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

In the early development of Bloomingdale Asylum, this extension of the influence and authority of the physician is the outstanding medical fact. It did away with division of responsibility and removed from discussion the question of moral as distinct from medical treatment. Thereafter a harmonious and effective application of all the resources of the institution to the problems of the patients became more easily and certainly possible. Since then, the resources for treatment directed to the mind have been developed as steadily and fully as those required for the treatment of physical conditions. The use of the organized agencies which were regarded by the founders as the main reliance in moral treatment, namely occupations, physical exercises and games, diversion, social contacts, and enjoyment, and management of behavior has been greatly extended, and specialized departments have been created for their application with system and growing precision. Great advances have also been made in the methods of examining the minds of the patients and of determining the mental factors in their disorders and the means of restoring their capacity for adjustment to healthy thinking and acting. Psychiatry has been furnished with a body of well-arranged facts, and with a technic which is not inferior in system and precision to that of many other branches of medicine. In the study and management of the minds of the patients the physician is thus enabled to apply himself to the task as he does to any other medical problem.

The advances in general medical science and practice have also necessitated great elaboration of the resources for the study and treatment of the physical condition of the patients. Instruments of precision, laboratories, x-ray departments, dental and surgical operating rooms, massage and hydrotherapy departments, facilities for eye, throat, nose, and ear examinations and treatment, and all the other means of determining disease processes and applying proper treatment have been supplied and the methods and standards of modern clinical medicine and surgery are utilized. It can now be clearly seen that it is necessary to direct attention to the whole personality of the patient, including his original physical and mental constitution, the physical as well as the mental factors which may be operating to produce his disorder, and the environmental conditions to which he has been and may again be exposed. In the treatment of mental disorders it is necessary to beware of what Pinel found to be the fault of the physicians and medical authors of his time, who he says were more concerned with the recommendation of a favorite remedy than with the natural history of the disease, "as if," he says, "the treatment of every disease without accurate knowledge of its symptoms involved in it neither danger nor uncertainty," and he quotes the following maxim of Dr. Gault: "We cannot cure diseases by the resources of art, if not previously acquainted with their terminations, when left to the unassisted efforts of nature." Exclusive attention to the physical condition and factors, or to the mental condition and factors, or concentration on one theory or one form of treatment to the exclusion of all others is sure to lead to neglect of that careful general inquiry into the whole personality of the patient, into the conditions out of which his disorder arose, and into all the manageable factors in the situation which is so essential to intelligent and effective treatment. Notwithstanding the great benefit which has been derived from physical measures in the study and treatment of mental disorders, and the well-founded hopes of greater advances in this direction, the main task still continues to be what Pinel calls the management of the mind. Experience and increasing knowledge show that this is a task which can only be successfully performed by the physician and by means of organized resources which are under medical direction and control. The hospital for mental disorders furnishes the means of providing social as well as individual treatment. It is a medical mechanism and for its proper management and use it is required of physicians that they accept the burden of much executive work and give their attention to many subjects and activities that may interfere seriously with what they have been taught to regard as more strictly professional interests. Like Pinel, one must be willing to forget the empty honor of one's titular distinction as a physician, and do whatever may be necessary to make the institution a truly medical agency for the healing of the sick. Considerable progress has been made in developing executive assistants to relieve the physicians of much of the administrative work which requires little or no medical supervision and direction. Special provision for the training of such executives has, however, received insufficient attention. This question might, with great advantage, be taken up by the hospitals and colleges. Nothing would add more to the quality of the service which the hospitals render than to supplement the work of the physicians by that of well educated and highly trained executive assistants who would themselves find an extremely interesting and productive field for their efforts.

A period has now been reached in this field of work when what amounts to a movement not inferior in significance and importance to that of a hundred years ago, seems to be in active operation. The character and scope of this movement and the lines of its progress have, to some extent, been indicated in the illuminating formulations which have been presented here to-day. The medical study and treatment of the mind is no longer so exclusively confined within the walls of institutions nor to the type or degree of disorder which necessitates compulsory seclusion. Psychiatry is extending out from the institutions into the communities by means of out-patient clinics and social workers, through newly created organized agencies, through informed individuals, physicians, nurses, and lay workers, and through the general spread of psychiatric knowledge. This process is being expedited by the efforts of organized bodies such as the National and State Committees and Societies for Mental Hygiene, and the public is rapidly learning what can properly be expected of institutions, officials, physicians, nurses, and other responsible individuals in whom special knowledge and ability are supposed to be found. As in the prevention of tuberculosis, so, in the prevention of mental disorders, the informed public is likely to start a campaign which the medical profession may have to make haste to follow in order to maintain its needed leadership. Although much is yet required to improve the facilities necessary in carrying on the present work, it seems to us that at such a time a further extension of the activities of an institution such as Bloomingdale Hospital may be necessary to enable it to fulfil its possibilities for greater usefulness. To extend the work our experience indicates that a department in the city at the General Hospital would be of great advantage. During the past few years the oversight of discharged patients has grown to such an extent that it seems as though some organized method of carrying it on may soon become necessary. This and out-patient work generally could be best attended to in a city department. Much emergency work and preliminary observation and the treatment of certain types of cases now frequently subjected to unfortunate delays, neglect, and unskilful treatment would also be thus provided for. It can be seen too that developments in construction and organization which would furnish organized treatment for types of disorders which are not so incapacitating as the pronounced psychoses might be of advantage in the treatment of both adults and children. The property on which the Hospital is located is large enough to permit of further extensions and developments which could be as closely connected with, or as widely separated and distinguished from, the present provision as circumstances required. In this way much needed provision for the treatment of persons suffering from the psychoneuroses and minor psychoses could be furnished. Better provision for a further period of readjustment after a patient is ready to leave the Hospital but not yet ready to face the risk of ordinary conditions in the community is a felt want. A group of supervised homes or an occupational colony might best serve this purpose. The more extensive use of the Hospital as a teaching centre is also a subject for consideration. A School for Nurses is now conducted, and much instruction is given in the occupational departments. More, however, could be done, especially in medical teaching, which could be best carried on in a department in the city and would tend to advance the standard of medical service throughout the Hospital.

The lines of further development are, perhaps, not yet perfectly clear in all directions. It seems certain, however, that they will lead toward a broader field of usefulness, in which the hospital will be regarded as a responsible agency for dealing with psychiatric problems in the community which it serves and will take part with other agencies in extending psychiatric knowledge and in applying it to prevention, and to the management of mental disorders as an individual and social problem beyond the walls of the institution. We hope that this meeting will prove a real starting point for this development. We are greatly indebted to those who have taken part in it both as speakers and as audience. We are especially indebted to those who came across the sea to be with us. It is peculiarly fitting that representatives of France and of England should have been here, for to Pinel, the Frenchman, and to Tuke, the Englishman, are due more than to any others whose names we know the foundations of the modern institutional treatment of mental disorders.



The Chairman: This, ladies and gentlemen, concludes our exercises. As the representative of the Governors, I find it quite impracticable, in supplementing what Dr. Russell has just said, to express adequately our admiration of and gratitude to these eminent scientists and apostles of light for their presence here and for their inspiring addresses. These, if I may be permitted to appraise them, seem to make a notable addition to medical literature, and, with the permission of their authors, we purpose, for our own gratification and for the benefit of the profession, to have all of the addresses preserved in a volume recording this centenary celebration. In due course a copy of this volume will be sent to each of our guests. The celebration itself, I think you will all agree with me, has been a moving one, with an underlying note of philanthropic endeavor as high as the stars. You heard its refrain in the pageant on the lawn this afternoon. As I have listened to-day to these words of profound wisdom, uttered in so noble a spirit of human ministry, my mind has gone back to the sentence from Cicero's plea for Ligarius,[18] which formed the text for Dr. Samuel Bard's eloquent appeal in 1769, mentioned this morning, for the establishment of the New York Hospital, and which may be freely rendered, "In no act performed by man does he approach so closely to the Gods as when he is restoring the sick to the blessings of health." And surely when that restoration to health consists in "razing out the written trouble of the brain" and reviving in the patient the conscious exercise of divine reason, it is difficult to imagine a more Godlike act.

