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 BLOOMINGDALE HOSPITAL 
 CENTENARY 
 
 1821-1921 
 
 " Cum corpore ut una 
 
 Crescere sentimus, pariterque senescere mentem." 
 
 LUCRETIUS 
 
 PRIVATELY PRINTED 
 
 BY THE SOCIETY OF THE NEW YORK HOSPITAL 
 1921
 
 . 
 
 m 
 
 ANNIVERSARY COMMITTEE 
 
 HOWARD TOWNSEND 
 BRONSON WINTHROP 
 R. HORACE GALLATIN
 
 PREFACE 
 
 The opening of Bloomingdale Asylum on June i, 
 1821, was an important event in the treatment of 
 mental disorders and in the progress of humanitarian 
 and scientific work in America. Hospital treatment 
 for persons suffering from mental disorders had been 
 furnished by the New York Hospital since its open- 
 ing in 1792, and the Governors had given much 
 thought and effort to securing the facilities needed. 
 The treatment consisted, however, principally in the 
 administration of drugs and the employment of such 
 other physical measures as were in vogue at that 
 time. Little attempt was made to study the minds 
 of the patients or to treat them by measures di- 
 rected specifically to influencing their thoughts, feel- 
 ings, and behavior, and what treatment of this 
 character there was had for its object little more 
 than the repression of excitement and disordered 
 activity. The value and importance of treatment 
 directed to the mind had, indeed, been long recog- 
 nized, but in practice it had been subordinated to 
 treatment of the actual and assumed physical dis- 
 orders to which the mental state of the patient was 
 attributed, and, in the few hospitals where persons 
 
 [vii]
 
 PREFACE 
 
 suffering from mental disorders were received, means 
 for its application were almost or quite entirely 
 lacking. The establishment of Bloomingdale Asy- 
 lum for the purpose of ascertaining to what extent 
 the recovery of the patients might be accomplished 
 by moral as well as by purely medical treatment 
 marked, therefore, the very earliest stages of the 
 development in America of the system of study and 
 treatment of mental disorders which with increasing 
 amplification and precision is now universally em- 
 ployed. 
 
 A hundred years of growth and activity in the work 
 thus established have now been accomplished, and 
 it seemed fitting to the Governors of the Hospital 
 that the event should be commemorated in a way 
 that would be appropriate to its significance and im- 
 portance. It was decided that the principal place in 
 the celebration should be given to the purely medical 
 and scientific aspects of the work, with special refer- 
 ence to the progress which had been made in the 
 direction of the practical usefulness of psychiatry 
 in the treatment of illness generally, and in the man- 
 agement of problems of human behavior and wel- 
 fare. Arrangements were made for four addresses 
 by physicians of conspicuous eminence in their par- 
 ticular fields, and invitations to attend the exercises 
 were sent to the leading psychiatrists, psychologists, 
 
 [ viii ]
 
 PREFACE 
 
 and neurologists of America, and to others who were 
 known to be specially interested in the field of study 
 and practice in which the Hospital is engaged. It 
 was felt that, in view of the place which France and 
 England had held in the movement in which Bloom- 
 ingdale Asylum had its origin, it would add greatly 
 to the interest and value of the celebration if repre- 
 sentatives of these countries were present and made 
 addresses. How fortunate it was, then, that it be- 
 came possible to welcome from France Dr. Pierre 
 Janet, who stands pre-eminent in the field of psy- 
 chopathology, and from England Dr. Richard G. 
 Rows, whose contributions to the study and treat- 
 ment of the war neuroses and to the relation between 
 psychic and physical reactions marked him as espe- 
 cially qualified to present the more advanced view- 
 point of British psychiatry. The other two princi- 
 pal addresses were made by Dr. Adolf Meyer, who, 
 by reason of his scientific contributions and his won- 
 derfully productive practical work in clinical and 
 organized psychiatry and in mental hygiene, is the 
 acknowledged leader of psychiatry in America, and 
 by Dr. Lewellys F. Barker, who, because of his emi- 
 nence as an internist and of the extent to which 
 he has advocated and employed psychiatric knowl- 
 edge and methods in his practice, has contributed 
 greatly to interesting and informing physicians con- 
 
 [ix]
 
 PREFACE 
 
 cerning the value and importance of psychiatry in 
 general medical practice. The addresses given by 
 these distinguished physicians, representing advanced 
 views in psychiatry held in Europe and America, 
 were peculiarly appropriate to the occasion and to 
 the object of the celebration. They were supple- 
 mented by an historical review of the origin and 
 development of the Hospital and of its work by Mr. 
 Edward W. Sheldon, President of the Society of the 
 New York Hospital, and by a statement concern- 
 ing the medical development, made by Dr. William 
 L. Russell, the Medical Superintendent. The greet- 
 ings of the New York Academy of Medicine were 
 presented in an interesting address by Dr. George D. 
 Stewart, President of the Academy. 
 
