See, for instance, Moebius, The Hopelessness of AllPsychology, reviewed in the Psychological Bulletin, vol. IV, 1907, pp. 170-179. ]

ADDRESS BYDR. LEWELLYS F. BARKER

_The Chairman_:--The Johns Hopkins Medical School lends us also to-dayDr. Lewellys F. Barker, its Professor of Clinical Medicine. Dr. Barkerhas done so much to define and settle the contradictions of mind andmatter, and has clarified so much, and in fields so varied, as teacher, research worker, and practitioner, that we welcome this opportunity oflistening to his discussion of "THE IMPORTANCE OF PSYCHIATRY IN GENERALMEDICAL PRACTICE. "

DR. BARKER

We have met to-day to celebrate the hundredth anniversary of thefounding of a hospital that, in its simpler beginnings and in itsevolution to the complex and highly organized activities of the present, has served an eminently practical purpose and has played an importantrôle in the development of the science and art of psychiatry in America. I desire, as a representative of general medicine, and, especially, ofinternal medicine, to add, on this occasion, my congratulations to thoseof the spokesmen of other groups, and, at the same time to express thehope that this institution, historically so significant for the centuryjust past, may maintain its relative influence and reputation in thecenturies to come. 

The interest taken in psychiatry by the general practitioner and by theconsulting internist has been growing rapidly of late. Some of thereasons for this growth of interest and heightening of appreciation Ihave drawn attention to on an earlier occasion. [4] Psychiatry as a wholewas for a long time as widely separated from general medicine aspenology is to-day, and for similar reasons. It was a long time beforepersons that manifested extraordinary abnormalities of thought, feeling, and behavior were regarded as deserving medical study and care, and evenwhen a humanitarian movement led to their transfer fromstraight-jackets, chains, and prison cells to "asylums for the insane, "these institutions were, for practical reasons, so divorced from thehomes of the people and from general hospitals that psychiatry had, andcould at the time have, but little intercourse with general medicine orwith general society. Mental disorders were moral and legal problemsrather than biological, social, and medical problems. Their genesis waswholly misunderstood, and legal, medical, social, religious, andphilosophic prejudices went far toward preventing any rationalscientific mode of approach to the questions involved or any formulationof investigative procedures that promised to be fruitful. Even to-daythe same prejudices are all too inhibitory; but thanks to theunprecedented development of the natural sciences during the periodsince this hospital was founded, we are witnessing, in our time, a rapidtransformation of thought and opinion concerning both the normal and thedisordered mind, a transformation that is reaching all circles of humanbeings, bidding fair to compel the strongholds of tradition andprejudice to relax, and inviting the whole-hearted co-operation ofworkers in all fields in a common task of overcoming some of thegreatest difficulties by which civilization and human progress areconfronted. And though the brunt of this task is borne and must be borneby the shoulders of medical men, physicians assume the burdencheerfully, now that they know that they can count upon the intelligentsupport and the cordial sympathy of an ever-enlarging extra-medicalaggregate. No better illustration could be given, perhaps, of the changein the status of psychiatry in this country and in the world than thecontents of the programme of our meeting to-day at which a distinguishedinvestigator from London tells us of the biological significance ofmental disorders, an eminent authority from Paris explains therelationship between certain diseases of the nervous system and thesedisorders, and a leading psychiatrist of this country speaks upon thecontributions of psychiatry to the understanding of the problems oflife. Psychiatry, like each of the other branches of medicine, has cometo be recognized as one of the subdivisions of the great science ofbiology, free to make use of the scientific method, in duty bound todiffuse the knowledge that it gains, and privileged to contributeabundantly to the lessening of human suffering and the enhancement ofhuman joys. General practitioners of medicine and medicalspecialists--at least the more enlightened of them--welcome thedeveloping science of psychiatry, are eager to hasten its progress, andwill 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 ofthe widely experienced general practitioners, though constantly comingin contact with major and minor psychic disturbances, are, however, still far from realizing the full meaning and value of the principlesand technic of modern psychology and of the newer psychiatry must, Ifear, be frankly admitted. [5] But dare we blame these practitioners fortheir ignorance of, apathy regarding, and even antipathy to, the psychicand especially the psychotic manifestations of their patients? Ought wenot rather to try to understand the reasons for this ignorance, thisapathy, and this aversion, all three of which seem astonishing to manyof our well-trained psychologists and psychopathologists? Are there notdefinite conditions that explain and at least partially excuse thedefects in knowledge and interest and the errors in attitude manifestedby those whom we would be glad to see cognizant and enthusiasticallyparticipant? Psychiatrists, who have taught us to understand and rescuevarious types of "sinners" and "social offenders" will, I feel sure, avoid any moralistic attitude when discussing the shortcomings of theirbrethren in the general medical profession, and will, instead, seek todiscover and to remove their causes. 

As an internist who values highly the gifts that modern psychology andpsychiatry have been making to medicine, I have given some thought tothe conditions and causes that may be responsible for these professionaldelinquencies that you deplore. Though this is not the time nor theplace fully to discuss them, the mere mention of some of the causes andconditions will, perhaps, contribute to comprehension and pardon, andmay serve to stimulate us all to livelier corrective activity. Let meenumerate some of them:

(1) A social stigma still attaches, despite all our efforts to abolishit, to mental disorders and has, to a certain extent, been transferredto those that study and treat patients manifesting these disorders. 

(2) The organization of our general education is very defective since itfails to make clear to each student man's place in the universe and anyorderly view of the world and man; it fails adequately to enlighten thestudent regarding the processes of life as adaptations of organisms totheir environment, man, himself, being such an organism reactingphysically and psychically to his surroundings in ways either favorableor unfavorable to his own preservation and that of his species; it failsto teach the student that the human organism represents a bundle ofinstincts each with its knowing, its feeling, and its strivingcomponent, that what we call "knowledge" and what we call "character"are gradual developments in each person, and that if we know how theyhave developed in a particular person we possess clues to the way thatperson will react under a given stimulus, that is to say, what he willthink, how he will feel, and how he will act; and it fails, again, properly to instruct students regarding the interrelationships ofmembers of different social groups (familial, civic, economic, occupational, ethical, national, racial, etc. ); in other words, ourgeneral educational organization is as yet far from successful ininculcating philosophical, biological, psychological, and sociologicalconceptions that are adequate symbols of reality. 

(3) Though our medical schools have made phenomenal advances in theorganization and equipment of their institutes and in provision forteaching and research in a large number of preclinical and clinicalsciences, they have up to now almost wholly ignored normal psychology, psychiatry, and mental hygiene. The majority of the professors in theseschools are so absorbed by the morphological, physical, and chemicalaspects of their subjects, that students rarely get from them anyinkling of the psychobiological aspect, any adequate knowledge of humanmotives, or any satisfactory data regarding human behavior, normal orabnormal. [6] It is only recently and only in a few schools thatpsychiatric clinics have been established as parts of the teachinghospitals, that medical students have been able to come into directcontact over an appreciable period of time with the objects ofpsychiatric study, that the psychic manifestations of patients havereceived any direct and particular attention in the general medical andsurgical wards, and that there has been any free and constant reciprocalexchange of thought and opinion between students of the somatic on theone hand and students of the psychic on the other. 

(4) The language of the psychiatrist is unique and formidable. The nameshe has applied to motives and impulses, to symptoms and syndromes, areforeign to the tongue of the general practitioner who is so awed bythem that he withdraws from them and remains humbly reticent in a stateof 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 ofconcise, authoritative, well-written text-books on psychiatry, and thegeneral medical journals rarely print psychiatric papers designed tointerest the average practitioner. The most widely diffused psychiatricreports of our time are the sensational news items of the daily press. 

(5) The overemphasis of psychogenetic factors to the apparent neglect ofimportant somatogenic factors by some psychiatrists has tended to arousesuspicion regarding the soundness of the opinions and methods ofpsychiatric workers in the minds of men thoroughly imbued withmechanistic conceptions and impressed with the results of medicalresearches based upon them. The ardor of the psychoanalysts, also, though in part doubtless justified by experience, has, it is to befeared, excited a certain amount of antipathy among the uninitiated. 

(6) The fears of insanity prevalent among the laity and the repugnanceof patients to any idea that they may be "psychotic" or "psychoneurotic"(words that, in their opinion, refer to "imaginary symptoms, " or tosymptoms that they could abolish if they would but "buck up" and exerttheir "wills") undoubtedly exert a reflex influence upon practitionerswho put the "soft pedal" on the psychobiological reactions and "pull outthe stop" that amplifies the significance of any abnormal physicalfindings. 

(7) Psychotherapy, to the mind of the average medical practitioner, is(or has been) something mysterious or occult. He uses much psychotherapyhimself but it is nearly always applied unconsciously and indirectlythrough some form of physical or chemical therapy that he believes willcure. He is usually quite devoid of insight into the effect of his ownexpressed beliefs and bodily attitudes upon the adjusting mechanisms ofhis patients. Conscious and direct psychotherapy is left by the averagepractitioner to New Thoughters, Christian Scientists, quacks, andcharlatans. If he were to use psychotherapy consciously and were toreceive a professional fee for it he would feel that he was being paidfor a value that the patient had not received. A highly respectedcolleague once privately criticised a paper of mine (read before theAssociation of American Physicians) on the importance of psychotherapy. "What you said is true, " he remarked; "we all use psychotherapy but weare a little ashamed of it; and it is better not to talk about it. " Evenhe did not realize that every psychotherapy is also a physical therapy. 

(8) The rise of specialism, through division of labor andintensification of interests restricted to limited fields, in practicalmedicine, the necessary result and to a large extent also a cause of therapid growth of knowledge and technic has brought with it manyadvantages, but also some special difficulties, among them (a) theimpossibility any longer of any single practitioner, unaided, to studyand treat a patient as well as he can be studied and treated by aco-ordinated group whose special analytical studies in single domainsare adequately synthesized by a competent integrator, and (b) in theabsence of such group work, the tendency to one-sided study, partialdiagnosis, and incomplete and unsatisfactory therapy. Through the riseof specialism, it is true, psychiatry itself has arisen and thepsychiatrist, like the skilled integrating internist, is interested inthe synthesis of the findings in all domains, for only through suchsynthetic studies, such integration of the functional activities of thewhole organism, is it possible to gain a global view of the patient as aperson, to make a complete somatic, psychic, and social diagnosis, andto plan a regimen for him that will ensure the best adjustment possibleof his internal and external relationships. [7]

Working in a diagnostic group myself as an integrating internist, I havebeen much helped by the reports of personality studies made by skilfulpsychiatrists; these are linked with the special reports on the severalbodily domains (cardiovascular, respiratory, hæmic, dental, digestive, urogenital, locomotor, neural, metabolic, and endocrine) in orderfinally to arrive at an adequately co-ordinated and (subordinated) totaldiagnosis from which the clues for an appropriate therapeutic regimencan safely be drawn. If group practice is to grow and be successful inthis country, as I think likely, groups must see to it that psychiatry, as well as the other medical and surgical specialties, is properlyrepresented in their make-up. [8] From now on, too, general practitionersshould, as Southard emphasized, be urged to be at least as familiarwith the general principles and methods of the psychiatrist as they arewith those of the gynecologist, the dermatologist, and thepædiatrist. [9] Well organized group-diagnosis and general will then helpto counteract the inhibiting influence of earlier isolated specialismupon the appreciation of psychiatry. 

This enumeration of some of the causes of the ignorance and apathy(existent hitherto) in the general profession regarding psychiatry mayperhaps suffice as explanation. These causes are, fortunately, rapidlybeing removed. We are entering upon an era in which psychiatry will berecognized as one of the most important specialties in medicine, an erathat will demand alliance and close communion among psychiatrists, internists, and the representatives of the various medical and surgicalspecialties. 

The internist and the psychiatrist will ever have a common interest inthe obscure problems of etiology and pathogenesis of diseases andanomalies that are accompanied by abnormalities of thought, feeling, andbehavior. Progress in this direction is bound to be slow for the studiesare exceptionally complex and there are many impediments to be removed. Though the problems are deep and difficult, they are doubtless solubleby the mind of man, and they exert an uncommon fascination upon thosewho visualize them. Causes may be internal or external, and are often acombination of both. The tracing of the direct and indirectrelationships between these causes and the abnormal cerebral functioningupon which the disturbances of psychobiological adjustment seem todepend is the task of pathogenesis. The internist who has studied theinfantile cerebropathies with their resulting imbecilities, syphilisfollowed by general paresis, typhoid fever and its toxic delirium, chronic alcoholism with its characteristic psychoses, cerebralthrombosis with its aphasias, agnosias, and apraxias, thalmic syndromesdue to vascular lesions with their unilateral pathological feeling-tone, frontal-lobe tumors with joke-making, uncus tumors with hallucinationsof taste and smell, lethargic encephalitis with its disturbance of thegeneral consciousness and its psychoneurotic sequelæ (lesions in theglobus pallidus and their motor consequences), pulmonary tuberculosiswith its euphoria, and endocrinopathies like myxoedema and exophthalmicgoitre with their pathological mental states, is encouraged to proceedwith his clinical-pathological-etiological studies in full assurancethat they will steadily contribute to advances in psychiatry. Theeclectic psychiatrist who is examining mental symptoms andsymptom-complexes ever more critically, who is seeking for paralleldisturbances in physiological processes and who considers bothpsychogenesis and somatogenesis in attempting to account forpsychobiological maladjustments will welcome, we can feel sure, any helpthat internal medicine and general and special pathology can yield. 

These studies in pathogenesis and etiology are fundamentally necessaryfor the development of a rational therapy and prophylaxis. Already muchthat is of applicable value in practice has been achieved. The internistshares with the psychiatrist the desire that knowledge of the factsregarding care, cure, and prevention of mental disorders may becomewidely disseminated among medical men and at least to some extent amongthe laity. Experts in psychiatry firmly believe that at least half ofthe mental disturbances now prevalent could have been prevented, if, during the childhood and adolescence of those afflicted, the facts andprinciples of existing knowledge and the practical resources nowavailable could have been applied. 

We have recently had an excellent illustration of the benefits ofapplied psychiatry in the remarkable results achieved during the greatwar through the activities of the head of the neuropsychiatric divisionof the Surgeon General's office and his staff[10] and those of thesenior consultant in neuropsychiatry and his divisional associates inthe American Expeditionary Force. In no other body of recruits and in noother army than the American was a comparable success arrived at, andthe credit for this is due to American applied psychiatry and its wiselychosen official representatives. 

The active campaign for the preservation of the mental health of ourpeople and for a better understanding and care of persons presentingabnormal mental symptoms carried on during the past decade by theNational Committee for Mental Hygiene marks a new epoch in preventivemedicine. [11]

The prevention of at least a large proportion of abnormal mental statesthrough the timely application of the principles of mental hygiene isnow recognized as a practically realizable ideal. Many important reformsare now in process throughout the United States, no small part of themdirectly attributable to the active efforts of our leading psychiatristsand 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 teachinghospitals and psychiatric instruction in the medical schools is beingvastly improved. The mental symptoms of disease now receive attention inhospitals and in private practice and at a much earlier stage thanformerly. Even the courts, the prisons, and the reformatories areawakening to the importance of scientific psychiatry; before longpenology may be brought more into accord with our newer and justerconceptions of the nature and origin of crime, dependency, anddelinquency. That schools of hygiene and the public health services mustsoon 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 officialsis no longer valid. In no direction, probably, could money and energy bemore profitably spent during the period just ahead than in the supportof a widely organized campaign for Mental Hygiene. [12] Psychiatristscan count upon internists and general practitioners to aid them ineducating the public regarding the nature and desirability of thiscampaign. 