FOOTNOTES:

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



THE TABLEAU-PAGEANT



SYNOPSIS

While the Symbolic Father Time bears witness, the Muse of History, as the Narrator, after alluding to the remote past, briefly summarizes the incidents leading up to the establishment of the Society of the New York Hospital by Royal Charter in 1771. The succeeding scenes are self-revealing. The familiar picture of Pinel at Salpetriere depicts conditions in that period. Several portraits of personalities intimately associated with the early history of Bloomingdale Hospital follow. These, together with an episode from the life of Dorothy Dix, stimulate our imagination with reference to the revival of interest in the care of the mentally ill in the first half of the last century. The closing scenes suggest the great advance which has taken place during the century, and the part that work and play take to-day in re-establishing and maintaining life's balances. Finally, in symbolic processional, tribute is paid to Hygeia, the goddess of Health and Happiness.

CHARACTERS AND SCENES IN TABLEAU-PAGEANT

Music: Orchestra Overture

Prologue

The Muse of History (Narrator): Adelyn Wesley Spirit of the Past (Time): Dr. D. Austin Sniffen

Music: Orchestra "Amaryllis"

SCENE I

COURT OF KING GEORGE III.—GRANTING OF THE CHARTER

Characters: King George III Queen Charlotte Prince of Wales Court Chamberlain Court Ladies Emissaries Cherokee Chief Gavot

Minuet

Through dramatic license, this scene takes place in the Court of King George III. Colonial emissaries, accompanied by a North American Indian, attend, and are graciously granted by the King a Royal Charter establishing the Society of the New York Hospital, along with a seal, insignia, and a money gift. A bit of color and romance attaches to the Cherokee's appearance in the scene.

Music: Orchestra "God Save the King" "Minuet Don Juan" "Largo" "Amaryllis"

SCENE II

PINEL A LA SALPETRIERE [Transcriber's note: original reads 'SALPTERIERE']

Characters: Pinel Patients Aides and Attendants

A courtyard scene in Salpetriere in 1792. Hopelessness and chained despair are pictured. Pinel enters, is saddened and indignant at the sight of so much unnecessary suffering, and instantly orders the chains to be struck off. The historic episode closes in a graphic tableau depicting the gratitude of the released.

Music: Orchestra "Kammenoi Ostrow"

SCENE III

PORTRAITS—PERSONALITIES OF THE PAST

Thomas Eddy, of the Board of Governors, 1815-1827.

Dr. James Macdonald, First Resident Physician, 1825-1837.

Dr. Pliny Earle,[Transcriber's note: original reads 'Early'] Organizer, 1844-1849.

Miss Eliza Macdonald, daughter of Dr. Macdonald, unveils the portrait of her father.

Music: Orchestra "Long, Long Ago"

SCENE IV

DOROTHY LYNDE DIX BEFORE A LEGISLATIVE COMMITTEE

Characters: [This instance of 'Characters:' added by transcriber] Dorothy L. Dix Members of the Committee Chairman

Miss Dix appears before a Committee of the Legislature and is heard in an impassioned appeal on behalf of adequate provision and care for the mentally ill. The scene closes with the Committee indicating their approval and congratulating Miss Dix on her successful effort.

Music: Orchestra "Maryland, My Maryland" "Columbia, the Gem of the Ocean"

SCENE V

OCCUPATIONAL-RECREATIONAL ACTIVITIES

Men's Crafts Women's Crafts Men's Sports Women's Sports

Maypole Dance

Supplementing the general medical work, the therapeutic value of organized occupational and recreational activities is gaining increasing recognition. Those arts and crafts lending themselves to graphic presentation are here selected: dyeing, weaving, spinning, basketry, caning, modelling, painting, pottery, metal work, net making, gardening, etc.: and similarly, in the recreative activities, tennis, golf, hockey, baseball, croquet, bowling, skiing, and skating. A Maypole dance closes the scene.

Music: Orchestra "Boccherina" "Henry VIII, Maypole Dance"

SCENE VI

INSPIRATIONS

Characters: Hygeia La Belle France Britannia Columbia

The closing scene is in the nature of a processional symbolizing international unity of purpose and a determination to pursue, until finally attained, the goal of Health and Happiness, personified by the goddess Hygeia.

Music: Orchestra "Marseillaise" "God Save the King" "Battle Hymn of the Republic" "The Star Spangled Banner" "Tammany"



NAMES OF THOSE WHO ATTENDED THE EXERCISES[19]

E. Stanley Abbot, M.D. Philadelphia, Pa. Louise Acton White Plains, N.Y. Elizabeth I. Adamson, M.D. White Plains, N.Y. William H. Allee, M.D. Ridgefield, Conn. Thaddeus H. Ames, M.D. New York City. Mrs. George S. Amsden White Plains, N.Y. Mrs. Isadora Anschutz White Plains, N.Y. Grosvenor Atterbury New York City.

Pearce Bailey, M.D. New York City. Amos T. Baker, M.D. Bedford Hills, N.Y. Mrs. Amos T. Baker Bedford Hills, N.Y. Lewellys F. Barker, M.D. Baltimore, Md. Clifford W. Beers New York City. Christopher C. Beling, M.D. Newark, N.J. Harrison Betts, M.D. Yonkers, N.Y. Anna T. Bingham, M.D. New York City. Mrs. Martha Bird Middletown, N.Y. Charles E. Birch, M.D. White Plains, N.Y. J. Fielding Black, M.D. White Plains, N.Y. Mrs. J. Fielding Black White Plains, N.Y. G. Alder Blumer, M.D. Providence, R.I. Leonard Blumgart, M.D. New York City. J. Arthur Booth, M.D. New York City. Miss Helen Booth New York City. S.M. Boyd Scarsdale, N.Y. Mrs. S.M. Boyd Scarsdale, N.Y. Mrs. Sidney C. Borg New York City. Rose Bell Bradley New York City. V.C. Branham, M.D. New York City. Holly Brown White Plains, N.Y. Helen Brown, M.D. New York City. Sanger Brown, 2d, M.D. New York City. Miss Elizabeth O. Buckingham Chicago, Ill. Alfred C. Buckley, M.D. Frankford, Philadelphia, Pa. Alice Gates Bugbee, M.D. White Plains, N.Y. Jesse C.M. Bullowa, M.D. New York City. William Browning, M.D. Brooklyn, N.Y. Marie von H. Byers New York City. Karl M. Bowman, M.D. White Plains, N.Y. Mrs. Karl M. Bowman White Plains, N.Y. Edna L. Byington White Plains, N.Y.

C.N.B. Camac, M.D. New York City. C. Macfie Campbell, M.D. Boston, Mass. Mrs. C. Macfie Campbell, M.D. Boston, Mass. Robert Carroll, M.D. Asheville, N.C. Mrs. Robert Carroll Asheville, N.C. Louis Casamajor, M.D. New York City. Ross McC. Chapman, M.D. Towson, Md. Helen Childs White Plains, N.Y. Mrs. Anne Choate Pleasantville, N.Y. E.H. Clarke New York City. Miss Marjory Clark, R.N. New York City. Joseph Collins, M.D. New York City. Michael Collins White Plains, N.Y. Arthur S. Corwin, M.D. Rye, N.Y. Mrs. Margaret Cornwell New Rochelle, N.Y. Henry A. Cotton, M.D. Trenton, N.J. Edith Cox White Plains, N.Y. C. Burns Craig, M.D. New York City. Henry W. Crane New York City. Raymond S. Crispell, M.D. New York City. Mrs. Seymour Cromwell Mendham, N.Y. Hugh S. Cummings, M.D., Surgeon-General U.S. Public Health Service Washington, D.C.