 Of scarcely less significance and interest than the 
 addresses was the pageant presented on the lawn 
 during the intermission between the sessions, de- 
 picting scenes and incidents illustrating the origin 
 and development of the Hospital, and of psychiatry 
 and mental hygiene. The text and the scenes dis- 
 played were prepared by Dr. Charles I. Lambert, 
 First Assistant Physician of the Hospital, and by 
 Mrs. Adelyn Wesley, who directed the performance 
 and acted as narrator. The performers were per- 
 sons who were connected with the Hospital, twenty- 
 two of whom were patients.
 
 PREFACE 
 
 The celebration was held on May 26, 1921. The 
 weather was exceptionally clear, with bright sunshine 
 and moderate temperature. The grounds, in their 
 Spring dress of fresh leaves and flowers, were espe- 
 cially beautiful. This added much to the attrac- 
 tiveness of the occasion and the pleasure of those who 
 attended. Luncheon was served on the lawn in 
 front of the Brown Villa and the pageant was pre- 
 sented on the adjoining recreation grounds. The 
 beauty of the day and the surroundings, the character 
 of the addresses and of the speakers, the remarkable 
 felicity and grace with which they were introduced 
 by the President, the dignity and noble idealism of 
 his closing words, and the distinguished character 
 of the audience, all contributed to make the celebra- 
 tion one of exceptional interest and value to those 
 who were present, and a notable event in the history 
 of the Hospital. 
 
 For the purpose of preserving, and of perhaps 
 extending to some who were not present, the spirit 
 of the occasion, and of placing in permanent form an 
 account of the proceedings and the addresses which 
 were made, this volume has been published by the 
 Society of the New York Hospital. 
 
 WILLIAM L. RUSSELL. 
 
 [xi]
 
 CONTENTS 
 
 PAGE 
 
 PREFACE vii 
 
 INVOCATION 3 
 
 REV. FRANK H. SIMMONDS 
 
 HISTORICAL REVIEW 
 
 EDWARD W. SHELDON, ESQ. 
 
 President of the Society of the New York Hospital 
 
 "THE CONTRIBUTIONS OF PSYCHIATRY TO THE UNDER- 
 STANDING OF LIFE PROBLEMS" 17 
 
 ADOLF MEYER, M.D. 
 
 Director of the Henry Phipps Psychiatric Clinic, Johns Hop- 
 kins 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 MEDI- 
 CINE 79 
 
 GEORGE D. STEWART, M.D. 
 
 President of the Academy
 
 CONTENTS 
 
 PAGE 
 
 "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 HOS- 
 PITAL" ...........'.. 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, 192!. 
 
 TRANSCRIPT FROM THE VISITORS BOOK OF THE RE- 
 TREAT, 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 GOV- 
 ERNORS IN RELATION TO ACTION TAKEN RESPECTING 
 THOS. EDDY'S COMMUNICATION DATED APRIL, 1815. 
 
 [xiv]
 
 CONTENTS 
 
 PAGE 
 
 APPENDIX V 212 
 
 ADDRESS TO THE PUBLIC BY THE GOVERNORS, l82I. 
 
 APPENDIX VI 216 
 
 BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW 
 YORK HOSPITAL, l82I AND 192!. 
 
 APPENDIX VII 218 
 
 ORGANIZATION OF BLOOMINGDALE HOSPITAL, l82I AND 
 1921. 
 
 [rv]
 
 ILLUSTRATIONS 
 
 New York Hospital and Lunatic Asylum, 1808 . Frontispiece 
 
 FACING PAGE 
 
 Bloomingdale Asylum, 1821 2 
 
 Bloomingdale Asylum, 1894 80 
 
 Bloomingdale Hospital, 1921 148 
 
 The Tableau-Pageant 172 
 
 Thomas Eddy 195
 
 THE SOCIETY OF 
 THE NEW YORK HOSPITAL
 
 BLOOMINGDALE HOSPITAL CENTENARY 
 
 The One Hundredth Anniversary of the estab- 
 lishment of Bloomingdale Hospital as a separate 
 department for mental diseases of The Society of 
 the New York Hospital was celebrated at the Hos- 
 pital at White Plains on Thursday, May 26, 1921. 
 The addresses were given in the Assembly Hall. 
 
 Mr. Edward W. Sheldon, the President of the 
 Society, acted as Chairman. 
 