Man is now consciously participating in the direction of his ownevolution. To cite England's poet laureate, who, you will recall, is aphysician: "The proper work of his (man's) mind is to interpret theworld according to his higher nature, and to conquer the materialaspects 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 theAmerican Medico-Psychological Association, 1914, entitled "The Relationsof Internal Medicine to Psychiatry. "]

[Footnote 5: _Cf. _ Polon (A. ) "The Relation of the General Practitionerto the Neurotic Patient, " Mental Hygiene, New York, 1920, IV, 670-678. ]

[Footnote 6: _Cf. _ Paton (S. ) Human Behavior in Relation to the Study ofEducational, Social, and Ethical Problems. New York, 1921. CharlesScribner'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, "ObjectivePsychobiology, or Psychobiology with Subordination of the MedicallyUseless 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 InternistCooperating with Groups of Medical and Surgical Specialists, " New YorkMedical Journal, 1918, 489, 538, 577; also, "The Rationale of ClinicalDiagnosis, " Oxford Medicine, 1920, vol. I, 619-684; also, "GroupDiagnosis 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, JournalAmerican Medical Association, LXXI, 1259-1261, Chicago, 1918. ]

[Footnote 10: _Cf. _ Bailey (P. ), "The Applicability of Findings ofNeuro-psychiatric Examinations in the Army to Civil Problems, " MentalHygiene, 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, " NewYork Medical Journal, CIX, 993, 1919; also, "The Future of Psychiatry inthe Army, " Mil. Surgeon, XLVII, 200, Washington, 1920. 

_Cf. _ "Origin, Objects, and Plans of the National Committee for MentalHygiene" (Publication No. 1, of the National Committee, New York City);and, "Some Phases of the Mental Hygiene Movement and the Scope of theWork 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 theTreatment 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 HygieneRequirements 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 oursole elder sister among American institutions, the PennsylvaniaHospital, of Philadelphia, which since its foundation in 1751 haspursued a career much like our own, treating mental cases in the generalhospital from the very beginning, and since 1841 maintaining a separatedepartment for mental diseases in West Philadelphia. Dr. Owen Copp, themasterly physician-in-chief and administrator of that department, was tohave been here, but unfortunately has been detained. Our morningexercises having come to an end, Dr. Russell asks me to say that yourinspection of the occupational buildings and other departments of theHospital is cordially invited; a pageant illustrative of the origin andaspirations of the Hospital will be given on the adjoining lawn; andthat after the pageant our guests are desired to return to the AssemblyHall, where we shall have the privilege of listening to addresses by Dr. Richard G. Rows, of London, and Dr. Pierre Janet, of Paris, who havecome across the Atlantic especially to take part in this anniversarycelebration. 

ADDRESS BYDR. GEORGE D. STEWART

[Illustration: BLOOMINGDALE ASYLUM

As it appeared in 1894 when it was discontinued and replaced byBloomingdale Hospital at White Plains, New York. ]

AFTERNOON SESSION

_The Chairman_: For the first seventy-five years of its existence theNew York Hospital was the nearest approach to an academy of medicinethat the city possessed. When the now famous New York Academy ofMedicine was established in 1847, a friendly and cordial co-operationbetween the two institutions arose, and while the activity of thisco-operation is not as pronounced as it was, we still cherish in ourhearts a warm regard for that ancient ally in the cause of humanity. ItsPresident, Dr. George D. Stewart, the distinguished surgeon, has come toextend the greetings of the medical profession of New York City. 

DR. STEWART

The emotions that attend the birthday celebrations of an individual areoften a mixture of joy and sadness, of laughter and of tears. In warmand imaginative youth there is no sadness and there are no tears, because that cognizance of the common end which is woven into the verywarp and woof of existence is then buried deep in our subconsciousnatures, or if it impresses itself at all, is too volatile and fleetingto be remembered. But as the years fall away and there is one lessspring to flower and green, the serious man "tangled for the present insome parcels of fibrin, albumin, and phosphates" looks forward andbackward and takes in both this world and the next. In the case ofinstitutions, however, the sadness and the tears do not obtain--for acentury of anniversaries may merely mean dignified maturity, as in thecase of Bloomingdale, with no hint of the senility and decay that mustcome to the individual who has lived so long. This institution wasfounded one hundred years ago to-day; the parent, the New York Hospital, has a longer history. Bloomingdale, as a separate and independentconcern, had its birthday a century ago. 

It is curious to let the mind travel back, and consider what washappening about that time. Just two years before the news had flashed onthe philosophical and scientific world that Oersted, a Danishphilosopher, had caused a deflection of the magnetic needle by thepassage near it of an electric current. The relation between the twoforces was then and there confirmed by separate observations all overthe civilized world. This discovery probably created more interest atthat time than Professor Einstein's recent announcement which, ifaccepted, may be so disturbing to the principia of Newton and to ourideas of time and space. There can be no doubt that the practicalsignificance of Oersted's experiment was much more widely appreciatedthan the theory of Einstein, for an understanding of the latter isconfined, we are told, to not many more men than was necessary to saveSodom and Gomorrah. Its immense practical significance, however, couldhave been foreseen by no man, no matter with what vision endowed. Justtwo years prior to the founding of this institution the first steamboathad crossed the Atlantic and in the same year that great conqueror, whohad so disturbed the peace of the world which was even then as nowslowly recovering from the ravages of war, breathed his last in SaintHelena, yielding to death as utterly as the poorest hind. 

In 1815, Bedlam Hospital in South London was converted into an asylumfor the insane who were at the time called "lunatics. " The name Bedlamis a corruption of the Hebrew "Bethlehem"--meaning the House ofBread--and while the name popularly came to signify a noisy place it wasthe beginning of really scientific treatment for the tragicallyafflicted insane. While the treatment of the insane in Europe was beingsteadily raised to a higher plane of efficiency, America has also reasonto be proud of her record in this respect. During all the years thathave followed, Bloomingdale has been an important factor in the medicalworld 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 beforedoctors had proven that they were in the forefront in the promotion ofhumanitarian activities. Medicine has always carried on its banners aninscription to the Brotherhood of Man. It is worthy of note that whenPinel and Tuke had begun to regard mental aberration as a disease and toprovide scientific hospital treatment therefor, American physicians, prepared by study and experimentation, were ready to accept and applythe new teachings. 

A second phase of great importance is that institutions likeBloomingdale have promoted the study of psychology far more than anyother factor, particularly because in them the personality stripped ofsome of its intricacies, the diseased personality, permits analysis, which the normal complex has so long defied. That it is high time thatmankind was undertaking this knowledge of himself is particularlyemphasized by the unrest and aberrance of human behavior now startlingand disturbing the whole world. If mankind does not take up this selfstudy as Trotter has said, Nature may tire of her experiment man, thatcomplex multicellular gregarious animal who is unable to protect himselfeven from a simple unicellular organism, and may sweep him from herwork-table to make room for one more effort of her tireless and patientcuriosity. Psychology should be taught to every doctor and to everylettered man. 

Digressing for a moment, to every one capable of understanding it, thereshould be imparted a knowledge of that simple economic law announcedfrom the Garden of Eden after the grounds had been cleared and the gatesclosed: "By the sweat of thy brow thou shalt earn thy bread. " Theeconomic phase indeed constitutes a highly important aspect of modernpsychology, for abnormal elements are antisocial, and from pickpocketsto anarchists flourish on the soil of pauperism. The key-note of thefuture is responsibility. To the educated and enlightened man who stillasks, "Am I my brother's keeper?" Cain has bequeathed a drop of hisfratricidal blood; and he who spurns to do his share of the world'swork, electing instead to fall a burden upon the community, deserves thefate of the barren fig-tree. 

However, amidst the social unrest, buffeted and perplexed by the crosscurrents of our time, we should not be pessimistic but should lookforward with courage, parting reluctantly with whatever of good the pastcontained and living hopefully in the present. As Ellis says: "Thepresent is in every age merely the shifting point at which past andfuture meet, and we can have no quarrel with either. There can be noworld without traditions; neither can there be any life withoutmovement. As Heraclitus knew at the outset of modern philosophy, wecannot bathe twice in the same stream, though as we know to-day, thestream still flows in an unending circle. There is never a moment whenthe new dawn is not breaking over the earth, and never a moment when thesunset ceases to die. It is well to greet serenely even the firstglimmer of the dawn when we see it, not hastening toward it with unduespeed, nor leaving the sunset without gratitude for the dying lightthat once was dawn. "

So to-day I bring to you from the New York Academy of Medicinefelicitations on your one hundredth anniversary and greetings to yourguests who have come from all over the world to join in your birthdaycelebration. 

ADDRESS BYDR. RICHARD G. ROWS

_The Chairman_: Besides the Royal Charter, the New York Hospital isindebted to Great Britain for invaluable encouragement and financial aidin our natal struggle in Colonial days. Dr. Rows has added charmingly tothat debt by journeying from London to take part in these exercises. Hissubject will be, "THE BIOLOGICAL SIGNIFICANCE OF MENTAL ILLNESS. "

As Director of the British Neurological Hospital for Disabled Soldiersand Sailors, at Tooting, he is giving the community and the medicalworld the benefit of his rich professional experience in the tryingyears of war as well as in peace, and gaining fresh laurels as hemarches, like Wordsworth's warrior, "from well to better, dailyself-surpast. "

DR. ROWS

I must first express to you my keen appreciation of the high honor youhave conferred on me by inviting me to come from England to address youon the occasion of the centenary celebration of the opening of thisHospital. 

It is perhaps difficult for us to realize what resistances lay in theway of reform at that time, resistances in the form of long-establishedbut somewhat limited views as to the nature of mental illnesses, as towhether the sufferer was not reaping what he had sown in angering thesupreme powers and in making himself a fit habitation for demons todwell in; in the form of a lack of appreciation of the need of sympathyfor those who, while in a disturbed state, offended against the socialorganism or in the form of an exaggerated fear which compelled theadoption of vigorous methods of protecting the social organism againstthose who exhibited such anti-social tendencies. The men and women ofthe different countries of the world who recognized this and made it thechief of their life's duties to spread a wider view of such conditionsand to insist that the unfortunate people should be regarded andtreated as fellow human beings will ever command our admiration. 

By the courtesy of Dr. Russell I have had an opportunity of seeing thepamphlet in which are recorded the efforts of Mr. Thomas Eddy in theyear 1815 to move his colleagues to consider this matter. [13] The resultof those efforts was the establishment of an institution on BloomingdaleRoad. 

Various changes followed until we arrived at the Bloomingdale Hospitalof to-day with its large and trained staff of medical officers, who, while still recognizing the difficulties of the task, are imbued with ahope of success which has arisen on a basis of wider knowledge, butwhich was unknown to many of their predecessors. To have the opportunityof joining with you in celebrating the big advance made a hundred yearsago, of exchanging ideas with you with regard to the difficulties whichstill confront us, whether in America or in England, and which demand aunited effort on the part of all who are interested in the scientificinvestigation of the subject, cannot fail to afford one the liveliestsatisfaction. 

In the brief history of the Hospital prepared by Dr. Russell we find therecommendations of another reformer, Dr. Earle, who in 1848 wasevidently still not satisfied with the treatment provided for thesufferers from mental illness. 

Both Mr. Eddy and Dr. Earle were influenced by their observation thateven in those suffering from mania much of their behavior could not bedescribed as irrational. If you will allow me I will quote a sentence oftwo 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 haveproceeded, the patient possesses small remains of ratiocination andself-command; and although they cannot be made sensible of theirrationality of their conduct or opinions, yet they are generally awareof those particulars for which the world considers them proper objectsof confinement. " With reference to treatment Dr. Earle said: "Theprimary object is to treat patients, so far as their condition willpossibly permit, as if they were still in the enjoyment of the healthyexercise of their mental faculties. "

To superficial observation these suggestions might well have appeared asthe phantasies of dreamers and perhaps at the present day theirimportance is not always fully appreciated. Recent advances inknowledge, however, have led us beyond the moral treatment recommended ahundred years ago and have enabled us to see that a more importanttruth underlay these suggestions. 

We are all familiar with the frequent difficulty we encounter in ourefforts to discover the actual mental disturbance which is supposed toexist in our patients. It is often a question of wit against wit asbetween patient and doctor, and not infrequently a rational andintelligent conversation may be maintained on an indifferent subject. The fact too that the disturbance is so frequently only temporarysuggests that the loss of rational control is a less serious phenomenonthan was generally supposed and we know that the control can befrequently restored by a period of rest or by a helpful stimulus. Quiterecently a patient who in hospital had been confused, undisciplined, abusive, and threatening, was removed to a house of detention. The shockof finding himself, as he said, amongst a lot of lunatics, led him toface reality from a fresh point of view. He admitted that it had taughthim a lesson and when he revisited the hospital, if not entirelygrateful to us for the experience, he evidently bore no ill will. 

But not only is it necessary to recognize what rational powers remain tothe patient, we must also inquire how much in their disturbed mentalactivity can be considered a rational reaction to the stimuli whichhave operated, and still may be operating, on them. 

In connection with this I would suggest that there are two aspects to beconsidered. First, what is the standard according to which we are tojudge them? Secondly, to what extent are the reactions of the patientabnormal in kind to the driving stimulus? They may perhaps be reckonedabnormal in degree, but, to what extent, if at all, are they abnormal inkind?

It may be readily admitted that the behavior of those suffering frommental illness offends against conventional usages and is anti-social. It must also be recognized that amongst human beings living inaggregates some conventional usages must be evolved and insisted on inorder to insure the greatest good of the greatest number. These usagesare regarded not merely as protective measures for the body corporate, but they are also supposed to indicate a beneficial standard for theindividual. But such a standard being adopted, observation is liable tobe limited so much to results without sufficient attention being givento the causes which had led to those results. 

By the recent advances in scientific knowledge and in methods ofinvestigation we have been led to see that the conditions underconsideration cannot be understood without a study of the mechanisms onwhich mental activity depends and without discovering the psychic andphysical causes, arising from without and from within, which havedisturbed the function of these mechanisms. We have learned that theseillnesses do not arise from one cause alone and that they are the resultof influences to which we all may be subject to some degree. 

The originator of these modern methods, Prof. Freud, has stimulated usto regard the ordinary symptoms of mental illnesses as directing postsindicating lines to be investigated, and he and others have suggestedvarious methods which may usefully be employed. 

It is essential that we carefully distinguish what are primary from whatare secondary symptoms. Two thousand years ago a physician, [Transcriber's note: original reads 'physican'] Areteus, pointed outthat mania frequently commenced as melancholia, and he drew attention tothe extreme frequency of an initial depression in cases of mentalillnesses. But he did not offer any explanation of this initial state. 

Such an initial state may perhaps be, to a certain extent, understood ifwe assume that the first evidences of mental disturbance consist in somedifficulty in carrying out ordinary mental processes, some difficulty inexercise of the function of perceiving, thinking, feeling, judging, andacting, and that any disturbance of the harmonious activity of thesefunctions must give rise to an emotional condition of anxiety anddepression. Some such disharmony will, by adequate investigation, befound in a large number of cases to exist in the early states of theillness and will be appreciated by the patient before there occur anyobvious signs, any outward manifestations of disability. 

But in any disharmony which may occur it must be recognized that themental mechanisms affected are those with which the patient wasoriginally endowed, which he has gradually trained throughout his pastexperience and which he has employed more or less successfully up to thetime the illness commenced. There is no new mechanism introduced toproduce a mental illness, but a putting out of gear of those common tothe race and their disturbance is the result of the action of influenceswhich may befall any one of us, unbearable ideas with which some intenseemotional state is intimately associated. The normal function of thesemechanisms, simple at first and remaining fundamentally unaltered, although possibly much modified gradually by added experiences fromwithin and without, depends on the maintenance of a harmonious balancebetween stimuli received and emotional reaction and motor response tothose stimuli so that the feeling of well-being may arise. 