Charles L. Dana, M.D. New York City. Thomas K. Davis, M.D. New York City. Henderson Brooke Deady, M.D. New York City. John W. Dean White Plains, N.Y. Mrs. Aline S. Devin Eliot, Maine. Allen Ross Diefendorf, M.D. New Haven, Conn. William Elliott Dold, M.D. Astoria, L.I., N.Y. George Drake White Plains, N.Y. John W. Draper, M.D. New York City. Nataline Dullas White Plains, N.Y. Charles S. Dunlap, M.D. New York City. Mrs. Alfred F. DeNike White Plains, N.Y.

R. Condit Eddy, M.D. New Rochelle, N.Y. Joseph P. Eidson, M.D. White Plains, N.Y. Mrs. Emma Eldridge Tuckahoe, N.Y. Charles A. Elsberg, M.D. New York City. William Else, M.D. New York City. Everett S. Elwood, Secretary State Hospital Commission Albany, New York.

Mrs. Ezra H. Fitch New York City. Ralph P. Folsom, M.D. New York City. Harold E. Foster, M.D. Boston, Mass. Diana Fowler White Plains, N.Y. Florence Fuller White Plains, N.Y. Isaac J. Furman, M.D. New York City.

Leslie Gager, M.D. New York City. William C. Garvin, M.D. Kings Park, N.Y. Arnold Gesell, M.D. New Haven, Conn. Bernard Glueck, M.D. New York City. J. Riddle Goffe, M.D. New York City. S. Philip Goodhart, M.D. New York City. Miss Annie W. Goodrich, R.N. New York City. Phyllis Greenacre, M.D. Baltimore, Md. Menas S. Gregory, M.D. New York City. Miss Pauline P. Gunderson White Plains, N.Y.

Louis J. Haas White Plains, N.Y. Thomas H. Haines, M.D. New York City. Miss Dorothy Hale New York City. Miss Natalie Hall White Plains, N.Y. Robert B. Hammond, M.D. White Plains, N.Y. Miss Elisa Hansen White Plains, N.Y. Milton A. Harrington, M.D. Alfred, N.Y. Isham G. Harris, M.D. Brooklyn, N.Y. George A. Hastings New York City. Winifred Hathaway New York City. Edna Haverstock White Plains, N.Y. C. Floyd Haviland, M.D. Middletown, Conn. F. Ross Haviland, M.D. Brooklyn, N.Y. Charles E. Haynes, M.D. New York City. Eunice W. Haydon New York City. Miss Katherine F. Hearn, R.N. White Plains, N.Y. Edna Hemingson White Plains, N.Y. George W. Henry, M.D. White Plains, N.Y. Mrs. George W. Henry White Plains, N.Y. Marcus B. Heyman, M.D. New York City. Beatrice M. Hinkle, M.D. New York City. L.E. Hinsie, M.D. New York City. P.F. Hoffman, M.D. White Plains, N.Y. John F. Holden, M.D. White Plains, N.Y. Hubert S. Howe, M.D. New York City. Thomas Howell, M.D. New York City. J. Ramsay Hunt, M.D. New York City. Helen Hunt White Plains, N.Y. Miss Augusta M. Huppuch New York City. Richard H. Hutchings, M.D. Utica, N.Y.

Frank N. Irwin, M.D. New York City.

Martha Joffe White Plains, N.Y. Walter B. James, M.D. New York City. Mrs. Walter James White Plains, N.Y. Professor Pierre Janet, M.D. Paris, France. Madame Pierre Janet Paris, France. M.E. Jarvis, M.D. New York City. Rev. Oscar Jarvis White Plains, N.Y. Walter Jennings Cold Spring Harbor, L.I., N.Y. Miss Gudron Johannessen, R.N. White Plains, N.Y. Miss Marguerite Jewell White Plains, N.Y. Miss Florence M. Johnson. New York City. Kenneth B. Jones, M.D. Thiells, N.Y. Miss Minnie Jordan, R.N. New York City.

Mrs. De Lancey A. Kane New Rochelle, N.Y. Lilian A. Kelm New York City. James P. Kelleher, M.D. New York City. Foster Kennedy, M.D. New York City. Marion E. Kenworthy, M.D. New York City. John Joseph Kindred, M.D. Astoria, L.I., N.Y. George W. King, M.D. Secaucus, N.J. Hermann G. Klotz, M.D. White Plains, N.Y. George W. Kline, M.D. Boston, Mass. George H. Kirby, M.D. New York City. Henry Klopp, M.D. Allentown, Pa. Augustus S. Knight, M.D. New York City. Frank Henry Knight, M.D. White Plains, N.Y. Mary S. Kirkbride Albany, N.Y. Walter M. Kraus, M.D. New York City. Edward J. Kempf, M.D. New York City.

Alexander Lambert, M.D. New York City. Charles I. Lambert, M.D. White Plains, N.Y. Mrs. Charles I. Lambert White Plains, N.Y. Arthur G. Lane, M.D. Greystone Park, N.J. G. Alfred Lawrence, M.D. New York City. W.A. Lawrence, M.D. White Plains, N.Y. Ruth W. Lawton White Plains, N.Y. Helen Letson White Plains, N.Y. Samuel Leopold, M.D. Philadelphia, Pa. Maurice J. Lewi, M.D. New York City. Mrs. Maurice J. Lewi New York City. Miss Ella H. Lowe White Plains, N.Y. Walter E. Lowthian, M.D. White Plains, N.Y. F.R. Lyman, M.D. Hastings-on-Hudson, N.Y. Samuel B. Lyon, M.D. New York City. Winslow Lyon New York City.

William H. McCastline, M.D. New York City. John T. McCurdy, M.D. New York City. Carlos F. MacDonald, M.D. New York City. D.W. McFarland, M.D. Greens Farms, Conn. Miss Eliza Macdonald Flushing, L.I., N.Y. John W. Mackintosh White Plains, N.Y. Daniel W. Maloney White Plains, N.Y. Grace F. Marcus, M.D. White Plains, N.Y. L. Markham, M.D. Amityville, N.Y. Miss Anna Maxwell, R.N. New York City. John F.W. Meagher, M.D. Brooklyn, N.Y. Adolf Meyer, M.D. Baltimore, Md. Carlos J. Miller, M.D. White Plains, N.Y. Henry W. Miller, M.D. Brewster, N.Y. Mrs. R. Van C. Miller New York City. George W. Mills, M.D. Central Islip, N.Y. Henry Moffett, M.D. Yonkers, N.Y. Mrs. Maude G. Moody New York City. Miss Madeline Moore White Plains, N.Y. Joseph W. Moore, M.D. Beacon, N.Y. Eugene T. Morrison, M.D. New Rochelle, N.Y. Miss Cecil Morrison White Plains, N.Y. Richard W. Moriarty, M.D. White Plains, N.Y. Herman Mortensen, R.N. White Plains, N.Y. Walter W. Mott, M.D. White Plains, N.Y. Florence Munn White Plains, N.Y.

Theodore W. Neumann, M.D. Central Valley, N.Y. Ethan A. Nevin, M.D. Newark, N.J. Miss Christine M. Nuno New York City.

George O'Hanlon, M.D. New York City. James M. O'Neill Harrison, N.Y. Herman Ostrander, M.D. Kalamazoo, Mich. Mary F. O'Grady White Plains, N.Y.