 MORNING SESSION 
 
 The exercises opened with an invocation by the 
 Reverend Frank H. Simmonds, rector of Grace 
 Episcopal Church at White Plains: 
 
 Oh, most mighty and all-merciful God, whose 
 power is over all Thy works, who wiliest that all 
 men shall glorify Thee in the constant bringing to 
 perfection those powers of Thine which shall more 
 and more make perfect the beings of Thy creation, 
 we glorify Thee in the gift of Thy Divine Son Jesus 
 Christ, the Great Physician of our souls, the Sun of 
 Righteousness arising with healing in His wings, who 
 disposeth every great and little incident to the glory 
 of God the Father, and to the comfort of them that 
 
 [3]
 
 A PSYCHIATRIC MILESTONE 
 
 love and serve him, we render thanks to Thee and 
 glorify Thy Name, this day, which brings to com- 
 pletion the hundredth anniversary of this noble in- 
 stitution's birthday. Oh, Thou, who didst put it into 
 the hearts and minds of men to dedicate their lives 
 and fortunes to the advancement of science and 
 medicine for the sick and afflicted, we render Thee 
 most high praise and hearty thanks for the grace 
 and virtue of the founders of this institution men 
 whose names are written in the Golden Book of life 
 as those who loved their fellow men. 
 
 We praise Thee for such men as Thomas Eddy, 
 James Macdonald, Pliny Earle, and these endless 
 others, who from age to age have held high the torch 
 of knowledge and have kept before them the golden 
 rule of service. Inasmuch as ye have done it unto 
 one of the least of these my brethren, ye have done 
 it unto me. 
 
 Be pleased, oh merciful Father, to bless this day 
 and gathering. Lift up and enlighten our hearts 
 and minds to a higher perception of all that is noble, 
 all that is true, all that is merciful. Awaken our 
 dull senses to the full knowledge of light in Thee, 
 and may all that is said and done be with the guid- 
 ing of Thy Holy Spirit. 
 
 We pray for the continued blessing of this institu- 
 tion and hospital, and on all those who are striving
 
 THE CENTENARY 
 
 to bring out of darkness those unhappy souls, into 
 the pure light of understanding. 
 
 Bless the Governors, physicians, and nurses, di- 
 rect their judgments, prosper their undertakings, 
 and dispose their ministry that the world may feel 
 the blessing and comfort of life in the prevention of 
 disease and the preservation of health. And may 
 we all be gathered in this nation to a more perfect 
 unity of life and purpose in the desire to spend and 
 be spent in the service of our fellow men. 
 
 We ask it all in the name and through the media- 
 tion of Thy Son Jesus Christ, our Lord. Amen. 
 
 [5]
 
 ADDRESS BY 
 
 MR. EDWARD W. SHELDON
 
 MR. SHELDON 
 
 It is with profound gratification that the Gover- 
 nors welcome your generous presence to-day on an 
 occasion which means so much to us and which has 
 perhaps some general significance. For we are met 
 in honor of what is almost a unique event in our 
 national history, the centennial anniversary cele- 
 bration of an exclusively psychopathic hospital. A 
 summary of its origin and development may be 
 appropriate. 
 
 A hundred and fifty years ago the only institu- 
 tions on this side of the Atlantic which cared for 
 mental diseases were the Pennsylvania Hospital, 
 chartered in 1751, a private general hospital which 
 had accommodations for a few mental cases, and 
 the Eastern State Hospital for the insane, at Wil- 
 liamsburg, Virginia, a public institution incorporated 
 in 1768. No other one of the thirteen Colonies had 
 a hospital of any kind, general or special. With a 
 view of remedying this deplorable lack in New York, 
 steps were taken in 1769 to establish an adequate 
 general hospital in the City of New York. This re- 
 sulted in the grant, on June n, 1771, of the Royal 
 Charter of The Society of the New York Hospital.
 
 A PSYCHIATRIC MILESTONE 
 
 Soon afterward the construction of the Hospital 
 buildings began on a spacious tract on lower Broad- 
 way opposite Pearl Street, in which provision was 
 also to be made for mental cases; but before any 
 patients could be admitted, an accidental fire, in 
 February, 1775, consumed the interior of the build- 
 ings. Reconstruction was immediately undertaken 
 and completed early in the spring of 1776. But by 
 that time the Revolutionary War was in full course, 
 and the buildings were taken over by the Continental 
 authorities as barracks for troops, and were sur- 
 rounded by fortifications. When the British cap- 
 tured the city in September, 1776, they made the 
 same use of the buildings for their own troops, who 
 remained there until 1783. A long period of read- 
 justment then ensued, and it was not until January, 
 1791, that the Hospital was at last opened to patients. 
 In September, 1792, the Governors directed the ad- 
 mission of the first mental case, and for the hundred 
 and twenty-nine years since that time the Society 
 has continuously devoted a part of its effort to the 
 care of the mentally diseased. After a few years a 
 separate building for them was deemed desirable, 
 and was constructed. The State assisted this expan- 
 sion of the Hospital by appropriating to the Society 
 $12,500 a year for fifty years. This new building 
 housed comfortably seventy-five patients, but ten 
 