If from any cause there occurs a failure to appreciate the stimuliclearly, if the emotional reactivity be disturbed, if the sense of valuebecomes biassed in one direction or another so that the response isrecognized by the patient as abnormal there will result a disharmony anda feeling of ill-being of the organism. Under these conditions theprocesses of facilitation along certain definite lines and inhibition ofall other lines--processes which are essential to clearconsciousness--will become difficult or perhaps impossible and a mentalillness will develop. In the slighter degrees the disharmony may beknown to the patient without there being any outward manifestation tobetray the conflict going on within. In the severe degrees the mentalactivity of the patient may be under the control of some dominantemotional state so that it may be impossible for him to adapt himself tohis surroundings in a normal manner although his behavior may not appearso irrational when we know the stimuli affecting him. Within theseextremes we discover all degrees of disturbance, and all varieties ofsigns and symptoms may be encountered. 

But the signs which become obvious to superficial observation are, to alarge extent, secondary products. The primary symptoms are felt by thepatient as a disturbance of the capacity to perceive, to think, to feel, to judge, and to act, and with these disabilities there will beassociated a certain degree of confusion and anxiety which cannot failto appear as the result of such alterations of function. 

The obvious signs may represent merely a more intense degree of theprimary affection, disturbed capacity together with some confusion andanxiety; or they may represent efforts on the part of the patient toovercome or to escape from the disturbance or to explain it to himself. And now the total lack of knowledge of the processes on which mentalactivity depends, the altered standard of judgment due to some degree ofdissociation, and the necessity of obtaining relief in some way or otherwill have much to do with determining the character of the symptoms withwhich we are all familiar. So many factors are concerned in theproduction of these secondary characters that it is difficult to assignto the symptoms their true value or to decide whether they possess muchvalue at all with regard to the fundamental disturbance whichconstituted the primary illness. So often they appear to be mererationalizations, mere false judgments on the part of the patient; theythus form subjects for investigation rather than fundamentalconstituents of the illness. 

We, therefore, must not accept the outward and visible signs at theirface value but attempt to discover what past experiences in the life ofthe patient have led to such disturbance of function, to such a changein his mental activity. 

It will possibly be of some assistance to provide one or two examples inorder to demonstrate the importance of the past experiences as agentscapable of producing such alterations. 

The first case will illustrate the results produced by the developmentof a dominant emotional tendency during early childhood. The patient upto 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 ofa new nurse which produced such an impression on her that she felt shewas a changed child. This nurse, described to me by the patient as ahandsome woman, having met the inevitable man, used frequently to meethim clandestinely. The child was neglected, was sometimes left alone, onone occasion in a graveyard, but she was forbidden to mention thesubject 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 onenight she had a severe nightmare in which a "bogey-man" came to carryher away. At the end of two years a profound change had taken place inher which she now describes thus: "I was a changed child; I wasseparated from my mother and could no longer confide in her nor did Iwish to do things for her as I had done before; I could not enjoy mytoys; I had no confidence in myself; I was not like other children. " Andfrom that time on, as girl and as woman, she has never felt that she hasbeen like others of her sex. Such a condition, being started andconfined by repetition, interfered with her free development and it wasremarkable how many incidents occurred in her life to confirm thedisability, but the germ of her serious breakdown thirty years later waslaid in her fifth and sixth years. 

The second case is that of a patient who, as a child, had someconvulsive attacks. She was therefore considered delicate and wasthoroughly spoiled. When nearly thirty she lived through a sexualexperience which caused extreme anxiety; she broke down and was admittedto an asylum. After admission she looked across the dormitory and saw ahead appearing above the bed-clothes, the hair of which had been cutshort for hygienic reasons. With a memory of her sexual indiscretionstill vivid in her mind she jumped to the conclusion that she was in aplace where men and women were crowded together in the same room. Shegot out of bed, refused to return to it, fought against the nurses andwas transferred to a single room, with the mattress on the floor and thewindow shuttered. She wondered where she was and came to the conclusionthat she was in a horse-box. Then arose a feeling of terror that shewould be at the disposal of the grooms when they returned from work. Thesound of heavy footsteps of the patients passing along the corridor tothe tea-room suggested that the grooms were returning and that her roomwould soon be invaded. The feeling of terror increased and she tried tohide in the corner, drawing the mattress and clothes over her. And soon. 

Months later when I had my first interview with her, her sole remarkduring the hour was "How can I speak in a place like this?" This wasrepeated almost without intermission throughout the hour. It formed agood example of the origin of the process of perseveration, a processfrequently adopted by the patient to guard against the disclosure of atroublesome secret. 

If we attempt to trace out some of the mechanisms employed in these twocases we shall see that in response to definite stimuli each reacted ina manner which cannot be considered abnormal in kind. It was normalreaction for the child to be distressed at being separated from hermother in such a way, to be frightened by being left in the graveyardalone, or at the threat of her being carried away by a "bogey-man" ifshe dared to mention anything of the clandestine meetings to her mother. It was not very abnormal that after her sexual experience the otherpatient while still in a confused state caused by the intense emotionalcondition of anxiety, should, on seeing a head with the hair croppedshort, jump to the conclusion that there was a man in a bed in the sameward with herself, or that she should feel frightened and wish to leavethe room. 

The mental activity in each case depended on mental content, that is, memory of past experiences with their intense emotional states whichacted as the driving force and also made the recall of the experience goextremely easy. The further developments after being placed in thesingle room with mattresses on the floor and the window shuttered wererationalizations also based on mental content, _i. E. _, on the memory ofrooms somewhat similar to that in which she found herself and of the useof such rooms. It is interesting to note also in the first case that inher wildest delirium during an acute attack she lived through episodesof her past life. One example may be given. In the course of herdelirium she thought that a "blackbird" had flown to her, touched herleft wrist and taken away all her vitality. This depended on anexperience of her going to Germany when a girl and meeting a youngGerman officer whom she did not like. A few years later she went toGermany and met the officer again. Without going into full details I maysay that on one occasion when walking with him he seized her left wristwith his right hand and attempted to kiss her; she struggled fiercelyand ran from him. Here we see that not only is her delirium based on apast experience, but that the whole memory is symbolized in the"blackbird" which was the emblem of the German nation in whose army theofficer was then serving. Connected with this there was also anotherunpleasant episode which dated from her tenth year. Much of her deliriumwas worked out in such a way that most of the details could be tracedback 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 superficialobservation, it must be admitted that when we know the mental content ofthat patient, we cannot but see that at any rate it was not soirrational. And not only was this recognized by the doctor, but, andthis is much more important, by the patient herself. 

It is, therefore, the mental content which must be discovered beforedoctor or patient can understand the disability and before any commonground between the two can be found. And when the mental content isknown it will be easy to recognize the affective condition of thepatient to be a normal response. It will also be specific and if intensewill dominate the patient. "Why is it I can never feel joy as I used todo?" was the pathetic inquiry of the patient dominated by a feeling ofmisery and fear. Was it not for the reason that being dominated bymisery and fear, joy could find no place? The emotion of misery becauseof its intensity could more or less inhibit the feeling of joy, but joycould not inhibit the misery. 

No repetition of the memory of the unpleasant experiences with theirassociated emotion of misery and fear led to the formation of a habit ofmind and feeling. And when once such a habit of mind is established itis remarkable by what a host of stimuli received in ordinary daily lifethe cause of the disturbance can be recalled. 

This question of stimuli deserves further notice. It is not so difficultto realize the mechanism by which a stimulus which clearly crosses thethreshold of consciousness can lead to a given reaction. But it isperhaps difficult to imagine how so many stimuli which do not cross thethreshold of consciousness or which, if they do, are not recognized bythe patient at the time as having any reference whatever to the specialmemory can yet set the memory mechanism into action. The result may notbe seen till after the relapse of some considerable period of time, asin the case of a man who for years had been disturbed by terrificnightmares, based on the idea of snakes coming out of the ground andattacking him. He complained one day that he was much worse, that threenights before he had had the worst nightmare of his life. On beingquestioned as to what could have suggested snakes to him he could nottell. A few minutes later he said: "I think I know the cause now. Ispent the evening before I had that nightmare with a sergeant who hadreturned from the service in India. " This friend amongst other thingshad mentioned that whenever they were about to bivouac they had tosearch every hole under a stone and every tuft of grass to see thatthere were no snakes there. This, which had been received as an ordinaryitem of information, had been the stimulus which had set his memorymechanism into action and the nightmare between two and three o'clock inthe morning had been the result. 

The result in many instances is evidenced by an emotional state aloneand the actual memory of the original experience may not come intoconsciousness. Many examples of this might be given. The sound of atrolley wheel on a tram wire in one case gave rise to terror instead ofits normal reaction, viz. , that of satisfaction at getting to thedestination quickly and without effort. This terror was produced becausethe sound on the wire resembled that of a shell which came over, blew ina dugout, killed three men, and buried the patient. No memory of thisincident came into consciousness, only a terror similar to thatexperienced at the time of the original incident was experienced. Or, the time four o'clock in the afternoon could act as a stimulus to arousean emotional state of misery similar to that experienced at the sametime of day during an illness some years previously. Or, passing thehouse of a doctor when on a bus could produce a sudden outburst ofanxiety, giddiness, and confusion; the patient had been taken into thathouse at the time of an epileptic attack. Or, showing photographs of thefront could lead to an epileptic attack which was based on the memory ofthe time when the patient was wounded in the head; this has occurred ontwo separate occasions separated by an interval of some months. Or, noticing a familiar critical tone in a remark made at a dinner-tablecould 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 thepiano so as to obtain the opinion of the guest who had exhibited thecritical tone, after dinner felt incapable of doing so. Her feelings hadbeen hurt on many former occasions by critical remarks made by him inthat tone. The critical remarks were not called to memory but therearose the feeling that under no circumstances could she play that pieceto him. 

Of special importance also are the experiences of childhood. An unhappyhome or unjust treatment as a child may warp the development of thepersonality, lead to a lack of self-confidence, to the predominance ofone emotional tendency, and so prevent that balanced equilibrium whichwill allow a rapid and suitable emotional reaction such as we mayconsider normal. This may lead to a failure of development or a loss ofthe sense of value, because the existence of one dominating emotionaltendency so often produces a prejudiced view which may render a justappreciation of our general experience almost impossible and mayseriously disturb our mental activity. 

And if, as Bianchi suggests, all mental activity depends on a series ofreflex actions, or, as Bechterew and Pavlov have insisted, a series ofconditioned reflexes becomes established, it will assist us tounderstand how such stimuli can give rise to mental disturbances, tomental illnesses. We shall see that there may be something of realimportance 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 havetaken life so seriously. " "I have never imagined that what I wentthrough in my childhood could so influence me now"; or "I have never hadconfidence in myself and often when I have appeared vivacious andinterested I have had an awful feeling of incapacity and dread withinmyself. "

The outward and obvious manifestations, therefore, are not necessarily atrue index of our mental and emotional conditions. This is true of allmental illnesses, even the most severe. 

One patient who had been in an asylum more than ten years illustratedthis in a most striking manner. His outward manifestations led one tofeel that he thought he possessed the institution in which he wasconfined and also the surrounding property and that the authorities werea set of usurpers and thieves who kept him incarcerated in order thatthey might enjoy what was really his money and his property. On oneoccasion I said to him, "George, what is that incident in your lifewhich you cannot forget and which has troubled you so seriously?" Thereply was a flood of abuse. I put the question to him several timeswithout getting any further answer, but when I came to leave the ward, George came up behind me and whispered over my shoulder, "Who told youabout it?" No abuse, no shouting as usually occurred, but a whisper, "Who told you about it?" Was not George running away from a memory withits emotion which was unbearable to an idea which allowed him to beangry with others instead of with himself? Many examples of this mightbe given and really might be found by us in our own experience. It isthe mental content which is important, a mental content which can berecalled by various stimuli, and which will be more persistently with usthe more intense is the emotion associated with it. 

But the basis of the condition is not completely understood when we haveapparently 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 physicalchanges which normally are associated with fear differ from those of joyor anger. This has been appreciated for a long time but recentresearches have recalled other reactions to us. Reactions in theinternal glands which further knowledge will probably prove to be ofgreat importance, in fact to form an integral part of the sum ofactivities, connect with mental processes. The secretions of the glandsexert an influence on the sensibility and reaction of the organsconnected with psychic phenomena and their functions themselves areaffected by reactions occurring in the nervous system. Revival of amemory may thus affect the functions of these glands, and the changesproduced in them may react on the sensibility and reactivity of thenervous mechanisms. If this be so, it will be evident that the organismworks as a whole, that a disturbance of one organ may interfere with thefunction of another and that in the repetition of all these influenceswe may find an explanation of the chronicity of many of these illnesses. A study of the activities and interactivities of all the organs of thebody is therefore essential and must be made before we shall understandthe biological significance of mental illness. 

FOOTNOTES:

[Footnote 13: See Appendix III, p. 200. ]

ADDRESS BYDR. PIERRE JANET

_The Chairman_: Our country may be hesitating a little--I hope it willnot be for long--in joining a league of nations to prevent war, butthere can be no doubt of our immediate readiness to co-operateinternationally to prevent and reduce disease. Our distinguished guestfrom gallant France, Dr. Pierre Janet, professor in the College ofFrance, evidently feels confident of our sympathy and willingness tocollaborate in this latter respect, for he has ventured across theocean, with Madame Janet, in response to our urgent invitation. Hisintroduction to an audience of American psychiatrists would be quite outof 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 hehas chosen as a subject, "THE RELATION OF THE NEUROSES TO THEPSYCHOSES. "

DR. JANET

Mr. President, my dear colleagues, ladies, and gentlemen: The Americansand the French have met on the battle-fields and they have facedtogether the same sufferings for the defense of their common ideal ofcivilization and liberty; it is right that they should meet likewisewhere Science stands up for the protection of health and human reason, and that they should celebrate together the Festivals of Peace. ThePresident and the organizers of this Congress have greatly honored me inasking me to represent France at the celebration of the centenary of theBloomingdale Hospital; but above all they have procured me a greatpleasure in offering me the opportunity of coming again to thisbeautiful land, of meeting once more friends who had welcomed us kindlyin former days; our old friends of past happy days who have become stilldearer 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 theFrench Government who have had the kindness to charge me to interpretthe sentiments of sympathy which they feel for all manifestationstending to render the relations that unite our two countries closer andmore fruitful. The Academy of Moral and Political Sciences has equallycharged me to assure you that it is happy to be represented by one ofits members at the commemoration of the centenary of BloomingdaleHospital that has so brilliantly and generously continued the traditionof Pinel and Esquirol. The Academy takes a lively interest in thepsychological and moral studies of this Congress that seek the cure ofdiseases of the mind and the lessening of mental disorders. TheMedico-Psychological Society, the Society of Neurology, the Society ofPsychology, the Society of Psychiatry of Paris are happy to take part inthese festivals and are desirous of associating still more closely theirwork to that of the scientific societies of the United States. 

The celebration of the centenary of a lunatic asylum gives birth to-dayto a national festivity in which all civilized nations participate. Thisis a fact that would have well astonished the first founders of lunaticasylums, the Pinels, the Esquirols, the William Tukes, and the firstorganizers of Bloomingdale. The public opinion respecting the diseasesof the mind, the care to be given to lunatics, is vastly different towhat 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 andthat is why it seems to me interesting to present you to-day with a fewreflections on the connections which unite neuroses and psychoses; forit is the discovery of these connections that has shown to the man soundin mind, or who imagines himself to be so, how near he always was tobeing a lunatic and how wise it was always to consider the lunatic as abrother. 