Flavius Packer, M.D. Riverdale, N.Y. Mrs. Flavius Packer Riverdale, N.Y. Irving H. Pardee, M.D. New York City. Jason S. Parker, M.D. White Plains, N.Y. Frederick W. Parsons, M.D. Buffalo, N.Y. Miss Margaret Patin White Plains, N.Y. Stewart Paton, M.D. Princeton, N.J. Christopher J. Patterson, M.D. Troy, N.Y. Guy Payne, M.D. Cedar Grove, N.J. Arthur M. Phillips, M.D. New York City. Charles W. Pilgrim, M.D., Chairman, State Hospital Commission, N.Y. Central Valley, N.Y. Mason Pitman, M.D. Riverdale-on-Hudson, N.Y. Miss Leah Pitman White Plains, N.Y. Miss Adele S. Poston, R.N. White Plains, N.Y. Howard W. Potter, M.D. Thiells, N.Y. Wilson M. Powell New York City. Mrs. Margaret J. Powers New York City. Miss Nina Prey New York City. W.B. Pritchard, M.D. New York City. Morton Prince, M.D. Boston, Mass. Rose Pringle, M.D. White Plains, N.Y. Sylvanus Purdy, M.D. White Plains, N.Y.

Paul R. Radosvljevich, M.D. New York City. E. Benjamin Ramsdell, M.D. New York City. Edwin G. Ramsdell, M.D. White Plains, N.Y. Mortimer W. Raynor, M.D. New York City. Lawrence F. Rainsford, M.D. Rye, N.Y. Mrs. Lawrence F. Rainsford Rye, N.Y. Henry A. Riley, M.D. New York City. Miss Elise Reilly White Plains, N.Y. Frank W. Robertson, M.D. New York City. M.A. Robinson, M.D. New York City. William C. Roden, R.N. White Plains, N.Y. A.J. Rosanoff, M.D. Kings Park, N.Y. Miss Catherine Ross, R.N. White Plains, N.Y. John T.W. Rowe, M.D. New York City. Richard G. Rows, M.D. London, England. Frederick D. Ruland, M.D. Westport, Conn. William L. Russell, M.D. White Plains, N.Y. Mrs. William L. Russell White Plains, N.Y. Earnest F. Russell, M.D. New York City. Paul L. Russell White Plains, N.Y. Mrs. Paul L. Russell White Plains, N.Y. Walter G. Ryon, M.D. Poughkeepsie, N.Y. Miss Helen K. Ryce Poughkeepsie, N.Y.

Miss Helen Sayre White Plains, N.Y. Thomas W. Salmon, M.D. New York City. Mrs. Thomas W. Salmon New York City. Irving J. Sands, M.D. Brooklyn, N.Y. James P. Sands, M.D. Philadelphia, Pa. William C. Sandy, M.D. New York City. Miss E. Saul New York City. William G. Schauffler, M.D. Princeton, N.J. Paul Schlegman, M.D. White Plains, N.Y. H. Ernest Schmid, M.D. White Plains, N.Y. Miss Gertrude Schmid White Plains, N.Y. Augusta Scott, M.D. New York City. Major Louis L. Seaman, M.D. New York City. Edward W. Sheldon New York City. George Sherrill, M.D. Stamford, Conn. Miss Eloise Shields, R.N. White Plains, N.Y. Lewis M. Silver, M.D. New York City. Mrs. A. Slesingle New York City. Mrs. Anna C. Schermerhorn New York City. Rev. Frank H. Simmonds White Plains, N.Y. Clarence J. Slocum, M.D. Beacon, N.Y. Mrs. Clarence J. Slocum Beacon, N.Y. Augustine J. Smith New York City. Miss M. Smith, R.N. Titusville, Pa. Philip Smith, M.D. New York City. Rev. George H. Smyth Scarsdale, N.Y. D. Austin Sniffen, D.D. White Plains, N.Y. John D. Southworth, M.D. New York City. Edith E. Spaulding, M.D. New York City. M. Allen Starr, M.D. New York City. Samuel A. Steele White Plains, N.Y. William Steinach, M.D. New York City. George S. Stevenson, M.D. New York City. Adolf Stern, M.D. New York City. Emil Strateman White Plains, N.Y. Israel Strauss, M.D. New York City. Frank K. Sturgis New York City. Miss Mary Ruth Swann, R.N. Washington, D.C. C.C. Sweet, M.D. Ossining, N.Y. Sarah Swift White Plains, N.Y.

William B. Terhune, M.D. New Haven, Conn. William J. Tiffany, M.D. New York City. Walter Clark Tilden, M.D. Hartsdale, N.Y. Frederick Tilney, M.D. New York City. Walter Timme, M.D. New York City. Howard Townsend New York City. E. Clark Tracy, M.D. White Plains, N.Y. Walter L. Treadway, M.D. Washington, D.C. Miss Gertrude Trefrey, R.N. White Plains, N.Y.

Miss Mary G. Urquhart White Plains, N.Y.

J.L. Van deMark, M.D. Albany, N.Y. T.J. Vosburgh, M.D. White Plains, N.Y. Henry J. Vier, M.D. White Plains, N.Y.

Emory M. Wadsworth, M.D. Brooklyn, N.Y. Miss Lillian D. Wald, R.N. New York City. Professor Howard C. Warren Princeton, N.J. Mrs. Caroline E. Washburn White Plains, N.Y. Miss Martha Washburn White Plains, N.Y. G.F. Washburne, M.D. Hastings-on-Hudson, N.Y. Chester Waterman, M.D. New York City. James J. Waygood, M.D. White Plains, N.Y. Mrs. James J. Waygood White Plains, N.Y. R.G. Wearne, M.D. New York City. Edward W. Weber, M.D. White Plains, N.Y. Israel S. Wechsler, M.D. New York City. Miss Kathryn I. Wellman. White Plains, N.Y. Mrs. Adelyn Wesley New York City. Lt. Col. Arthur W. Whaley, M.D. New York City. Mrs. Arthur W. Whaley New York City. Miss Margaret Wheeler Short Hills, N.J. Payne Whitney New York City. Frankwood E. Williams, M.D. New York City. Rodney R. Williams, M.D. Poughkeepsie, N.Y. O.J. Wilsey, M.D. Amityville, N.Y. John E. Wilson, M.D. New York City. Miss A. Wilson New York City. J.M. Winfield, M.D. Brooklyn, N.Y. G. Howard Wise New York City. Miss Frances E. Wood White Plains, N.Y. Robert C. Woodman, M.D. Middletown, N.Y. Robert S. Woodworth, Ph.D. New York City.

Rev. John C. York Brooklyn, N.Y.

Edwin G. Zabriskie, M.D. New York City. Charles C. Zacharie, M.D. White Plains, N.Y.

FOOTNOTES:

[Footnote 19: If any names are omitted it is because these names and addresses were not obtained.]



APPENDICES



APPENDIX I

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

May 5th, 1921.

DEAR DR. RUSSELL:

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

We have looked through the Minutes, which are complete from the opening of the Retreat in 1796, and also examined a large number of original letters of William and Samuel Tuke respecting the Institution, but have not succeeded in tracing the letter from S. Tuke to William Eddy, to which you refer. As you are probably aware, S. Tuke was the grandson of William Tuke, the founder, and when he published the History of the Retreat in 1812 he was but twenty-eight years of age. This book had a far-reaching influence on the treatment of the insane, and it is remarkable that a man untrained in medicine and without university education should have been able to write it. The book is now very rare, but as we have three duplicate copies, I am authorized by the Directors of the Retreat to present your Hospital with one of them. I have already sent you a copy of an address of my own dealing with Psychiatry in England at about the time your Hospital was instituted.