Formerly a lunatic was considered as a separate being, quite apart fromother members of society. The old prejudices which banished the patientfrom the tribe as a useless and dangerous individual had diminished nodoubt with respect to the diseases of the body, which were more and moreregarded as frequent and natural things to which each of us might beexposed. But these prejudices persisted with respect to some sexualdiseases that were still considered ignominious and chiefly with respectto diseases of the mind. No doubt some intelligent and charitablephysicians took interest in the lunatic, endeavored to spare him manysufferings, to defend him, to take care of him. But the people fearedthe lunatic and despised him as if he had been struck by somemalediction which excommunicated him. I have seen lately a patient'sparents upset with emotion, as they had to cross the gardens of theasylum to visit their daughter, at the single thought that they mightcatch sight of a lunatic. This individual, in fact, had lost in the eyesof the public the particular quality of man, reason, which, it appears, distinguishes us from beasts; he seemed still living, but he was morallydead; he was no longer a man. 

No doubt it was a dreadful misfortune when some member of a familybecame insane, but this terrible calamity, which nothing could make oneanticipate or avoid, was happily exceptional, like thunderbolts. Theother men and even the members of the family presented nothing similarand regarded themselves with pride as very different to this wretchedbeing transformed into a beast. This victim of heavenly curse waspitied, settled comfortably in a nice pavilion at Bloomingdale and nevermore spoken of. People still preserve on this point ideas similar tothose they had formerly about tuberculosis, known only under the form ofterrible but exceptional pulmonary consumption. Now it has at last beenunderstood that there are slight tuberculoses, curable, but tremendouslyfrequent. It will be the same with mental disorders; one day it will berecognized that under diverse forms, more or less attenuated they existto-day on all sides, among a crowd of individuals that one does not feelinclined to consider as insane. 

Little by little, in fact, men have had to state with astonishment thatall lunatics were not at Bloomingdale. Outside the hospital, in thefamily of the unfortunate lunatic, or even in other groups, one observedstrange 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, abnormalbehaviors, very different to normal behaviors, regularized by the lawsand by reason. 

What was the meaning of these queer behaviors? At first they were verybadly understood; they were supposed to have some connection with beingpossessed (with the devil), with miasmata, vapors, unlikelyperturbations of the body and animal spirits that circulated in thenerves. One spoke, as did still Prof. Pomme at the end of the eighteenthcentury, "of the shrivelling up of the nerves. "[14] But above all, onepreserved the conviction that these queer disorders were very differentto the mental disorders of lunacy. These peculiar individuals had, itwas said, all their reason; they remained capable of understanding theirfellow creatures and of being understood by them; they were not to beexpelled from society like the poor lunatics; therefore their illnessshould be anything but the mental disorders of lunacy. 

Physicians, as it is just, watched their patients and only confirmedtheir opinion by fine scientific theories. They christened these newdisorders by the name of neuroses, reserving the name of psychoses forthe mental disorders of lunatics. During the whole of the nineteenthcentury the radical division of neuroses and psychoses was accepted as adogma; 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 theconnections those very ill-defined disorders might have the ones withthe others. This division was accentuated by the organization of thestudies and the treatment of the patients. The houses that received theneurotic patients and the insane were absolutely distinct. Thephysicians who attended the ones and the others were different, and evensupplied by different competitions. In France, even now, the recruitingof asylum house pupils and hospital house pupils, the recruiting ofasylum doctors and that of hospital doctors, give an opportunity fordifferent competitions. One might almost say that these two categoriesof house pupils and doctors have quite a different education. The resultwas that the examination of the patients, the study thereof, and eventheir treatment, were for the most part often conceived in quite adifferent manner. For example, neuroses were studied publicly; theexamination was on elementary sensibilities, the movements of the limbs, and especially reflexes; the insane were more closely examined in themental point of view, in conversations held with them by the physicianalone. Their arguments, their ideas were noted more than theirelementary movements. Strange to say, just when the psycho-therapeutictreatments by reasoning and moralizing with the patients were beingdeveloped, they stood out the contrary of what one might havesupposed--that this treatment should be applied to neurotic patientsalone. It was admitted that lunatics were probably not able to feel thismoral and rational influence; they were treated by isolation, shower-baths, and purgatives. 

This complete division did not fail to bring about singular andunfortunate consequences. In a hospital such as La Salpetrière the ticsufferers, the impulsive, those beset with obsessions, the hystericalwith fits and delirium were placed near the organic hemiplegics and thetabetics who did not resemble them in the least, and completelyseparated from the melancholic, the confused, the systematical raving, notwithstanding evident analogies. If Charcot who, moreover, has broughtabout so much progress in these studies, committed some serious errorsin the interpretation of certain phenomena of hysteria, is it notgreatly due to his having studied these neurotic patients with theneurology methods without ever applying psychiatry methods? Is it notstrange to refuse psychological treatment precisely to those who presentpsychological disorders to the highest degree, and to place the insanewho thinks and suffers altogether outside of psychology?

In fine, this distinction between the neurotic sufferer and the mentalsufferer was mostly arbitrary and depended more than was believed on thepatient's social position and fortune. Important and rich families couldnot be resigned to see one of their members blemished by the name oflunatic, and the physician very often qualified him as neurasthenic toplease the family. A few years ago this distinction of the patients andof the physicians gave rise to a very amusing controversy in thenewspapers. The professor of the clinic for diseases of the nervoussystem asserted that neurotic sufferers should be patients set apart forneurologist physicians alone, whereas the alienist should contenthimself with real lunatics. The professor of the clinic for mentaldiseases protested with much wit and claimed the right of attendingequally the neurotic patients. All this proved a great confusion in theideas. 

Notwithstanding these difficulties, Charcot's studies themselves onhysterical accidents began to make people's minds uneasy and to modifyconceptions of neuroses. They showed that neurotic sufferers presenteddisorders in their thoughts, that many of their accidents, in allappearance physical, were in connection with ideas, with the_conviction_ of paralysis, of illness, with the remembrance of such orsuch an event which had determined some great emotion. Without doubt, this interpretation of hysteria, which I have myself contributed toextend, must never be exaggerated, and it must not be concluded fromthis that every neuropathic accident always and solely depends on someremembrance or some emotion. In my opinion, this is only exact in a verylimited number of cases; and then it only explains the particular formof such or such an accident and not the entire disease. Without doubt itseems to me exaggerated to-day to see in neuroses those psychologicaldisorders alone, whereas the disorders of the circulation, the disordersof internal secretions, the disorders of the functions of thesympathetic which will be spoken of just here must also have a greatimportance. But, however, this observation proved very useful at thatmoment. A remembrance, an emotion, are evidently psychologicalphenomena, and to connect neuropathic disorders with facts of the kindis to include the study thereof with that of mental disorders. At thistime, in fact, they began to repeat on all sides a notion that hadalready been indicated in a more vague manner; it is that neuroses wereat the root, were in reality diseases of the mind. 

If such is the case, what becomes of the classical distinction betweenneuroses and psychoses? No one can deny that the latter are above alldiseases of the mind and we have here to review the reasons which seemto justify their complete separation. Will it be said that withpsychoses the disorders of the mind last very much longer? But somepatients who enter the asylum with a certificate of insanity are veryfrequently cured in a few months and some neuropathic disorders may lastyears. I could name you patients who since thirty years keep the sameobsessions, and who at the age of fifty still ask themselves questionsupon their pact with heaven, as they did at the age of twenty. Shall wespeak of the consciousness the patient has of his state? But thisconsciousness may be complete in certain melancholies and veryincomplete in certain impulsions. 

Is it necessary to insist on the presence or absence of anatomicallesions which one tries to ascertain at the post-mortem examination?Shall we say with Sandras, Axenfeld, Huchard, Hack, Tuke, that neurosesare diseases without lesions? One finds lesions in general paralysiswhich is ranged with insanity and we find some also in epilepsies whichare considered as neuroses; one no more finds lesions in melancholicconditions than in conditions of obsessions. Besides, as I have oftenrepeated, this absence of lesions is of no importance; it is quite inkeeping with our ignorance. Every one admits that organic alterationsmore or less momentary, but actually not suspected, must exist inneuroses as in other diseases. Neuroses as well as psychoses are muchmore likely to be diseases with unknown lesions than diseases withoutlesions, and it is impossible to take this characteristic into accountto distinguish the ones from the others. 

In reality, the notion of lunatic has lost its former superstitioussignification and it has taken no precise medical signification. Thatword is now the term of the police language. It indicates only anembarrassment felt by the police before certain persons' conduct. Whenan individual shows himself to be dangerous for others, the publicadministration has the habit of defending us against him by the systemof threats and punishments. As a rule, in fact, when a normal mind is inquestion, threats can stop him before the execution of crime, andpunishments, when crime has been committed, can prevent him frombeginning again; that is the psychological fact which has given birth tothe idea of responsibility. But in certain disorders it becomes evidentthat neither threats nor punishments have a favorable effect, for theindividual seems to have lost the phenomenon of responsibility. When anindividual shows himself to be dangerous for others or for himself, andthat he has lost his responsibility, we can no longer employ theordinary means of defense; we are obliged to defend ourselves againsthim, and defend him against himself by special means which it is uselessto apply to other men; we are obliged to modify legal conduct towardhim. All disorders of the mind oblige us to modify our social conducttoward the patient, but only in a few cases are we obliged to modify atthe same time our legal conduct; and these are the sort of cases thatconstitute lunacy. 

This important difference in the police point of view is of no greatimportance in the psychological point of view nor in the medical pointof view, for the danger created by the patient is extremely varied. Itis impossible to say that such or such a disorder defined by medicineleaves always the patient inoffensive and that such another alwaysrenders him dangerous. There are melancholies, general paralytics, insane who are inoffensive, and whom one should not call lunatics; thereare impulsive psychasthenics who are dangerous and whom one shall haveto call lunatics. The danger created by a patient depends a great dealmore upon the social circumstances in which he lives than upon thenature of his psychological disorders. If he is rich, if he has no needto earn his living, if he is surrounded by devoted watchfulness, if helives in the country, if his surroundings are simple, the very seriousmental 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 hisposition is delicate and complex, the same mental disorders, exactly atthe same degree, will soon constitute a danger, and the physician willbe forced to place him in an asylum with a good certificate. This is apractical distinction, necessary for order in towns, which has noimportance in the point of view of medical science. [15] If we put theseaccidental and slightly important differences on one side, we certainlysee a common ground in neuroses and psychoses. The question is always analteration in the conduct, and, above all, in the social conduct, analteration which tends, if I am not mistaken, toward the same part ofthe conduct. 

The conduct of living beings is a special form of reaction by which theliving being adapts himself to the society to which he belongs. Theprimitive adaptations of life are characterized by the organization ofinternal physiological functions. Later on they consist in externalreactions, in displacements, in uniform movements of the body whicheither keep him from or draw him near to the surrounding bodies. Thefirst of these movements are the reflex movements, then are developedthose combinations of movements which we called perceptive or suspensiveactions in keeping with perceptions. Later came the social acts, theelementary intellectual acts which gave birth to language, the primitivevoluntary acts, the immediate beliefs, then the reflected acts, therational acts, experimental, etc. As I said formerly, there is, in eachfunction, quite a superior part which consists in its adaptation to theparticular circumstance existing at the present moment. The function ofalimentation, for instance, has to exercise itself at this moment when Iam to take aliments on this table in the midst of new people, that is tosay, among whom I have not yet found myself in this circumstance, wearing a special dress and submitting my body and my mind to veryparticular social rites. In reality it is nevertheless the function ofalimentation, but it must be noted that the act of dining, when wearinga dress suit and talking to a neighbor, is not quite the samephysiological phenomenon as the simple secretion of the pancreas. Certain patients lose only the superior part of this function ofalimentation which consists in eating in society, in eating in new andcomplex circumstances, in eating while being conscious of what one isdoing, and in submitting to rules. Although the physiologist does notimagine that these functions are connected with the exercise of sexualfunctions in humanity, there is a pathology of the betrothal and of thewedding-tour. 

It is just on this superior part of the functions, on their adaptationto present circumstances, that the disorders of conduct(self-government) which occupy us to-day bear. If one is willing tounderstand by the word "evolution" the fact that a living being iscontinually transforming himself to adapt himself to new circumstances, neuroses and psychoses are disorders or halts in the evolution offunctions, in the development of their highest and latest part. [16]

This halt in evolution can be connected with different physiologicalcauses, 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 distinguishbetween forms of these diseases; but to-day the common character ofneuroses and psychoses is that this diminution of vitality bears uponthe highest functions of self-government. 

Whatever be the disorders you may consider, aboulias, hystericalaccidents, psychasthenic obsessions, periodical depressions, melancholics, systematized deliriums, asthenic insanity, you will alwaysfind a number of facts resulting from this general perturbation. 

In plenty of cases, the acts, far from being diminished, appearexaggerated; the patient moves about a great deal, he accomplishes actsof defense, of escape, of attack, he speaks enormously, he seems toevoke many remembrances and combine all sorts of stories duringinterminable reveries. But pray examine the value and the level of allthese acts; they are mere gestures, shocks of limbs, laughter, sobs, reactions simply reflex or perceptive, in connection with immediatestimulation, with inhibition, without choice, without adaptation byreflection. The thoughts that fill these ruminations are childish andstupid, just as the acts are vulgar and awkward; there is a manifestreturn to childhood and barbarism. The behavior of the agitatedindividual is well below that which he should show normally. It is easyto explain these facts in the language we have adopted. The agitationconsists in an activity, more less complete, in inferior tendencies verymuch below those the subject should normally utilize. 

It is that in reality the agitation never exists alone, it isaccompanied by another very important phenomenon which it dissimulatessometimes, I mean the depression characterized by the diminution or thedisappearance of superior actions, appertaining to the highest level ofour hierarchy. It is always observed that with these patients certainactions have disappeared, that certain acts executed formerly withrapidity and facility can no longer be accomplished. The patients seemto have lost their delicacy of feeling, their altruism, theirintelligent critique. The stopping of tendencies by stimulation, thetransformation of tendencies into ideas, the deliberation, the endeavor, the reflection; in one word, both the moral effort and the call uponreserves for executing painful acts are suppressed. There exists visiblya lowering of level, and it is right to say that these patients arebelow themselves. 

The two phenomena, agitation and depression, are almost alwaysassociated in neuroses as well as in psychoses. It is likely that theirunion depends upon some very general law, relating to the exhaustion ofpsychological forces. It is probable that the superior phenomena exactunder a form of concentration, of particular tension, much more powerthan acts of an inferior order, although the latter seem more violentand more noisy. "When the force primitively destined to be spent for theproduction of a certain superior phenomenon has become impossible, derivations happen, that is to say, that this force is spent inproducing other useless and especially inferior phenomena. "[17]

A very great number of phenomena observed in neuroses and psychoses arein connection with depression and agitation. Convulsive attacks, diversefits of agitation, prove to us that before the fit there existeddisproportion between the quantity and the tension of the psychologicalforces, and that the spending of forces during the fit re-establishesthe equilibrium. But at the same time, after this spending, one observesa notable lowering of the mental level, a real psycholepsy. It is verylikely that studies of this kind will produce some day the key of theepilepsy problem, for vertigos and certain epileptic fits are certainlyphenomena of relaxation, the meaning of which we do not comprehendbecause we do not study sufficiently the state of psychological tensionbefore and after the accidents. 

The difficulty of accomplishing superior acts, the exhaustion resultingfrom their accomplishment, renders them fearful to the patient who hasthe fear, the phobia of these acts, just as he has the terror of thatdepression which gives the feeling of the diminution of life. Theshrinking of activity and conscience, phobias, negativisms, generallytake their starting point in this fear of exhaustion caused by somedifficult action. In other cases the patient feels incapable ofaccomplishing correctly the reflected acts necessary to social and morallife, and feeling no longer protected by reflection, he is afraid ofwilling or believing something, as one is afraid of walking in adangerous path, when one cannot see. The vertigo of life produces itselflike the vertigo of heights, when one is not sure of oneself. 

Depressed patients have felt, wrongly or rightly, a certain excitationafter a certain action. Through some curious mechanism, certain acts, instead of exhausting them, have raised their psychological tension. Theneed, the desire to raise themselves inspires them with the wish torenew 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 inneuroses. 

I shall not insist any more on a very interesting phenomenon inconnection with the oscillations of the mind and which still plays agreat part in these diseases. I am speaking of the change of feelingwhich may accompany the same action in the course of the oscillations ofthe mind. At the level with the reflected action, more or less complete, the thought of an action which appears important and of which one oftenthinks, determines interrogations, doubts, scruples. If the individualdescends one degree, if he becomes quite incapable of reflecting andtherefore of doubting, the same action he continues to think about maypresent itself under the form of an impulsion more or less irresistible. 

There are patients who in the first stage have the fear and horror ofcommitting an act and who in the second stage are driven to accomplishit. In other cases a subject may make use of an action as a means ofexciting and raising himself; he seeks it, and the thought of thisaction is accompanied by love and desire. Let him become depressed andhe will no longer be able to accomplish this same action withoutexhausting himself; he is then reduced to dread it and take an aversionto 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 thecourse of neuroses and psychoses. In a score of my observations thefrenzy of persecution and hatred presents itself as an evolution ofthose obsessions of love and domination. 

These are very curious facts that one observes in the oscillations ofthe mind, in particular when the psychasthenic depression becomes moreserious and transforms itself in psychasthenic delirium, which is morefrequent than one generally imagines. As a rule the properly so-calledpsychasthenic has only disorders of the reflection; he doubts but hedoes not rave. But under different influences, his depression mayaugment, and when he drops below reflection he has no longer the doubts, the hesitations, he no longer shows manias of love and of direction, hetransforms his obsessions into deliriums and often his loves intohatreds. 

These are a few examples of the perturbations of conduct common toneurotic sufferers and the diseased in mind. One perceives that the samelaws relating to the diminution of force and the lowering of thepsychological tension intervene in the same way with the one as with theothers. The distinctions, which have been established for social reasonsand practical conveniences, no longer exist when one tries to find, byanalysis of the symptoms, the nature of neuroses and psychoses. 

The latter reflection shows us, however, that in certain cases, atleast, there is a certain difference in degree between neuroses andpsychoses. The evolution of the human mind has been formed by degrees, by successive stages, and we possess in ourselves a series of superposedlayers which correspond to diverse stages of the psychologicaldevelopment; when our forces diminish we lose successively these diverselayers commencing with the highest. It is the superior floors of thebuildings that are reached first by the bombardments of the war and thecellars are not destroyed at first; they acquire even more importance, as people are beginning to inhabit them. Well, according as thedepression descends more or less deeply, the disorders which result fromthe loss of the superior functions and the exaggerated action of theinferior ones become more and more serious and are appreciateddifferently. The superior psychological functions are, in my opinion, experimental tendencies and rational tendencies. They are tendencies tospecial actions in which man takes in account remembrances of formeracts and of their results, in which he enforces on himself by a specialeffort obedience to logical and moral laws. A little fatigue and aslight degree of exhaustion are sufficient for such an action to becomedifficult and impossible to prolong for a long time. Furthermore, thedisorders of the experimental conduct or of the rational conduct arevery frequent. These disorders only reach the superior actions which arenot absolutely necessary to the conservation of social order. They canbe easily repaired by inferior acts: if the man does not obey pure moralprinciples, at least he can conduct himself in appearance in ananalogous manner through fear of the prison. Also, these disorders ofthe 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 actsare simply reflex. When the disease descends to this level, when theelementary acts can no longer be executed correctly, we do not hesitateeither, and we consider these disorders (related with known lesions) asorganic diseases of the nervous system. But between these two terms wenote disorders in behavior which are more difficult to interpret. Thesedisorders are too grave and too difficult to modify by our usualprocesses of education and punishment for us to consider them as mereerrors or as moral faults; they are variable; they are not accompaniedby actually visible lesions and we have trouble in classing them amongthe acknowledged deteriorations of the organism. There is the provinceof neuroses and psychoses, intermedium between that of rational errorsand that of organic diseases of the nervous system. It corresponds tothe disorders of medium psychological functions, to the group of theseoperations which establish a union more or less solid between thelanguage and the movements of limbs and which give birth to our willsand beliefs. 

Can one establish, in this group, a distinction between neuroses andpsychoses that rests on some more precise notion and that is not limitedto distinguishing them in a legal point of view? A more profoundknowledge of the mechanisms of the will and belief would perhaps permitus to do so. We are capable of wills and beliefs of a superior orderwhen we reach decision after reflection. The operation of reflectionwhich hinders tendencies and maintains them in the shape of ideas, whichcompares 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 withoutreflection, without stoppage of ideas, without deliberation; they arethe result of an immediate assent which transforms verbal formulas intowills and beliefs as soon as they strike the attention, as soon as theyare accompanied by a powerful sentiment. The immediate assent is theinferior form of these tendencies. 

If one wished to establish a scientific distinction between neuroses andpsychoses, I should say, in a summary fashion, that in neuroses thereflection alone is disturbed, that in psychoses the immediate assentitself is affected. The shrinkage of the conscience, doubts, aboulias, obsessions, scruples are always disorders of the reflected will andbelief. On the contrary, irresistible impulsions, deliriums, indifferences which suppress desires and only allow elementaryagitations to subsist, show alterations in the immediate assent, in thewill, and the primitive belief and must be considered as psychoses. Below could be placed the disorders of elementary intelligence, thedisorder of the perceptive and social functions which characterize themental deficiencies of imbeciles and idiots. One might also distinguishthese disorders according to the degree of depth the destruction of theedifice has reached, according to the more or less distant state ofevolution to which the patient goes back. But these psychologicalclassifications are purely theoretical, and in practice many otherfactors intervene which oblige us to consider such a patient asincapable of doing any harm and such another as dangerous; this is theonly difference to-day between neuroses and psychoses. Later on, withoutdoubt, we shall be able to substitute for these simply symptomatical andpsychological diagnostics, some etiological and physiologicaldiagnostics. We shall be able from the very outset to recognize that adisorder, in all appearance slight and which is not deeply set, presentsa bad prognosis, and we shall be able to foresee a serious and deeppsychosis in the future. To-day, without doubt, one can oftendistinguish from the outset the future general paralytic from the simpleneurasthenic. But in the actual state of science this ability todistinguish is not frequent and the future evolution of a depressedstate can scarcely be foreseen with precision. 

Certain individuals pass in a few years from psychasthenic depressionwith doubts and obsessions to psychasthenic deliriums with stubbornnessand negativism, then to asthenic insanity with irremediable and completewant of power. Is it necessary to say that we made a mistake in ourdiagnostic and that from the first demential psychosis should have beenrecognized? I am not convinced of this: these diseases, excepting a fewcases with rapid evolution, are not characterized from the outset. Without doubt we must note that these depressions which disturb thereflective tendencies of young patients in full period of formation, are dangerous and can bring on still deeper depressions of thepsychological tension. But that evolution is rarely fatal; it can veryoften be checked, and it seems to me fair to preserve the distinctionbetween neuroses and psychoses considered as different degrees ofpsychological decadence. 

Neuroses are, therefore, the intermedium between the errors and thefaults which appeared to us almost normal, and alienation which seemedexceptional and distant from us. The first appearances of thatdepression which in a continuous manner descends to alienation are to befound already in the disorders of character which seemed to be quiteinsignificant. The miser, the misanthrope, the hypocrite are describedby the writer before they are claimed by the physician. A great numberof neuropathic disorders which I have described are related to thepopular type of mother-in-law. This type is not necessarily that of awoman whose daughter has married, but the type of a depressed woman ofabout fifty, aboulic, discontented with herself and others, domineering, and jealous, because she suffers from the mania of being loved thoughshe is incapable of acquiring any one's affection. All exhaustions, allmoral failings have the closest connection with neuroses and psychoses. 

These reflections prove to us that the alienist physician shouldinterest himself more and more in the treatment of neuroses even slight, to rectifying the disorders of temper, to the education of the young, tothe direction of the moral hygiene of his country. On many of thesepoints America leads the way; your works of social hygiene, the goodbattle you are righting against alcoholism, are examples for us. You arethe new world, younger, not rendered so inactive by secular habits. Youcan act more easily than we. We may have the advantage, in the oldworld, of the experience of old people and the habit of observation, butwe are slack in reform and action. "If youth had experience and old ageability, " says one of our proverbs. We must remain united and join yourstrength to our experience for the greater progress of the studies whichare 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 BYDR. WILLIAM L. RUSSELL

[Illustration: BLOOMINGDALE HOSPITAL, WHITE PLAINS, NEW YORK, 1921]

_The Chairman_: The year 1921 is rich in anniversaries for the NewYork Hospital. Next October we plan to celebrate the one hundred andfiftieth anniversary of the granting of our charter. To-day we areoccupied with the Bloomingdale Centenary. A fortnight ago thetwenty-fifth annual graduating exercises of our Training School forNurses were held in this room. This year also marks the decennial of Dr. Russell's term of office as Medical Superintendent. When his devotedpredecessor, Dr. Samuel B. Lyon, asked in 1911 to be relieved fromactive duty and became our first Medical Superintendent Emeritus, wewere most fortunate in securing as his successor Dr. Russell. Coming tothis institution after a broad psychiatric and administrativeexperience, he has taken up our special problems with deep insight andgratifying success. He has selected for his subject this afternoon "THEMEDICAL DEVELOPMENT OF BLOOMINGDALE HOSPITAL. " No one can speak withgreater authority on a theme of which it may be said _quorum magnapars_--fortunately not only _fuit_--but _est_ and _erit_ as well. 

DR. RUSSELL

The object of this celebration is not merely to glorify the past andleast of all is it to laud the present. What we hope from it is that itwill establish a milestone, not only to mark the progress thus far madebut to point the way to a path of greater usefulness. The advances inmedical science and practice and in the specialty of psychiatry duringthe past hundred years fill one with wonder and hope. It is worth whileto review them merely to obtain this help. The outlook for the centuryto come is, however, so far as can be anticipated, still brighter. 

To review the past is, at a time like this, not unprofitable. It mayprevent us, in our zeal for the new, from discarding what is valuable inthe old, and from overvaluing some things which may have outlived theirusefulness. We must be careful that we do not fall into errors similarto those from which the medical profession was rescued by the movementof which Bloomingdale Asylum was an offspring. It should be recalledthat the establishment of the asylum was due to the initiative of theGovernors of the New York Hospital, especially Mr. Eddy, rather than tothe active interest and direction of physicians. The object of theestablishment was, according to Mr. Eddy, to afford an opportunity ofascertaining how far insanity may be relieved by moral treatment alone, which, he says, "it is believed, will, in many instances, be moreeffective in controlling the maniacs than medical treatment. " The moralmanagement he referred to, though advocated by Pinel and a few others, some of whom were benevolent and intelligent laymen, had not beenaccepted by physicians as a distinct form of medical treatment. Fewphysicians of the period had accepted management of the mind asdescribed and practised by Pinel as being a distinct medical procedure, as having the same value in overcoming mental disorders as the drasticmedical remedies which they were accustomed to employ, or as having anyexclusive healing power. This is clearly shown by the case records ofthe mental department of the New York Hospital which have been preservedsince 1817, and of those of Bloomingdale Asylum for some years after itsopening in 1821. It is plainly set forth in Dr. Rush's book on diseasesof the mind, which was first published in 1810 and again in a fourthedition in 1830. Rush was physician to the Pennsylvania Hospital and hisbook was the principal, if not the only, one of the period by anAmerican author. American physicians like their European brothers, had, as Pinel observes, "allowed themselves to be confined within the fairycircle of antiphlogisticism, and by that means to be deviated from themore important management of the mind. " Rush believed that madness was adisease 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 singlesymptom that takes place in an ordinary fever, except a hot skin, thatdoes not occur in an acute attack of madness. " He found in his autopsyobservations confirmation of this view and concludes that "madness is tophrenitis what pulmonary consumption is to pneumony, that is, a chronicstate of an acute disease. " The reason for believing that madness was adisease of the blood-vessels, which seemed to him most conclusive, was"from the remedies which most speedily and certainly cure it beingexactly the same as those which cure fever or disease in theblood-vessels from other causes and in other parts of the body. " Thetreatment he recommended and which was generally employed was copiousblood-letting, blisters, purges, emetics, and other severe depletingmeasures. When Bloomingdale Asylum was established, therefore, theprovision for moral treatment did not contemplate that this should beapplied by the physician or that he should have full control of theresources by means of which it could be applied. The records do notindicate that either the physicians or the Governors realized that thismight be necessary or advantageous. The present system of administrationin which the chief physician is also the chief executive officer of theinstitution was a result of an evolution which took many years to reachits full consummation. 

Pinel, many years before Bloomingdale Asylum was opened, had shown bythe most careful observation and practice that the management anddiscipline of the hospital was a most powerful agent in the treatment ofthe patients. The manner in which he was led to this conclusion is aremarkable example of the scientific method. When he became physician tothe Bicetre he found that the methods of classification and treatmentrecommended in the books seemed to be inadequate, and, desiring furtherinformation, he says: "I resolved to examine myself the facts which werepresented to my attention; and, forgetting the empty honor of my titulardistinction as a physician, I viewed the scene that opened to me withthe eye of common sense and unprejudiced observation. .. . From systems ofnosology, I had little assistance to expect; since the arbitrarydistributions of Sauvages and Cullen were better calculated to impressthe conviction of their insufficiency than to simplify my labor. I, therefore, resolved to adopt that method of investigation which hasinvariably succeeded in all the departments of natural history, viz. , tonotice successively every fact, without any other object than that ofcollecting materials for future use; and to endeavor, as far aspossible, to divest myself of the influence, both of my ownprepossessions and the authority of others. With this view, I first ofall took a general statement of the symptoms of my patients. Toascertain their characteristic peculiarities, the above survey wasfollowed by cautious and repeated examinations into the condition ofindividuals. All our new cases were entered at great length upon thejournals of the house. " Having thus studied carefully the course of thedisease in a number of patients who were subjected only to the guidanceand control made possible by the management of the hospital under thedirection of a remarkably highly qualified Governor, it came to him withthe force of a new discovery that this man who was not a physician wasdoing more for the patients than he was, and that insanity was curablein many instances by mildness of treatment and attention to the state ofmind exclusively. "I saw with wonder, " he says, "the resources of naturewhen left to herself, or skilfully assisted in her efforts. My faith inpharmaceutic preparations was gradually lessened, and my scepticismwent at length so far as to induce me never to have recourse to them, until moral remedies had completely failed. " So convinced did he becomeof the significance and importance of the management and discipline ofthe hospital in the treatment of the patients, that, when a few yearslater, he wrote his "Treatise on Insanity, " he states that one of theobjects of his writing it was, "to furnish precise rules for theinternal police and management of charitable establishments and asylums;to urge the necessity of providing for the insulation of the differentclasses of patients at houses intended for their confinement; and toplace first, in point of consequence, the duties of a humane andenlightened superintendency and the maintenance of order in the servicesof the Hospitals. "

Pinel's views had apparently not been fully understood or adopted by thephysicians of America at the time Bloomingdale Asylum was planned andestablished. Dr. Rush did not mention him in his book, and Mr. Eddy, inhis communication to the Governors of the New York Hospital, referredonly to the writings of Drs. Creighton, Arnold, and Rush and the Accountof the York Retreat by Samuel Tuke. 