The use of the term "moral treatment" as opposed to treatment of physical disease has in recent years become especially interesting. It is clear that Tuke and Pinel foresaw that psychotherapeutic treatment is necessary, and their efforts were directed towards providing effective "sublimation" of misdirected psychical energy.

One is pleased to see in your report the extent to which organized occupations are developed at Bloomingdale—a pleasure not unmixed with envy at seeing the picture of the men's occupational pavilion, and the prospective erection of a similar building for women.

In the early days of the Retreat large numbers of visitors came from all parts of the world. There is a gap in the Visitors' Book between 1800-1815, and the list of visitors is not complete.

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

May I congratulate you on the centenary of your Hospital and also congratulate you and the Governors on its remarkable development and progress. Here at the Retreat we carry on using the original buildings still, striving to give our patients modern treatment in premises now almost ancient, but which do not appear so out of date in this City of York. York congratulates New York upon its wonderful prosperity, and we gladly recognize its development in the practice of psychiatry fully corresponds with its development in other directions.

I remain,

Yours sincerely,

BEDFORD PIERCE.

EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE RETREAT

The Retreat, York

Meeting of Directors held on April the 30th, 1921

Copy of Minute No. 8

At this Meeting of the Directors and Agents of York Retreat we hear with pleasure that the Bloomingdale Hospital, the section of the Society of the New York Hospital devoted to the Treatment of Mental Diseases, is to celebrate next month the centenary of its foundation. The facsimile reproduction of the letter of Thomas Eddy which has been presented to the Retreat Library is specially interesting to us as it acknowledges the pioneer work at the Retreat and specially refers to correspondence with Samuel Tuke. We have pleasure in sending to the Governors of the Bloomingdale Hospital a copy of Samuel Tuke's classical work "The Description of the Retreat" in the belief that the principles therein set forth are of lasting importance. We send our hearty congratulations to the Bloomingdale Hospital on its century of good work and wish it every success in the future.

Signed,

CHARLES WEOMANS, Chairman.

OSCAR F. RUMLEN, Treasurer.

* * * * *

TRANSCRIPT FROM THE VISITORS BOOK OF THE RETREAT

EARLY AMERICAN VISITORS

1803. 3 mon 11th. Abrm. Barker, New Bedford, Massachusits, a young man (a Friend) on a tour; has been in Russia, Denmark, Sweden & Holland. (In William Tuke's writing)

1815. Nov. 30. John W. Francis, M.D. of N. York. J.W. Francis is not wholly ignorant of the State of the Lunatic Asylums in North America, and he has visited almost all the institutions for the Insane that are established in England. He now embraces this opportunity of stating that after an examination of the Retreat for some hours, he should do injustice to his feelings were he not to declare that this establishment far surpasses anything of the kind he has elsewhere seen, and that it reflects equal credit on the wisdom and humanity of its conductors.

Perhaps it is no inconsiderable honour to add that institutions of a similar nature and on the same plan are organizing in different parts of the United States. The New World cannot do better than imitate the old so far as concerns the management of those who labour under mental infirmities. J.W.F.

1816. 1 Mon 4. Sharon Carter, Philadelphia.

1816. 1 mon. Wm. S. Warder, from Philadelphia.

1816. 2 mon 21. Rev. Thomas H. Gallaudet, who visits Europe for the purpose of qualifying himself to superintend an Asylum for the Deaf and Dumb, proposed to be established in Hartford, Connecticut, of the United States of America.

1816. 4 mon 8th. Archibald Gracie, Junr., New York.

1816. April 29th. George F. Randolph, Philadelphia. John Hastings, Baltimore.

1816. 6 mon 19th. Charles Longstreth, from Philadelphia.

1816. 6 mon 19th. Jacob Smedley, from Philadelphia.

1817. 7 mon. Henry Kollock, of Savannah, Georgia. Dr. Wm. Parker, Savannah. G.C. Versslanchi, of New York.

1817. 11/24. Hannah Field, North America, with Elizabeth Fry.

1817. 12 Mo. G.J. Browne, United States of America (Cincinnati).



In 1815 Thomas Eddy, one of the Governors of the Society of the New York Hospital, presented a communication in which he advocated the establishment in the country of a branch for the moral treatment of the insane. This led to the establishment of Bloomingdale Asylum.]

FOOTNOTES:

[Footnote 20: Bloomingdale Hospital Press.]



APPENDIX II

A LETTER ON PAUPER LUNATIC ASYLUMS[21]

The Governors of the New York Hospital, conceiving that the very judicious remarks and sentiments contained in the following letter, might be highly useful to the community, as well as to the institution with which they are connected, have requested the same to be published. The work alluded to in the letter, called, "Practical hints on the construction and economy of Pauper Asylums," is believed to be one of the most valuable and interesting works of the kind ever published. This work was sent by the author to one of the Governors, and is now deposited in the Hospital library. It is very desirable that it should be republished in this country; but as such republication would be expensive, on account of the few copies that would be wanted, the Governors have directed, that if any person, or trustees of any public institution, in any part of the United States, should be desirous of obtaining a copy of this very valuable work, with a view to aid them in erecting a similar Asylum, or the improvement of any already established, that a manuscript copy shall be furnished them, upon an application to the subscriber,

THOMAS EDDY.

New-York, 12th month, 30th, 1815.

YORK, 7mo. 17th, 1815.

To Thomas Eddy,

Our mutual friend, L. Murray, has put into my hands a letter and pamphlet, lately received from thee, respecting the erection of an asylum for lunatics near New-York.[22] He has wished me to make any remarks which may occur to me on the perusal; but, having just published a few hints on the construction and economy of Pauper Lunatic Asylums, which contain much of the information thou requests, I shall have but little to add. Those hints, however, relating to institutions for the poorest class of society, must be applied with some modifications to establishments for persons of different pervious habits, and for whom a greater portion of attendance can be afforded. The great objects, however, which are stated in the hints to be so important for the comfort of lunatics, apply equally to those of all ranks and classes.

From the sum you propose to receive from the patients, intended to occupy the new building, I conclude you are providing for patients of the middle ranks of life, a class hardly less to be commiserated, when thus afflicted, than the very poorest, since the expense and difficulty of private management, may bring to ruin a respectable family, as well as expose it to great personal dangers. There would, I think, be considerable objection to the accumulation of 40 patients of this class, in three contiguous rooms, as proposed in the hints for pauper lunatics. You purpose building for 50 patients, and as you probably intend to accommodate both sexes, the number of each sex may be very suitable for the accommodation of three contiguous rooms, which, of course, need not be so large as those in the Wakefield Asylum. It would be difficult to offer a detailed plan, without knowing more than we do of your local circumstances, and the classes of patients you purpose to admit. I doubt, however, whether you can do better than to adopt the general form of the Wakefield Asylum, and as you are providing for only a small number, it deserves consideration whether all the rooms might not be advantageously placed on the ground floor. This plan affords great facilities to easy inspection, and safe communication with airing grounds, and the roof might project so far over the building, as to form an excellent collonnade for the patients; which seems peculiarly desirable under an American Sun.

With these views, I send a sketch drawn by the Architect whose plan is to be adopted at Wakefield; and though it may not be, in many respects, adapted to your particular wants, yet I hope it will not be altogether useless. Should it be thought too expensive, I think the rooms, 1, 2, and 3, might be dispensed with, and rooms marked "attendants, sick and bath," might be appropriated to the patients during the day. The attendants room is not a requisite, though it has been thought that it would be more agreeable to patients of superior rank, not to have the society of a servant. This, however, chiefly applies to the convalescents, and these might occupy the room marked 'sick', whilst the middle class, and the attendants, would be in the centre, marked "attendants." A sick and bath room might probably be obtained in the galleries: if you are inclined for the sake of appearance, to make the centre building two stories high, you might bring the wings nearer to the centre, and accommodate most of the convalescent patients with bed rooms in the upper story. In this case, perhaps it would be desirable to give the wings a radiating form. You will however be best able to modify the sketch to your particular wants, if the general idea should meet your approbation.

I observe with pleasure, that one leading feature of your new institution, is the introduction of employment amongst the patients, an object which I am persuaded is of the utmost importance in the moral treatment of insanity. It is related of an institution in Spain, which accommodated all ranks, and in which the lower class were generally employed, that a great proportion of these recovered, whilst the number of the Grandees was exceedingly small. It will however, require great address to induce patients to engage in manual labour, who have not been accustomed to it previously to their indisposition, and it must be admitted, that where the reluctance on the part of the patient is great, the irritation which compulsory means are likely to excite, will probably be more injurious to the patient, than the exercise will be beneficial. The employment of insane persons should, as far as it is practicable, be adapted to their previous habits, inclinations and capacities, and, though horticultural pursuits may be most desirable, the greatest benefit will, I believe, be found to result from the patient being engaged in that employment in which he can most easily excel, whether it be an active or a sedentary one. If it be the latter, of course sufficient time should be allotted to recreation in the air. Some persons imagine, that exercises of diversion, are equally beneficial with those that are useful. The latter appear to me to possess a decided preference, by imparting to the mind that calm feeling of satisfaction, which the mere arts of amusement, though not to be neglected, can never afford. To the melancholy class, this is an important distinction between amusing and useful employments, and labour is to be prefered for the maniacal class as less calculated to stimulate the already too much excited spirits.

It is proposed that the new asylum should be placed a few miles from the city. The visitors to it, (I do not mean the medical ones) will, I presume, be residents in New-York, and from what I have seen of the zeal of persons under such appointments in this country, it appears desirable, to render the performance of this duty, so important for the welfare of asylums, as easy as it can be with propriety. One mile perhaps would not be objectionable, and might probably afford as good air and retirement, as a greater distance.

I need hardly say, I was much gratified to find by the pamphlet, that the importance of moral treatment in the cure of insanity, was duly appreciated in America. When we consider, as Lord Bacon observes, speaking of common diseases, that "all wise physicians in the prescription, of their regimen to their patients, do ever consider accidentia animi, as of great force to further or hinder remedies or recoveries;" it is difficult to account for the general neglect of moral considerations in the treatment of deranged mind. I hope, however, though in many instances medicine may not be employed with advantage, and its indiscriminate use has been seriously injurious, that we shall not abandon it as altogether useless, in what we term disease of the mind. All the varieties, included under this general term, have been produced by physical causes: by external accidents, by intoxication, the improper use of medicines, repelled eruptions, obstructed secretions, &c. In some instances, dissection has discovered, after death, the cause of the mental affection, and though, in many instances, no physical cause can be detected, yet, when it is considered, how limited are the investigations of the anatomist, and that the art is so imperfect, that diseases occasioning instant death, cannot always be discovered on the most minute dissection, it is not unreasonable to suppose, that the body is in all cases the true seat of the disease.

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

I hope my unknown friend will excuse the length and freedom of this letter: its length has much exceeded my intentions, yet I may have omitted information which the experience of the Retreat might afford, and which would have been useful to promoters of the New-York Asylum, Should this be the case, I shall be glad to answer, as well as I am able, any questions which they may propose; and, with the best wishes for the success of their benevolent and important undertaking,

I remain, respectfully,

Thy friend,

SAMUEL TUKE.

FOOTNOTES:

[Footnote 21: A letter on Pauper Lunatic Asylums, by Samuel Tuke, New York, 1815. Reprinted Bloomingdale Hospital Press, June 3, 1919.]

[Footnote 22: Appendix III.]



APPENDIX III

THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815[23]

Of the numerous topics of discussion on subjects relating to the cause of humanity, there is none which has stronger claims to our attention, than that which relates to the treatment of the insane.

Though we may reasonably presume, this subject was by no means overlooked by the ancients, we may fairly conclude, it is deservedly the boast of modern times, to have treated it with any degree of success.

It would have been an undertaking singularly interesting and instructive, to trace the different methods of cure which have been pursued in different ages, in the treatment of those labouring under mental derangement: and to mark the various results with which they were attended. The radical defect, in all the different modes of cure that have been pursued, appears to be, that of considering mania a physical or bodily disease, and adopting for its removal merely physical remedies. Very lately, however, a spirit of inquiry has been excited, which has given birth to a new system of treatment of the insane; and former modes of medical discipline have now given place to that which is generally denominated moral management.

This interesting subject has closely engaged my attention for some years, and I conceive that the further investigation of it may prove highly beneficial to the cause of humanity, as well as to science, and excite us to a minute inquiry, how far we may contribute to the relief and comfort of the maniacs placed under our care. In pursuing this subject, my views have been much extended, and my mind considerably enlightened, by perusing the writings of Doctors Creighton, Arnold, and Rush; but, more particularly, the account of the Retreat near York, in England. Under these impressions I feel extremely desirous of submitting to the consideration of the Governors, a plan to be adopted by them, for introducing a system of moral treatment for the lunatics in the Asylum, to a greater extent than has hitherto been in use in this country. The great utility of confining ourselves almost exclusively to a course of moral treatment, is plain and simple, and incalculably interesting to the cause of humanity; and perhaps no work contains so many excellent and appropriate observations on the subject, as that entitled, The Account of the Retreat. The author, Samuel Tuke, was an active manager of that establishment, and appears to have detailed, with scrupulous care and minuteness, the effects of the system pursued toward the patients. I have, therefore, in the course of the following remarks, with a view of illustrating the subject with more clearness, often adopted the language and opinions of Tuke, but having frequently mixed my own observations with his, and his manner of expression not being always adapted to our circumstances and situation, I have attempted to vary the language, so as to apply it to our own institution; this will account for many of the subsequent remarks not being noticed as taken from Tuke's work.

It is, in the first place, to be observed, that in most cases of insanity, from whatever cause it may have arisen, or to whatever extent it may have proceeded, the patient possesses some small remains of ratiocination and self-command; and although many cannot be made sensible of the irrationality of their conduct or opinions, yet they are generally aware of those particulars for which the world considers them proper objects of confinement. Thus it frequently happens, that a patient, on his first introduction into the asylum, will conceal all marks of mental aberration; and, in some instances, those who before have been ungovernable, have so far deceived their new friends, as to make them doubt their being insane.

It is a generally received opinion, that the insane who are violent, may be reduced to more calmness and quiet, by exciting the principle of fear, and by the use of chains or corporal punishments. There cannot be a doubt that the principle of fear in the human mind, when moderately and judiciously excited, as it is by the operation of just and equal laws, has a salutary effect on Society. It is of great use in the education of children, whose imperfect knowledge and judgment, occasion them to be less influenced by other motives. But where fear is too much excited, and especially, when it becomes the chief motive of action, it certainly tends to contract the understanding, weaken the benevolent affection, and to debase the mind. It is, therefore, highly desirable, and more wise, to call into action, as much as possible, the operation of superior motives. Fear ought never to be induced, except when an object absolutely necessary cannot be otherwise obtained. Maniacs are often extremely irritable; every care, therefore, should be taken, to avoid that kind of treatment that may have any tendency towards exciting the passions. Persuasion and kind treatment, will most generally supersede the necessity of coercive means. There is considerable analogy between the judicious treatment of children and that of insane persons. Locke has observed "the great secret of education is in finding out the way to keep the Child's Spirit easy, active and free; and yet, at the same time, to restrain him from many things he has a mind to, and to draw him to things which are uneasy to him." Even with the more violent and vociferous maniacs, it will be found best to approach them with mild and soft persuasion. Every pains should be taken to excite in the patient's mind a desire of esteem. Though this may not be sufficiently powerful to enable them to resist the strong irregular tendency of their disease; yet, when properly cultivated, it may lead many to struggle to overcome and conceal their morbid propensities, or at least, to confine their deviations within such bounds as do not make them obnoxious to those about them. This struggle is highly beneficial to the patient; by strengthening his mind, and conducing to a salutary habit of self-restraint, an object, no doubt, of the greatest importance to the care of insanity by moral means.