When Bloomingdale Asylum was opened, the form of organizationintroduced was that under which the department at the New York Hospitalhad been conducted. Mr. Laban Gardner was made Superintendent or Wardenwith two men and three women keepers to aid him in the control andmanagement of the seventy-five patients. There was an AttendingPhysician who visited once a week and a Resident Physician, neither ofwhom received salaries. There is nothing in the records to indicate thatin the beginning, the Governors of the Hospital looked upon the moraltreatment of the patients, which was the object for which theinstitution was established, as the task of the Physicians. The aim wasto furnish employment, diversion, discipline, and social enjoyment, without much attempt at precision or close medical direction andcontrol. For a time the results were considered to be satisfactory. In1824, however, a joint Committee of the Board reported that they wereimpressed by the necessity of improving the moral treatment, andrecommended that two discreet persons be appointed to take charge ofsuch of the patients as might from time to time be in a condition to beamused or employed on the farm or in walking exercises in the open or inclasses to be designated by the Resident Physician "with, " however, "theapprobation of the Superintendent, " who you will recall was not aphysician. These patients were, the report recommends, to beparticularly under the charge of the Resident Physician when thusemployed or amused "out of the Asylum. " At this time, the Attending andResident Physicians were placed on a small salary, and the ResidentPhysician was instructed to "devote a greater portion of his time andattention to the moral part of the establishment and to communicate tothe Committee such improvements as his experience shall suggest to beuseful and necessary in carrying into more complete effect the system ofmoral treatment and to report from time to time to the Committee theeffect of the measure adopted. " This seems to have been the beginning ofa realization that the moral management of the patients was inseparablefrom medical treatment and must necessarily be the task of thephysician. Seven years after this, in 1831, the Committee found itadvisable to spread upon the minutes an "interpretation andregulations, " relating to the Superintendent and Matron of the Asylumand to the Asylum physicians, to the effect that the Committeeunderstood that the regulations "placed the moral treatment on thephysician alone, under the direction of the Asylum Committee, and thatthe responsibility remains with him alone, that this treatment commencedwith the reception of the patient, the ward where he shall be placed, his exercises, amusement, admission of friends, the time of dischargefrom the house. .. . And that all orders to nurses and keepers which thephysicians may think necessary to carry these orders into effect _shallbe communicated through the Superintendent_" (or Warden). In 1832, theResident Physician, Dr. James Macdonald, who had just returned fromEurope after having spent a year in visiting the institutions for mentaldisorders there, made a report in which he rather significantly referredto the impracticability of making a sharp distinction between themedical and moral treatment of the patients, it being difficult to saywhere the one ended and the other began, or to put one into successfuloperation without bringing in the other. At this time the position ofAttending Physician was abolished and the Resident Physician was madethe Chief Medical Officer of the Asylum. It was not until 1837 that anamendment to the by-laws regulating the powers of the physician and theWarden was adopted which gave to the physician the power of appointingand discharging at pleasure all the attendants on the patients, while tothe Warden was reserved the power of appointing and dismissing all otheremployees. Fourteen years had thus elapsed since the opening of theAsylum before the physician was given control of even the nursingservice. The first Annual Report of the Resident Physician of theAsylum to be published appeared in 1842. In this, Dr. William Wilsonmakes a general statement in regard to the beneficial effects of themoral as well as the medical treatment pursued in the institution, andrefers 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 themanagement of the institution had been extended and it is perhapssignificant that in his report of the following year Dr. Wilson refersto a plan for distribution of food which had been evolved inco-operation with the Warden. Under the direction of Dr. Pliny Earle, who was appointed physician to the Asylum in 1844, treatment directed tothe mind was further elaborated and systematized, and the place of thephysician in the management of the hospital was more firmly established. 

This brief survey indicates how, in the development of the work of theinstitution, it required years of practical experience to show to theGovernors that, in order to secure for the patients the treatment whichthe Asylum had been established to furnish, it was necessary to extendthe powers and duties of the physician so that he could control anddirect the internal management and discipline, and all the resourcesfor social as well as individual treatment. This extension was continueduntil finally the present form of organization was adopted in which thechief physician is also the chief executive officer of the institution. This was, however, not fully accomplished until 1877. It is nowuniversally recognized that the physician must be the supreme head ofthe organization, and all American institutions and most, if not all, ofthose in other countries are now similarly organized. 

In the early development of Bloomingdale Asylum, this extension of theinfluence and authority of the physician is the outstanding medicalfact. It did away with division of responsibility and removed fromdiscussion the question of moral as distinct from medical treatment. Thereafter a harmonious and effective application of all the resourcesof the institution to the problems of the patients became more easilyand certainly possible. Since then, the resources for treatment directedto the mind have been developed as steadily and fully as those requiredfor the treatment of physical conditions. The use of the organizedagencies which were regarded by the founders as the main reliance inmoral treatment, namely occupations, physical exercises and games, diversion, social contacts, and enjoyment, and management of behaviorhas been greatly extended, and specialized departments have beencreated for their application with system and growing precision. Greatadvances have also been made in the methods of examining the minds ofthe patients and of determining the mental factors in their disordersand the means of restoring their capacity for adjustment to healthythinking and acting. Psychiatry has been furnished with a body ofwell-arranged facts, and with a technic which is not inferior in systemand precision to that of many other branches of medicine. In the studyand management of the minds of the patients the physician is thusenabled to apply himself to the task as he does to any other medicalproblem. 

The advances in general medical science and practice have alsonecessitated great elaboration of the resources for the study andtreatment of the physical condition of the patients. Instruments ofprecision, laboratories, x-ray departments, dental and surgicaloperating rooms, massage and hydrotherapy departments, facilities foreye, throat, nose, and ear examinations and treatment, and all the othermeans of determining disease processes and applying proper treatmenthave been supplied and the methods and standards of modern clinicalmedicine and surgery are utilized. It can now be clearly seen that it isnecessary to direct attention to the whole personality of the patient, including his original physical and mental constitution, the physical aswell as the mental factors which may be operating to produce hisdisorder, and the environmental conditions to which he has been and mayagain be exposed. In the treatment of mental disorders it is necessaryto beware of what Pinel found to be the fault of the physicians andmedical authors of his time, who he says were more concerned with therecommendation of a favorite remedy than with the natural history of thedisease, "as if, " he says, "the treatment of every disease withoutaccurate knowledge of its symptoms involved in it neither danger noruncertainty, " and he quotes the following maxim of Dr. Gault: "We cannotcure diseases by the resources of art, if not previously acquainted withtheir terminations, when left to the unassisted efforts of nature. "Exclusive attention to the physical condition and factors, or to themental condition and factors, or concentration on one theory or one formof treatment to the exclusion of all others is sure to lead to neglectof that careful general inquiry into the whole personality of thepatient, into the conditions out of which his disorder arose, and intoall the manageable factors in the situation which is so essential tointelligent and effective treatment. Notwithstanding the great benefitwhich has been derived from physical measures in the study andtreatment of mental disorders, and the well-founded hopes of greateradvances in this direction, the main task still continues to be whatPinel calls the management of the mind. Experience and increasingknowledge show that this is a task which can only be successfullyperformed by the physician and by means of organized resources which areunder medical direction and control. The hospital for mental disordersfurnishes the means of providing social as well as individual treatment. It is a medical mechanism and for its proper management and use it isrequired of physicians that they accept the burden of much executivework and give their attention to many subjects and activities that mayinterfere seriously with what they have been taught to regard as morestrictly professional interests. Like Pinel, one must be willing toforget the empty honor of one's titular distinction as a physician, anddo whatever may be necessary to make the institution a truly medicalagency for the healing of the sick. Considerable progress has been madein developing executive assistants to relieve the physicians of much ofthe administrative work which requires little or no medical supervisionand direction. Special provision for the training of such executiveshas, however, received insufficient attention. This question might, withgreat advantage, be taken up by the hospitals and colleges. Nothingwould add more to the quality of the service which the hospitals renderthan to supplement the work of the physicians by that of well educatedand highly trained executive assistants who would themselves find anextremely interesting and productive field for their efforts. 

A period has now been reached in this field of work when what amounts toa movement not inferior in significance and importance to that of ahundred years ago, seems to be in active operation. The character andscope of this movement and the lines of its progress have, to someextent, been indicated in the illuminating formulations which have beenpresented here to-day. The medical study and treatment of the mind is nolonger so exclusively confined within the walls of institutions nor tothe type or degree of disorder which necessitates compulsory seclusion. Psychiatry is extending out from the institutions into the communitiesby means of out-patient clinics and social workers, through newlycreated organized agencies, through informed individuals, physicians, nurses, and lay workers, and through the general spread of psychiatricknowledge. This process is being expedited by the efforts of organizedbodies such as the National and State Committees and Societies forMental Hygiene, and the public is rapidly learning what can properly beexpected of institutions, officials, physicians, nurses, and otherresponsible individuals in whom special knowledge and ability aresupposed to be found. As in the prevention of tuberculosis, so, in theprevention of mental disorders, the informed public is likely to start acampaign which the medical profession may have to make haste to followin order to maintain its needed leadership. Although much is yetrequired to improve the facilities necessary in carrying on the presentwork, it seems to us that at such a time a further extension of theactivities of an institution such as Bloomingdale Hospital may benecessary to enable it to fulfil its possibilities for greaterusefulness. To extend the work our experience indicates that adepartment in the city at the General Hospital would be of greatadvantage. During the past few years the oversight of dischargedpatients has grown to such an extent that it seems as though someorganized method of carrying it on may soon become necessary. This andout-patient work generally could be best attended to in a citydepartment. Much emergency work and preliminary observation and thetreatment of certain types of cases now frequently subjected tounfortunate delays, neglect, and unskilful treatment would also be thusprovided for. It can be seen too that developments in construction andorganization which would furnish organized treatment for types ofdisorders which are not so incapacitating as the pronounced psychosesmight be of advantage in the treatment of both adults and children. Theproperty on which the Hospital is located is large enough to permit offurther extensions and developments which could be as closely connectedwith, or as widely separated and distinguished from, the presentprovision as circumstances required. In this way much needed provisionfor the treatment of persons suffering from the psychoneuroses and minorpsychoses could be furnished. Better provision for a further period ofreadjustment after a patient is ready to leave the Hospital but not yetready to face the risk of ordinary conditions in the community is a feltwant. A group of supervised homes or an occupational colony might bestserve this purpose. The more extensive use of the Hospital as a teachingcentre is also a subject for consideration. A School for Nurses is nowconducted, and much instruction is given in the occupationaldepartments. More, however, could be done, especially in medicalteaching, which could be best carried on in a department in the city andwould tend to advance the standard of medical service throughout theHospital. 

The lines of further development are, perhaps, not yet perfectly clearin all directions. It seems certain, however, that they will lead towarda broader field of usefulness, in which the hospital will be regarded asa responsible agency for dealing with psychiatric problems in thecommunity which it serves and will take part with other agencies inextending psychiatric knowledge and in applying it to prevention, and tothe management of mental disorders as an individual and social problembeyond the walls of the institution. We hope that this meeting willprove a real starting point for this development. We are greatlyindebted to those who have taken part in it both as speakers and asaudience. We are especially indebted to those who came across the sea tobe with us. It is peculiarly fitting that representatives of France andof England should have been here, for to Pinel, the Frenchman, and toTuke, the Englishman, are due more than to any others whose names weknow the foundations of the modern institutional treatment of mentaldisorders. 

_The Chairman:_ This, ladies and gentlemen, concludes our exercises. Asthe representative of the Governors, I find it quite impracticable, insupplementing what Dr. Russell has just said, to express adequately ouradmiration of and gratitude to these eminent scientists and apostles oflight for their presence here and for their inspiring addresses. These, if I may be permitted to appraise them, seem to make a notable additionto medical literature, and, with the permission of their authors, wepurpose, for our own gratification and for the benefit of theprofession, to have all of the addresses preserved in a volume recordingthis centenary celebration. In due course a copy of this volume will besent to each of our guests. The celebration itself, I think you will allagree with me, has been a moving one, with an underlying note ofphilanthropic endeavor as high as the stars. You heard its refrain inthe pageant on the lawn this afternoon. As I have listened to-day tothese words of profound wisdom, uttered in so noble a spirit of humanministry, my mind has gone back to the sentence from Cicero's plea forLigarius, [18] which formed the text for Dr. Samuel Bard's eloquentappeal in 1769, mentioned this morning, for the establishment of the NewYork Hospital, and which may be freely rendered, "In no act performed byman does he approach so closely to the Gods as when he is restoring thesick to the blessings of health. " And surely when that restoration tohealth consists in "razing out the written trouble of the brain" andreviving in the patient the conscious exercise of divine reason, it isdifficult to imagine a more Godlike act. 

FOOTNOTES:

[Footnote 18: Homines enim ad Deos nulla re proprius accedunt, quamsalutem hominibus dando. ]

THE TABLEAU-PAGEANT

[Illustration: SCENE FROM THE TABLEAU PAGEANT PRESENTED ON THE GROUNDSOF BLOOMINGDALE HOSPITAL, MAY 26, 1921]

SYNOPSIS

While the Symbolic Father Time bears witness, the Muse of History, asthe Narrator, after alluding to the remote past, briefly summarizes theincidents leading up to the establishment of the Society of the New YorkHospital by Royal Charter in 1771. The succeeding scenes areself-revealing. The familiar picture of Pinel at Salpetrière depictsconditions in that period. Several portraits of personalities intimatelyassociated with the early history of Bloomingdale Hospital follow. These, together with an episode from the life of Dorothy Dix, stimulateour imagination with reference to the revival of interest in the care ofthe mentally ill in the first half of the last century. The closingscenes suggest the great advance which has taken place during thecentury, and the part that work and play take to-day in re-establishingand 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 WesleySpirit 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 ofher 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 CraftsWomen's CraftsMen's SportsWomen'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 andaddresses were not obtained. ]

APPENDICES

APPENDIX I

COMMUNICATIONS FROM DR. BEDFORD PIERCE, MEDICAL SUPERINTENDENT OF THERETREAT, YORK, ENGLAND

May 5th, 1921. 

DEAR DR. RUSSELL:

I have read with much pleasure your pamphlet giving the history ofBloomingdale Hospital. The reproduction in facsimile of Thomas Eddy'scommunication[20] is especially interesting and it will be placed withthe records of the early days of the Retreat. 

We have looked through the Minutes, which are complete from the openingof the Retreat in 1796, and also examined a large number of originalletters of William and Samuel Tuke respecting the Institution, but havenot succeeded in tracing the letter from S. Tuke to William Eddy, towhich you refer. As you are probably aware, S. Tuke was the grandson ofWilliam Tuke, the founder, and when he published the History of theRetreat in 1812 he was but twenty-eight years of age. This book had afar-reaching influence on the treatment of the insane, and it isremarkable that a man untrained in medicine and without universityeducation 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 Directorsof the Retreat to present your Hospital with one of them. I have alreadysent you a copy of an address of my own dealing with Psychiatry inEngland at about the time your Hospital was instituted. 

The use of the term "moral treatment" as opposed to treatment ofphysical disease has in recent years become especially interesting. Itis clear that Tuke and Pinel foresaw that psychotherapeutic treatment isnecessary, 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 organizedoccupations are developed at Bloomingdale--a pleasure not unmixed withenvy at seeing the picture of the men's occupational pavilion, and theprospective erection of a similar building for women. 

In the early days of the Retreat large numbers of visitors came from allparts of the world. There is a gap in the Visitors' Book between1800-1815, and the list of visitors is not complete. 

We have copied out the names of the American Visitors, together with anentry by John W. Francis, M. D. , in 1815. It is interesting to note thatan American woman Friend, Hannah Field, was accompanied to the Retreatby Elizabeth Fry. In 1818 a party of North American Indians visited theRetreat and signed the Visitors' Book with pictorial representations oftheir names. These we have had photographed and I send the printsherewith. 