It frequently occurs, that one mark of insanity is a fixed false conception, and a total incapacity of reasoning. In such cases, it is generally advisable to avoid reasoning[24] with them, as it irritates and rivets their false perception more strongly on the mind. On this account, every means ought to be taken to seduce the mind from unhappy and favourite musings; and particularly with melancholic patients; they should freely partake of bodily exercises, walking, riding, conversations, innocent sports, and a variety of other amusements; they should be gratified with birds, deer, rabbits, etc. Of all the modes by which maniacs may be induced to restrain themselves, regular employment is perhaps the most efficacious; and those kind of employments are to be preferred, both on a moral and physical account, which are accompanied by considerable bodily action, most agreeable to the patient, and most opposite to the illusions of his disease.

In short the patient should be always treated as much like a rational being as the state of his mind will possibly allow. In order that he may display his knowledge to the best advantage, such topics should be introduced as will be most likely to interest him; if he is a mechanic or an agriculturalist, he should be asked questions relating to his art, and consulted upon any occasion in which his knowledge may be useful. These considerations are undoubtedly very material, as they regard the comforts of insane persons; but they are of far greater importance as they relate to the cure of the disorder. The patient, feeling himself of some consequence, is induced to support it by the exertion of his reason, and by restraining those dispositions, which, if indulged, would lessen the respectful treatment he wishes to receive, or lower his character in the eyes of his companions and attendants.

Even when it is absolutely necessary to employ coercion, if on its removal the patient promises to control himself, great reliance may frequently be placed upon his word, and under this engagement, he will be apt to hold a successful struggle with the violent propensities of his disorder. Great advantages may also be derived, in the moral management of maniacs, from an acquaintance with the previous employment, habits, manners, and prejudices of the individual: this may truly be considered as indispensably necessary to be known, as far as can be obtained; and, as it may apply to each case, should be registered in a book for the inspection of the Committee of the Asylum, and the physician; the requisite information should be procured immediately on the admission of each patient; the mode of procuring it will be spoken of hereafter.

Nor must we forget to call to our aid, in endeavouring to promote self-restraint, the mild but powerful influence of the precepts of our holy religion. Where these have been strongly imbued in early life, they become little less than principles of our nature; and their restraining power is frequently felt, even under the delirious excitement of insanity. To encourage the influence of religious principles over the mind of the insane, may be considered of great consequence, as a means of cure, provided it be done with great care and circumspection. For this purpose, as well as for reasons still more important, it would certainly be right to promote in the patient, as far as circumstances would permit, an attention to his accustomed modes of paying homage to his Maker.

In pursuing the desirable objects above enumerated, we ought not to expect too suddenly to reap the good effects of our endeavours; nor should we too readily be disheartened by occasional disappointments. It is necessary to call into action, as much as possible, every remaining power and principle of the mind, and to remember, that, "in the wreck of the intellect, the affections very frequently survive." Hence the necessity of considering the degree in which the patient may be influenced by moral and rational inducements.

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

Agreeably to these principles, I beg leave to suggest the following regulations to be adopted, in accomplishing the objects in view.

1st. No patient shall hereafter be confined by chains.

2nd. In the most violent states of mania, the patient should be confined in a room with the windows, etc., closed, so as nearly to exclude the light, and kept confined if necessary, in a straight jacket, so as to walk about the room or lie down on the bed at pleasure; or by strops, etc., he may, particularly if there appears in the patient a strong determination to self-destruction, be confined on the bed, and the apparatus so fixed as to allow him to turn and otherwise change his positions.

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

4th. The common attendants shall not apply any extraordinary coercion by way of punishment, or change in any degree the mode of treatment prescribed by the physician; on the contrary, it is considered as their indispensable duty, to seek by acts of kindness the good opinion of the patients, so as to govern them by the influence of esteem rather than of severity.

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

6th. When it is deemed necessary to apply the strait-jacket, or any other mode of coercion, by way of punishment or restraint, such an ample force should be employed as will preclude the idea of resistance from entering the mind of the patient.

7th. It shall be the duty of the deputy-keeper, immediately on a patient being admitted, to obtain his name, age, where born, what has been his employment or occupation, his general disposition and habits, when first attacked with mania; if it has been violent or otherwise, the cause of his disease, if occasioned by religious melancholy, or a fondness for ardent spirits, if owing to an injury received on any part of the body, or supposed to arise from any other known cause, hereditary or adventitious, and the name of the physician who may have attended him, and his manner of treating the patient while under his direction.

8th. Such of the patients as may be selected by the physician, or the Committee of the Asylum, shall be occasionally taken out to walk or ride under the care of the deputy-keeper; and it shall be also his duty to employ the patients in such manner, and to provide them with such kinds of amusements and books as may be approved and directed by the Committee.

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

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

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

The sentiments and improvements proposed in the preceding remarks, for the consideration of the Governors, are adapted to our present situation and circumstances; but a further and more extensive improvement has occurred to my mind, which I conceive, would very considerably conduce towards affecting the cure, and materially ameliorate the condition, and add to the comfort of the insane; at the same time that it would afford an ample opportunity [Transcriber's note: original reads 'apportunity'] of ascertaining how far that disease may be removed by moral management alone, which it is believed, will, in many instances, be more effectual in controlling the maniac, than medical treatment especially, in those cases where the disease has proceeded from causes operating directly on the mind.

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

The cost and annual expense of supporting this establishment, are matters of small consideration, when we duly consider the important advantages it would offer to a portion of our fellow-creatures, who have such strong claims on our sympathy and commiseration.

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

Supposing the ground, building, etc., to cost $50,000, the interest on this sum at 6 per cent. would be $3,000, there would yet remain $7,400, for the maintenance and support of the establishment; a sum larger than would be required for that purpose.

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

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

FOOTNOTES:

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

[Footnote 24: The following anecdotes illustrate the observation before made, that maniacs frequently retain the power of reasoning to a certain extent; and that the discerning physician may oftimes successfully avail himself of the remains of this faculty in controlling the aberrations of his patient:—A patient in the Pennsylvania Hospital, who called his physician his father, once lifted his hand to strike him. "What!" said his physician, (Dr. Rush), with a plaintive tone of voice, "Strike your father?" The madman dropped his arm, and instantly showed marks of contrition for his conduct. The following was related to me by Samuel Coates, President of the Pennsylvania Hospital:—maniac had made several attempts to set fire to the Hospital: upon being remonstrated with, he said, "I am a salamander"; "but recollect," said my friend Coates, "all the patients in the house are not salamanders;" "That is true," said the maniac, and never afterwards attempted to set fire to the Hospital.]



APPENDIX IV

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

April 4, 1815.

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

July 3, 1815.

The Committee on the communication from Thos. Eddy, relative to the treatment of Insane patients, report attention to the subject and that in their opinion it is advisable to have a few acres of land purchased in the vicinity of the City for the better accommodation of this unhappy class of our fellow creatures—the Committee are continued.

On motion Resolved that Thomas Eddy, John A. Murray, and John Aspinwall, be a Committee to look out for a suitable spot of land, and to make a purchase, if in their opinion it shall become necessary.

8th Month (August) 1st, 1815.

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

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

That another building for the use of those unfortunate persons who have lost the use of their reason, is not only advisable, but seems to be absolutely necessary.

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

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

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

That considering the various kinds of insanity, your Committee, are clearly of the opinion, that two buildings should be erected at the distance of at least one hundred yards from each other. The sedate or melancholy madman should not have his slumbers broken by living under the same roof with disorderly persons, who by singing, or other noisy proceedings, will not suffer their neighbours to sleep.

That for the above and similar considerations, it would be advisable, to purchase, within a few miles of this City, at least twenty acres of land, detached from private buildings, in a healthy and pleasant situation, where the water is good and where materials for buildings may be obtained on easy terms: and the portage of fuel not expensive.

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

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

The Committee to whom was referred, to purchase a suitable Lot of Land for the erection of a House for the accommodation of maniacs, Report that they have purchased 38 acres of Land, being part of the Estate belonging to Gerard Depeyster at Bloomingdale, at the rate of $246. per acre, payable 25 per cent down, 371/2 per cent on 1st November and 373/4 per cent on 1st February next, with interest.

THOMAS EDDY, Chairman

August 1st, 1815

Whereupon Resolved that the Report of the Committee be accepted, and they are instructed to take the Titles, after P.A. Jay shall have examined the Records, and be satisfied that the property is free of incumbrance.



APPENDIX V

ADDRESS TO THE PUBLIC BY THE GOVERNORS 1821[25]

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

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

This institution has been established by the bounty of the Legislature of the state of New-York, on the most liberal and enlarged plan, and with the express design to carry into effect that system of management of the insane, happily termed moral treatment, the superior efficacy of which has been demonstrated in several of the Hospitals of Europe, and especially in that admirable establishment of the Society of Friends, called "THE RETREAT," near York, in England. This mild and humane mode of treatment, when contrasted with the harsh and cruel usage, and the severe and unnecessary restraint, which have formerly disgraced even the most celebrated lunatic asylums, may be considered as one of the noblest triumphs of pure and enlightened benevolence. But it is by no means the intention of the governors to rely on moral, to the exclusion of medical treatment. It is from a judicious combination of both, that the greatest success is to be expected in every attempt to cure or mitigate the disease of insanity.

In the construction of the edifice and in its interior arrangements, it has been considered important to avoid, as far as practicable, consistently with a due regard to the safety of the patients, whatever might impress their minds with the idea of a prison, or a place of punishment, and to make every thing conduce to their health and to their ease and comfort. The self-respect and complacency which may thus be produced in the insane, must have a salutary influence in restoring the mind to its wonted serenity. In the disposition of the grounds attached to the Asylum, everything has been done with reference to the amusement, agreeable occupation, and salutary exercise of the patients.

Agricultural, horticultural, and mechanical employments, may be resorted to, whenever the inclination of the patient, or their probable beneficial effects may render them desirable. To dispel gloomy images, to break morbid associations, to lead the feelings into their proper current, and to restore the mind to its natural poise, various [Transcriber's note: original reads 'varius'] less active amusements will be provided. Reading, writing, drawing, innocent sports, tending and feeding domestic animals, &c. will be encouraged as they may be found conducive to the recovery of the patients. A large garden has been laid out, orchards have been planted, and yards, containing more than two acres, have been inclosed for the daily walks of those whose disorder will not allow more extended indulgence. The plants of the Elgin Botanic garden, presented to this institution by the Trustees of Columbia College, have been arranged in a handsome green-house, prepared for their reception.

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

Care has been taken to appoint a Superintendent and Matron, of good moral and religious characters, possessing cheerful tempers, and kind dispositions, united with firmness, vigilance and discretion. A Physician will reside in the house, and one or more Physicians, of established character and experience, will attend regularly, and afford medical aid in all cases where the general health, or the particular cause of the patient's insanity, may require it. The relations or friends of patients will be at liberty, if they prefer it, to employ their own physicians, who will be allowed to attend patients, subject to the general regulations of the house.

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

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

Patients at the expense of the different towns of the state, will be received at the lowest rate.

Application for the admission of patients into the Asylum, must be made, at the New York Hospital, in Broadway, where temporary accommodation will be provided for such patients as may require it, previously to their being carried to the Asylum out of town. A committee of the Governors will, when necessary, attend at the Hospital in Broadway, for the purpose of admitting patients into the Asylum, and to agree on the terms and security for payment to be given.

By order of the board of Governors.

MATTHEW CLARKSON, President.

THOMAS BUCKLEY, Secretary.

New-York, 10th May, 1821.

N.B. The friends of the patients are requested to send with them an account of their cases, stating the probable causes of their insanity, the commencement and peculiar character of the disorder. It is desirable that this statement, where it is practicable, should be drawn up by a physician.

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

FOOTNOTES:

[Footnote 25: Address of the Governors of the New York Hospital to the Public, Relative to the Asylum for the Insane at Bloomingdale. New York, May 10th, 1821. Reprinted Bloomingdale Hospital Press, May 1921.]



APPENDIX VI

BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL

1821 AND 1921

1821

Matthew Clarkson, President Thomas Eddy, Vice President Thomas Franklin Jonathan Little Thomas Buckley William Johnson Andrew Morris John R. Murray John B. Lawrence George Newbold Ebenezer Stevens Peter A. Jay Najah Taylor Cadwallader D. Colden Robert H. Bowne Robert I. Murray Thomas C. Taylor John Adams, Treasurer John McComb Benjamin W. Rogers, Assistant Treasurer William Bayard Nathan Comstock Duncan P. Campbell Rev. F.C. Schaeffer John Clark, Jr. William Edgar, Jr.

1921

Hermann H. Cammann Henry W. deForest Richard Trimble Howard Townsend George F. Baker Augustine J. Smith Charles S. Brown Edward W. Sheldon, President Bronson Winthrop Frank K. Sturgis David B. Ogden Joseph H. Choate, Jr. Henry G. Barbey Cornelius B. Bliss, Jr. Paul Tuckerman, Treasurer William Woodward Arthur Iselin Payne Whitney, Vice President G. Beekman Hoppin Lewis Cass Ledyard, Jr. Henry R. Taylor R. Horace Gallatin Walter Jennings

BLOOMINGDALE COMMITTEE

1821

Thomas Eddy Cadwallader D. Colden Thomas C. Taylor John Adams Thomas Buckley John B. Lawrence

1921

Frank K. Sturgis Augustine J. Smith Henry R. Taylor Henry G. Barbey Walter Jennings Howard Townsend



APPENDIX VII

ORGANIZATION OF BLOOMINGDALE HOSPITAL

1821 AND 1921

1821

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

Total 22

Number of patients 75

1921

Officers and employees:

Men 217 Women 195 —- Total 412

Patients:

Men 132 Women 156 —- Total 288

General Administration: Medical Superintendent 1 Steward 1-2

Clinical and Laboratory Service: Physicians: Resident 9 Consultants 3 Dentist 1 Assistant 1 Apothecary 1 Technicians 2 Stenographers 5-22

Nursing Service: Director, Assistant, and Instructor 3 Nurses, attendants, and pupils 135 Maids and porters 46-184

Occupational Therapy 13 Physical Training 7 Hydrotherapy and Massage 5 Dietary Department 25 Housekeeping and Laundry Departments 60 Financial, Purchasing, and Supplies 10 Engineering Department 18 Building Department 20 Industrial Department 5 Farm and Grounds 38 Miscellaneous 8 Chaplain, Librarian, Watchmen, Telephonists, Postal Clerk, Barber.

STATISTICS: 1821-1921

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

THE END