May I congratulate you on the centenary of your Hospital and alsocongratulate you and the Governors on its remarkable development andprogress. Here at the Retreat we carry on using the original buildingsstill, striving to give our patients modern treatment in premises nowalmost ancient, but which do not appear so out of date in this City ofYork. York congratulates New York upon its wonderful prosperity, and wegladly recognize its development in the practice of psychiatry fullycorresponds 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 withpleasure that the Bloomingdale Hospital, the section of the Society ofthe New York Hospital devoted to the Treatment of Mental Diseases, is tocelebrate next month the centenary of its foundation. The facsimilereproduction of the letter of Thomas Eddy which has been presented tothe Retreat Library is specially interesting to us as it acknowledgesthe pioneer work at the Retreat and specially refers to correspondencewith Samuel Tuke. We have pleasure in sending to the Governors of theBloomingdale Hospital a copy of Samuel Tuke's classical work "TheDescription of the Retreat" in the belief that the principles thereinset forth are of lasting importance. We send our hearty congratulationsto the Bloomingdale Hospital on its century of good work and wish itevery 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 YorkHospital, presented a communication in which he advocated theestablishment in the country of a branch for the moral treatment of theinsane. 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 veryjudicious remarks and sentiments contained in the following letter, might be highly useful to the community, as well as to the institutionwith which they are connected, have requested the same to be published. The work alluded to in the letter, called, "Practical hints on theconstruction and economy of Pauper Asylums, " is believed to be one ofthe most valuable and interesting works of the kind ever published. Thiswork was sent by the author to one of the Governors, and is nowdeposited in the Hospital library. It is very desirable that it shouldbe republished in this country; but as such republication would beexpensive, on account of the few copies that would be wanted, theGovernors have directed, that if any person, or trustees of any publicinstitution, in any part of the United States, should be desirous ofobtaining a copy of this very valuable work, with a view to aid them inerecting a similar Asylum, or the improvement of any alreadyestablished, that a manuscript copy shall be furnished them, upon anapplication 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 andpamphlet, lately received from thee, respecting the erection of anasylum for lunatics near New-York. [22] He has wished me to make anyremarks which may occur to me on the perusal; but, having justpublished a few hints on the construction and economy of Pauper LunaticAsylums, which contain much of the information thou requests, I shallhave but little to add. Those hints, however, relating to institutionsfor the poorest class of society, must be applied with somemodifications to establishments for persons of different pervioushabits, and for whom a greater portion of attendance can be afforded. The great objects, however, which are stated in the hints to be soimportant for the comfort of lunatics, apply equally to those of allranks and classes. 

From the sum you propose to receive from the patients, intended tooccupy the new building, I conclude you are providing for patients ofthe middle ranks of life, a class hardly less to be commiserated, whenthus afflicted, than the very poorest, since the expense and difficultyof private management, may bring to ruin a respectable family, as wellas expose it to great personal dangers. There would, I think, beconsiderable 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 toaccommodate both sexes, the number of each sex may be very suitable forthe accommodation of three contiguous rooms, which, of course, need notbe so large as those in the Wakefield Asylum. It would be difficult tooffer a detailed plan, without knowing more than we do of your localcircumstances, and the classes of patients you purpose to admit. Idoubt, however, whether you can do better than to adopt the general formof the Wakefield Asylum, and as you are providing for only a smallnumber, it deserves consideration whether all the rooms might not beadvantageously placed on the ground floor. This plan affords greatfacilities to easy inspection, and safe communication with airinggrounds, and the roof might project so far over the building, as to forman excellent collonnade for the patients; which seems peculiarlydesirable under an American Sun. 

With these views, I send a sketch drawn by the Architect whose plan isto 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 altogetheruseless. Should it be thought too expensive, I think the rooms, 1, 2, and 3, might be dispensed with, and rooms marked "attendants, sick andbath, " might be appropriated to the patients during the day. Theattendants room is not a requisite, though it has been thought that itwould be more agreeable to patients of superior rank, not to have thesociety of a servant. This, however, chiefly applies to theconvalescents, and these might occupy the room marked 'sick', whilst themiddle class, and the attendants, would be in the centre, marked"attendants. " A sick and bath room might probably be obtained in thegalleries: if you are inclined for the sake of appearance, to make thecentre building two stories high, you might bring the wings nearer tothe centre, and accommodate most of the convalescent patients with bedrooms in the upper story. In this case, perhaps it would be desirable togive the wings a radiating form. You will however be best able to modifythe sketch to your particular wants, if the general idea should meetyour approbation. 

I observe with pleasure, that one leading feature of your newinstitution, is the introduction of employment amongst the patients, anobject which I am persuaded is of the utmost importance in the moraltreatment of insanity. It is related of an institution in Spain, whichaccommodated all ranks, and in which the lower class were generallyemployed, that a great proportion of these recovered, whilst the numberof the Grandees was exceedingly small. It will however, require greataddress to induce patients to engage in manual labour, who have not beenaccustomed to it previously to their indisposition, and it must beadmitted, that where the reluctance on the part of the patient is great, the irritation which compulsory means are likely to excite, willprobably be more injurious to the patient, than the exercise will bebeneficial. The employment of insane persons should, as far as it ispracticable, be adapted to their previous habits, inclinations andcapacities, and, though horticultural pursuits may be most desirable, the greatest benefit will, I believe, be found to result from thepatient being engaged in that employment in which he can most easilyexcel, 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 equallybeneficial with those that are useful. The latter appear to me topossess a decided preference, by imparting to the mind that calm feelingof satisfaction, which the mere arts of amusement, though not to beneglected, can never afford. To the melancholy class, this is animportant distinction between amusing and useful employments, and labouris to be prefered for the maniacal class as less calculated to stimulatethe already too much excited spirits. 

It is proposed that the new asylum should be placed a few miles from thecity. The visitors to it, (I do not mean the medical ones) will, Ipresume, be residents in New-York, and from what I have seen of the zealof persons under such appointments in this country, it appearsdesirable, to render the performance of this duty, so important for thewelfare of asylums, as easy as it can be with propriety. One mileperhaps would not be objectionable, and might probably afford as goodair and retirement, as a greater distance. 

I need hardly say, I was much gratified to find by the pamphlet, thatthe importance of moral treatment in the cure of insanity, was dulyappreciated in America. When we consider, as Lord Bacon observes, speaking of common diseases, that "all wise physicians in theprescription, of their regimen to their patients, do ever consideraccidentia animi, as of great force to further or hinder remedies orrecoveries;" it is difficult to account for the general neglect of moralconsiderations 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 shallnot abandon it as altogether useless, in what we term disease of themind. All the varieties, included under this general term, have beenproduced by physical causes: by external accidents, by intoxication, theimproper use of medicines, repelled eruptions, obstructed secretions, &c. In some instances, dissection has discovered, after death, the causeof the mental affection, and though, in many instances, no physicalcause can be detected, yet, when it is considered, how limited are theinvestigations of the anatomist, and that the art is so imperfect, thatdiseases occasioning instant death, cannot always be discovered on themost minute dissection, it is not unreasonable to suppose, that the bodyis in all cases the true seat of the disease. 

All I would infer from this speculation is, the importance of havingjudicious medical attendants, to watch the progress of the disorder, tobe ready to apply their art as bodily symptoms may arise, and toascertain, with greater precision than has hitherto been done, "how andhow far the humours and effects of the body, do alter and work upon themind; and how far the passions and apprehensions of the mind, do alterand work upon the body. " Even if the disease is not confined to thecorporal organs of mind, but extends to the pure and eternalintelligence, medical aid may still be useful from the well knownreciprocal action of the two parts of our system upon each other. 

I hope my unknown friend will excuse the length and freedom of thisletter: its length has much exceeded my intentions, yet I may haveomitted 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 amable, any questions which they may propose; and, with the best wishesfor 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, NewYork, 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 causeof 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 meansoverlooked by the ancients, we may fairly conclude, it is deservedly theboast of modern times, to have treated it with any degree of success. 

It would have been an undertaking singularly interesting andinstructive, to trace the different methods of cure which have beenpursued in different ages, in the treatment of those labouring undermental derangement: and to mark the various results with which they wereattended. The radical defect, in all the different modes of cure thathave been pursued, appears to be, that of considering mania a _physical_or _bodily_ disease, and adopting for its removal merely physicalremedies. Very lately, however, a spirit of inquiry has been excited, which has given birth to a new system of treatment of the insane; andformer modes of medical discipline have now given place to that which isgenerally denominated _moral management_. 

This interesting subject has closely engaged my attention for someyears, and I conceive that the further investigation of it may provehighly beneficial to the cause of humanity, as well as to science, andexcite us to a minute inquiry, how far we may contribute to the reliefand comfort of the maniacs placed under our care. In pursuing thissubject, my views have been much extended, and my mind considerablyenlightened, by perusing the writings of Doctors Creighton, Arnold, andRush; but, more particularly, the account of the Retreat near York, inEngland. Under these impressions I feel extremely desirous of submittingto the consideration of the Governors, a plan to be adopted by them, forintroducing a system of moral treatment for the lunatics in the Asylum, to a greater extent than has hitherto been in use in this country. Thegreat utility of confining ourselves almost exclusively to a course ofmoral treatment, is plain and simple, and incalculably interesting tothe cause of humanity; and perhaps no work contains so many excellentand appropriate observations on the subject, as that entitled, _TheAccount of the Retreat_. The author, Samuel Tuke, was an active managerof that establishment, and appears to have detailed, with scrupulouscare and minuteness, the effects of the system pursued toward thepatients. I have, therefore, in the course of the following remarks, with a view of illustrating the subject with more clearness, oftenadopted the language and opinions of Tuke, but having frequently mixedmy own observations with his, and his manner of expression not beingalways adapted to our circumstances and situation, I have attempted tovary the language, so as to apply it to our own institution; this willaccount for many of the subsequent remarks not being noticed as takenfrom Tuke's work. 

It is, in the first place, to be observed, that in most cases ofinsanity, from whatever cause it may have arisen, or to whatever extentit may have proceeded, the patient possesses some small remains ofratiocination and self-command; and although many cannot be madesensible of the irrationality of their conduct or opinions, yet they aregenerally aware of those particulars for which the world considers themproper objects of confinement. Thus it frequently happens, that apatient, on his first introduction into the asylum, will conceal allmarks of mental aberration; and, in some instances, those who beforehave been ungovernable, have so far deceived their new friends, as tomake 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 cannotbe a doubt that the principle of fear in the human mind, when moderatelyand judiciously excited, as it is by the operation of just and equallaws, has a salutary effect on Society. It is of great use in theeducation of children, whose imperfect knowledge and judgment, occasionthem to be less influenced by other motives. But where fear is _toomuch_ excited, and especially, when it becomes the chief motive ofaction, it certainly tends to contract the understanding, weaken thebenevolent affection, and to debase the mind. It is, therefore, highlydesirable, and more wise, to call into action, as much as possible, theoperation of superior motives. Fear ought never to be induced, exceptwhen an object absolutely necessary cannot be otherwise obtained. Maniacs are often extremely irritable; every care, therefore, should betaken, to avoid that kind of treatment that may have any tendencytowards exciting the passions. Persuasion and kind treatment, will mostgenerally supersede the necessity of coercive means. There isconsiderable analogy between the judicious treatment of children andthat of insane persons. Locke has observed "the great secret ofeducation 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 manythings he has a mind to, and to draw him to things which are uneasy tohim. " Even with the more violent and vociferous maniacs, it will befound best to approach them with mild and soft persuasion. Every painsshould be taken to excite in the patient's mind a desire of esteem. Though this may not be sufficiently powerful to enable them to resistthe strong irregular tendency of their disease; yet, _when properlycultivated_, it may lead many to struggle to overcome and conceal theirmorbid propensities, or at least, to confine their deviations withinsuch bounds as do not make them obnoxious to those about them. Thisstruggle is highly beneficial to the patient; by strengthening his mind, and conducing to a salutary habit of self-restraint, an object, nodoubt, of the greatest importance to the care of insanity by _moralmeans_. 

It frequently occurs, that one mark of insanity is a fixed falseconception, and a total incapacity of reasoning. In _such_ cases, it isgenerally advisable to avoid reasoning[24] with them, as it irritatesand rivets their false perception more strongly on the mind. On thisaccount, every means ought to be taken to seduce the mind from unhappyand favourite musings; and particularly with melancholic patients; theyshould freely partake of bodily exercises, walking, riding, conversations, innocent sports, and a variety of other amusements; theyshould be gratified with birds, deer, rabbits, etc. Of all the modes bywhich maniacs may be induced to restrain themselves, regular employmentis perhaps the most efficacious; and those kind of employments are to bepreferred, both on a moral and physical account, which are accompaniedby considerable bodily action, most agreeable to the patient, and mostopposite to the illusions of his disease. 

In short the patient should be always treated as much like a rationalbeing as the state of his mind will possibly allow. In order that he maydisplay his knowledge to the best advantage, such topics should beintroduced as will be most likely to interest him; if he is a mechanicor 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 thecomforts of insane persons; but they are of far greater importance asthey relate to the cure of the disorder. The patient, feeling himself ofsome consequence, is induced to support it by the exertion of hisreason, and by restraining those dispositions, which, if indulged, wouldlessen the respectful treatment he wishes to receive, or lower hischaracter in the eyes of his companions and attendants. 

Even when it is absolutely necessary to employ coercion, if on itsremoval the patient promises to control himself, great reliance mayfrequently be placed upon his word, and under this engagement, he willbe apt to hold a successful struggle with the violent propensities ofhis disorder. Great advantages may also be derived, in the moralmanagement of maniacs, from an acquaintance with the previousemployment, habits, manners, and prejudices of the individual: this maytruly be considered as indispensably necessary to be known, as far ascan be obtained; and, as it may apply to each case, should be registeredin a book for the inspection of the Committee of the Asylum, and thephysician; the requisite information should be procured immediately onthe admission of each patient; the mode of procuring it will be spokenof hereafter. 

Nor must we forget to call to our aid, in endeavouring to promoteself-restraint, the mild but powerful influence of the precepts of ourholy religion. Where these have been strongly imbued in early life, theybecome little less than principles of our nature; and their restrainingpower is frequently felt, even under the delirious excitement ofinsanity. To encourage the influence of religious principles over themind of the insane, may be considered of great consequence, as a meansof cure, provided it be done _with great care and circumspection_. Forthis purpose, as well as for reasons still more important, it wouldcertainly be right to promote in the patient, _as far as circumstanceswould permit_, an attention to his accustomed modes of paying homage tohis Maker. 

In pursuing the desirable objects above enumerated, we ought not toexpect too suddenly to reap the good effects of our endeavours; norshould we too readily be disheartened by occasional disappointments. Itis necessary to call into action, as much as possible, every remainingpower and principle of the mind, and to remember, that, "in the wreck ofthe intellect, the affections very frequently survive. " Hence thenecessity of considering _the degree_ in which the patient may beinfluenced by moral and rational inducements. 

The contradictory features in their characters, frequently render itexceedingly difficult to insure the proper treatment of insane persons;to pursue this with any hopes of succeeding, so that we may in anydegree ameliorate their distressed condition, renders it indispensablynecessary that attendants only should be chosen who are possessed ofgood sense, and of amiable dispositions, clothed, as much as possible, with philosophical reflexion, and above all, with that love and charitythat mark the humble Christian. 

Agreeably to these principles, I beg leave to suggest the followingregulations 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 confinedin a room with the windows, etc. , closed, so as nearly to exclude thelight, and kept confined if necessary, in a straight jacket, so as towalk 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 strongdetermination to self-destruction, be confined on the bed, and theapparatus so fixed as to allow him to turn and otherwise change hispositions. 

3rd. The power of judicious kindness to be generally exercised, mayoften be blessed with good effects, and it is not till after other moralremedies are exercised, that recourse should be had to restraint, or thepower of fear on the mind of the patient; yet it may be propersometimes, by way of punishment, to use the shower bath. 

4th. The common attendants shall not apply any extraordinary coercion byway of punishment, or change in any degree the mode of treatmentprescribed by the physician; on the contrary, it is considered as theirindispensable duty, to seek by acts of kindness the good opinion of thepatients, so as to govern them by the influence of esteem rather than ofseverity. 

5th. On the first day of the week, the Superintendent, or the principalkeeper of the Asylum, shall collect as many of the patients as mayappear to them suitable, and read some chapters in the Bible. 

6th. When it is deemed necessary to apply the strait-jacket, or anyother mode of coercion, by way of punishment or restraint, such an ampleforce should be employed as will preclude the idea of resistance fromentering the mind of the patient. 

7th. It shall be the duty of the deputy-keeper, immediately on a patientbeing admitted, to obtain his name, age, where born, what has been hisemployment or occupation, his general disposition and habits, when firstattacked with mania; if it has been violent or otherwise, the cause ofhis disease, if occasioned by religious melancholy, or a fondness forardent spirits, if owing to an injury received on any part of the body, or supposed to arise from any other known cause, hereditary oradventitious, 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 theCommittee of the Asylum, shall be occasionally taken out to walk or rideunder the care of the deputy-keeper; and it shall be also his duty toemploy the patients in such manner, and to provide them with such kindsof amusements and books as may be approved and directed by theCommittee. 

9th. The female keeper shall endeavour to have the female patientsConstantly employed at suitable work; to provide proper amusements, books, etc. , to take them out to walk as may be directed by theCommittee. 

10th. It shall be the indispensable duty of the keepers, to have all thepatients as clean as possible in their persons, and to preserve greatorder and decorum when they sit down to their respective meals. 

11th. It shall be the duty of the physician to keep a book, in whichshall be entered an historical account of each patient, stating hissituation, and the medical and moral treatment used; which book shall belaid before the Committee, at their weekly meetings. 

The sentiments and improvements proposed in the preceding remarks, forthe consideration of the Governors, are adapted to our present situationand circumstances; but a further and more extensive improvement hasoccurred to my mind, which I conceive, would very considerably conducetowards affecting the cure, and materially ameliorate the condition, andadd to the comfort of the insane; at the same time that it would affordan ample opportunity [Transcriber's note: original reads 'apportunity']of ascertaining how far that disease may be removed by moral managementalone, which it is believed, will, in many instances, be more effectualin controlling the maniac, than medical treatment especially, in thosecases where the disease has proceeded from causes operating directly onthe mind. 

I would propose, that a lot, not less than ten acres, should bepurchased by the Governors, conveniently situated, within a few miles ofthe city, and to erect a substantial building, on a plan calculated forthe accommodation of fifty lunatic patients; the ground to be improvedin such a manner as to serve for agreeable walks, gardens, etc. , for theexercise and amusement of the patients: this establishment might beplaced under the care and superintendence of the Asylum Committee, andbe visited by them once every week: a particular description of patientsto remain at this Rural Retreat; and such others as might appearsuitable objects might be occasionally removed there from the Asylum. 

The cost and annual expense of supporting this establishment, arematters of small consideration, when we duly consider the importantadvantages it would offer to a portion of our fellow-creatures, who havesuch strong claims on our sympathy and commiseration. 

But, it is a fact that can be satisfactorily demonstrated, that such anestablishment would not increase our expenses; and, moreover, wouldrepay us even the interest of the money that might be necessary to beadvanced, for the purchase of the ground and erecting the buildings. Theboard of patients (supposing fifty) would yield two hundred dollars perweek, or ten thousand four hundred dollars per annum. 

Supposing the ground, building, etc. , to cost $50, 000, the interest onthis 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 thanwould be required for that purpose. 

We had lately in the Asylum, more than ninety patients; and, at thattime, had repeated applications to receive an additional number; theCommittee however, concluded, that as the building was not calculated toaccommodate more than seventy-five, it would be an act of injustice totake in any more; they, therefore, concluded to reduce the number ofseventy-five, and strictly to refuse receiving any beyond that number. This may serve clearly to show, that we might safely calculate, that weshould readily have applications to accommodate one hundred andtwenty-five patients. 

This succinct view of the subject may suffice, at this time, as outlinesof my plan; and which is respectfully submitted to the Governors, fortheir Consideration. 

FOOTNOTES:

[Footnote 23: "Hints for Introducing an Improved Mode of Treating theInsane in the Asylum"; read before the Governors of the New YorkHospital on the 4th of Fourth-month, 1815. By Thomas Eddy, one of theAsylum Committee. New York, 1815. Reprinted Bloomingdale Hospital Press, 1916. ]

[Footnote 24: The following anecdotes illustrate the observation beforemade, that maniacs frequently retain the power of reasoning to a certainextent; and that the discerning physician may oftimes successfully availhimself of the remains of this faculty in controlling the aberrations ofhis patient:--A patient in the Pennsylvania Hospital, who called hisphysician his father, once lifted his hand to strike him. "What!" saidhis physician, (Dr. Rush), with a plaintive tone of voice, "Strike yourfather?" The madman dropped his arm, and instantly showed marks ofcontrition for his conduct. The following was related to me by SamuelCoates, President of the Pennsylvania Hospital:--maniac had made severalattempts to set fire to the Hospital: upon being remonstrated with, hesaid, "I am a salamander"; "but recollect, " said my friend Coates, "allthe patients in the house are not salamanders;" "That is true, " said themaniac, and never afterwards attempted to set fire to the Hospital. ]

APPENDIX IV

EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TOACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED APRIL, 1815

_April 4, 1815. _

A communication was received from Thos. Eddy suggesting severalimprovements in the mode of treating Insane persons, which is referredto Dr. Hugh Williamson, George Newbold, William Johnson, Peter A. Jay, and John R. Murray--Resolved that the Treasurer have fifty copies of thereport printed for use of the Governors. 

_July 3, 1815. _

The Committee on the communication from Thos. Eddy, relative to thetreatment of Insane patients, report attention to the subject and thatin their opinion it is advisable to have a few acres of land purchasedin the vicinity of the City for the better accommodation of this unhappyclass 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 apurchase, if in their opinion it shall become necessary. 

_8th Month (August) 1st, 1815. _

The Committee on the communication from Thomas Eddy, made the followingReport, which was intended to have been laid before the last meeting ofthe Board; which was now accepted, and ordered to be inserted in theminutes. 

"The Committee appointed to consider the expediency of erecting anotherBuilding for the accommodation of Insane Persons Report:

That another building for the use of those unfortunate persons who havelost the use of their reason, is not only advisable, but seems to beabsolutely necessary. 

That though there are at present more patients in the Asylum, by nearlyone third, than can with perfect Safety, and the best hopes of recovery, be lodged there; many more insane persons, perhaps twenty within a fewmonths, have by their friends been soliciting a place in thatBuilding--In speaking of the want of safety, the Committee only mean toexpress an opinion, that when two or more insane persons, from the wantof room are lodged together in one cell, the life of the weaker must besomewhat endangered by the stronger, who in a high Paroxysm of insanitymight strangle him in his sleep, or otherwise destroy him. 

That such additional Building, from the want of room, cannot possibly beerected near the hospital, in this city. 

That there are many reasons for believing that the recovery from a stateof insanity would be greatly promoted, by having a considerable space ofground adjoining the Asylum or Public Building, in which many of thepatients might have the privilege of walking, or taking other kinds ofexercise. 

That considering the various kinds of insanity, your Committee, areclearly of the opinion, that two buildings should be erected at thedistance of at least one hundred yards from each other. The sedate ormelancholy madman should not have his slumbers broken by living underthe same roof with disorderly persons, who by singing, or other noisyproceedings, 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 ofland, detached from private buildings, in a healthy and pleasantsituation, where the water is good and where materials for buildings maybe obtained on easy terms: and the portage of fuel not expensive. 

Your Committee are aware that a smaller lot of ground might suffice forall the buildings that are now required, or all this Corporation may, ina short time, be enabled to complete. But they count it advisable toprepare for a period that must certainly come; a period in which such alot will be needed, and not easily obtained, for it is evident from thetopography, and geographical position of this City, that the time mustcome, when New York will be not only the greatest City in the UnitedStates, or in America; but must rival the most distinguished City's inthe old Continent. 

Wherefore it is recommended, that a Committee be appointed, who shallexamine the sundry places, corresponding with the above description, that may be purchased. And that they report the means of making thepurchase, and of erecting such Buildings, as seem at this time to berequired. "

The Committee to whom was referred, to purchase a suitable Lot of Landfor the erection of a House for the accommodation of maniacs, Reportthat they have purchased 38 acres of Land, being part of the Estatebelonging to Gerard Depeyster at Bloomingdale, at the rate of $246. Peracre, payable 25 per cent down, 37½ per cent on 1st November and 37¾ percent on 1st February next, with interest. 

THOMAS EDDY, Chairman

August 1st, 1815

Whereupon Resolved that the Report of the Committee be accepted, andthey are instructed to take the Titles, after P. A. Jay shall haveexamined the Records, and be satisfied that the property is free ofincumbrance. 

APPENDIX V

ADDRESS TO THE PUBLIC BY THE GOVERNORS 1821[25]

The Governors of the New-York Hospital have the satisfaction to announceto the public, the completion of the Asylum for the insane; and that itwill be open for the reception of patients, from any part of the UnitedStates, on the first day of June. 

This Asylum is situated on the Bloomingdale road, about seven miles fromthe City Hall of the city of New-York, and about three hundred yardsfrom the Hudson River. The building is of hewn free-stone, 211 feet inlength, and sixty-feet deep, and is calculated for the accommodation ofabout two hundred patients. Its site [Transcriber's note: original reads'scite'] is elevated, commanding an extensive and delightful view of theHudson, the East River, and the Bay and Harbour of New-York, and theadjacent country, and is one of the most beautiful and healthy spots onNew-York Island. Attached to the building are about seventy acres ofland, a great part of which has been laid out in walks, ornamentalgrounds, and extensive gardens. 

This institution has been established by the bounty of the Legislatureof the state of New-York, on the most liberal and enlarged plan, andwith the express design to carry into effect that system of managementof the insane, happily termed _moral treatment_, the superior efficacyof which has been demonstrated in several of the Hospitals of Europe, and especially in that admirable establishment of the Society ofFriends, called "THE RETREAT, " near York, in England. This mild andhumane mode of treatment, when contrasted with the harsh and cruelusage, and the severe and unnecessary restraint, which have formerlydisgraced even the most celebrated lunatic asylums, may be considered asone of the noblest triumphs of pure and enlightened benevolence. But itis by no means the intention of the governors to rely on moral, to theexclusion of medical treatment. It is from a judicious combination ofboth, that the greatest success is to be expected in every attempt tocure or mitigate the disease of insanity. 

In the construction of the edifice and in its interior arrangements, ithas been considered important to avoid, as far as practicable, consistently with a due regard to the safety of the patients, whatevermight impress their minds with the idea of a prison, or a place ofpunishment, and to make every thing conduce to their health and to theirease and comfort. The self-respect and complacency which may thus beproduced in the insane, must have a salutary influence in restoring themind to its wonted serenity. In the disposition of the grounds attachedto 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 resortedto, whenever the inclination of the patient, or their probablebeneficial effects may render them desirable. To dispel gloomy images, to break morbid associations, to lead the feelings into their propercurrent, and to restore the mind to its natural poise, various[Transcriber's note: original reads 'varius'] less active amusementswill be provided. Reading, writing, drawing, innocent sports, tendingand feeding domestic animals, &c. Will be encouraged as they may befound conducive to the recovery of the patients. A large garden has beenlaid out, orchards have been planted, and yards, containing more thantwo acres, have been inclosed for the daily walks of those whosedisorder will not allow more extended indulgence. The plants of theElgin Botanic garden, presented to this institution by the Trustees ofColumbia College, have been arranged in a handsome green-house, preparedfor their reception. 

The apartments of the house are adapted to the accommodation of thepatients, according to their sex, degree of disease, habits of life, andthe wishes of their friends. The male and female apartments are entirelyseparated, so as to be completely secluded from the view of each other. 

Care has been taken to appoint a Superintendent and Matron, of goodmoral and religious characters, possessing cheerful tempers, and kinddispositions, united with firmness, vigilance and discretion. APhysician will reside in the house, and one or more Physicians, ofestablished character and experience, will attend regularly, and affordmedical aid in all cases where the general health, or the particularcause of the patient's insanity, may require it. The relations orfriends of patients will be at liberty, if they prefer it, to employtheir own physicians, who will be allowed to attend patients, subject tothe general regulations of the house. 

The institution will be regularly visited and inspected by a committeeof the Governors of the Hospital, who will, as often as they may thinkit advantageous, be attended by some of the physicians of the city ofhigh character and respectability. 

The charges for board and the other advantages of the institution, willbe moderate, and proportioned to the different circumstances of thepatients, and the extent of the accommodations desired for them. 

Patients at the expense of the different towns of the state, will bereceived 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 accommodationwill be provided for such patients as may require it, previously totheir being carried to the Asylum out of town. A committee of theGovernors will, when necessary, attend at the Hospital in Broadway, forthe purpose of admitting patients into the Asylum, and to agree on theterms 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 anaccount of their cases, stating the probable causes of their insanity, the commencement and peculiar character of the disorder. It is desirablethat this statement, where it is practicable, should be drawn up by aphysician. 

Applications from abroad, for information relative to the admission ofpatients, may be made by letters addressed to THOMAS BUCKLEY, Secretaryof the New-York Hospital. 

FOOTNOTES:

[Footnote 25: Address of the Governors of the New York Hospital to thePublic, 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, PresidentThomas Eddy, Vice PresidentThomas FranklinJonathan LittleThomas BuckleyWilliam JohnsonAndrew MorrisJohn R. MurrayJohn B. LawrenceGeorge NewboldEbenezer StevensPeter A. JayNajah TaylorCadwallader D. ColdenRobert H. BowneRobert I. MurrayThomas C. TaylorJohn Adams, TreasurerJohn McCombBenjamin W. Rogers, Assistant TreasurerWilliam BayardNathan ComstockDuncan P. CampbellRev. F. C. SchaefferJohn Clark, Jr. William Edgar, Jr. 

1921

Hermann H. CammannHenry W. DeForestRichard TrimbleHoward TownsendGeorge F. BakerAugustine J. SmithCharles S. BrownEdward W. Sheldon, PresidentBronson WinthropFrank K. SturgisDavid B. OgdenJoseph H. Choate, Jr. Henry G. BarbeyCornelius B. Bliss, Jr. Paul Tuckerman, TreasurerWilliam WoodwardArthur IselinPayne Whitney, Vice PresidentG. Beekman HoppinLewis Cass Ledyard, Jr. Henry R. TaylorR. Horace GallatinWalter Jennings

BLOOMINGDALE COMMITTEE

1821

Thomas EddyCadwallader D. ColdenThomas C. TaylorJohn AdamsThomas BuckleyJohn B. Lawrence

1921

Frank K. SturgisAugustine J. SmithHenry R. TaylorHenry G. BarbeyWalter JenningsHoward Townsend

APPENDIX VII

ORGANIZATION OF BLOOMINGDALE HOSPITAL

1821 AND 1921

1821

Superintendent or Warden 1Housekeeper 1Keepers, Men 3Keepers, Women 2Chambermaids 1Cooks 3Baker 1Assistant Baker 1Dairymaid 1Washerwoman 1Assistant washerwoman 1Yard Keeper 1Waitresses 2Gardener 1Farmer 1Assistant farmer 1

 Total 22

Number of patients 75

1921

Officers and employees:

Men 217Women 195 ---Total 412

Patients:

Men 132Women 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_ 8Chaplain, Librarian, Watchmen, Telephonists, Postal Clerk, Barber. 

STATISTICS: 1821-1921

Number of cases admitted 1821 to 1921 13, 411Number discharged recovered 1821 to 1921 4, 651Number discharged improved 1821 to 1921 3, 873