 [10]
 
 HISTORICAL REVIEW 
 
 years later even this proved inadequate in size and 
 undesirable in surroundings. In the meanwhile a 
 wave of reform in the care of the insane was rising 
 in Europe under the influence of such benefactors as 
 Philippe Pinel in France, and William and Samuel 
 Tuke in England. Thomas Eddy, a philanthropic 
 Quaker Governor of the Society, who was then its 
 Treasurer and afterward in succession its Vice- 
 President and President, becoming aware of this 
 movement, and having made a special study of the 
 care and cure of mental affections, presented a com- 
 munication to the Governors in which he advocated 
 a change in the medical treatment, and in particular 
 the adoption of the so-called moral management 
 similar to that pursued by the Tukes at The Retreat, 
 in Yorkshire, England. This memorable communi- 
 cation was printed by the Governors, and consti- 
 tutes one of the first of the systematic attempts 
 made in the United States to put this important 
 medical subject on a humane and scientific basis. 
 To carry out his plan, Mr. Eddy urged the purchase 
 of a large tract of land near the city and the 'erection 
 of suitable buildings. He ventured the moderate 
 estimate that the population of the city, then about 
 110,000, might be doubled by 1836, and quadrupled 
 by 1856. In fact, it was more than doubled in those 
 first twenty years, and sextupled in the second
 
 A PSYCHIATRIC MILESTONE 
 
 twenty. He was justified, therefore, in believing 
 that the hospital site on lower Broadway would 
 soon be surrounded by a dense population, and quite 
 unsuited for the efficient care of mental diseases. 
 The Governors gave these recommendations im- 
 mediate and favorable consideration. Various tracts 
 of land, containing in all about seventy-seven acres, 
 and lying on the historic Harlem Heights between 
 what are now Riverside Drive and Columbus Avenue, 
 and ic>7th and i2Oth Streets, were subsequently 
 bought by the Society for about $31,000. To aid 
 in the construction and maintenance of the neces- 
 sary hospital buildings, the Legislature, by an act 
 reciting that there was no other institution in the 
 State where insane patients could be accommodated, 
 and that humanity and the interest of the State re- 
 quired that provision should be made for their care 
 and cure, granted an additional annual appropria- 
 tion of $10,000 to the Society from 1816 until 1857. 
 The main Hospital, built of brownstone, stood where 
 the massive library of Columbia University now is, 
 and the brick building still standing at the north- 
 east corner of Broadway and n6th Street was the 
 residence of the Medical Superintendent. The only 
 access to this site by land was over what was known 
 as the Bloomingdale Road, running from Broadway 
 and 23d Street through the Bloomingdale district 
 
 [12]
 
 HISTORICAL REVIEW 
 
 on the North River to n6th Street, and from that 
 fact our institution assumed the name of Blooming- 
 dale Asylum, or, as it is now called, Bloomingdale 
 Hospital. This beautiful elevated site overlooking 
 the Hudson River and the Harlem River was admi- 
 rably fitted for its purpose. The spacious tract of 
 land, laid out in walks and gardens, an extensive 
 grove of trees, generous playgrounds and ample 
 greenhouses, combined to give the spot unusual 
 beauty and efficiency. This notable work finished, 
 the Governors of the Society issued on May 10, 
 1821, an "Address to the Public"* which marks so 
 great an advance in psychiatry in our country that 
 it deserves study. The national character of the 
 institution was indicated in the opening paragraph, 
 where it announced that the Asylum would be open 
 for the reception of patients from any part of the 
 United States on the first of the following June. 
 Accommodation for 200 patients was provided, and 
 to these new surroundings were removed on that day 
 all the mental cases then under treatment at the New 
 York Hospital on lower Broadway. 
 
 In this retired and ideal spot the work of Bloom- 
 ingdale Hospital was successfully prosecuted for 
 
 * Address of the Governors of the New York Hospital, to the 
 Public, relative to the Asylum for the Insane at Bloomingdale, New 
 York, May loth, 1821. Reprinted by Bloomingdale Hospital Press, 
 White Plains, May 26, 1921. See Appendix V, p. 212. 
 
 [13]
 
 A PSYCHIATRIC MILESTONE 
 
 three-quarters of a century. But the seven miles 
 that separated it from the old hospital was steadily 
 built over, and before fifty years had gone the growth 
 of the city had passed the asylum grounds. Fore- 
 seeing that they could not maintain that verdant 
 oasis intact for many years longer, the Governors, 
 in 1868, bought this 3<DO-acre tract on the outskirts 
 of the Village of White Plains. After prolonged 
 consideration of the time and method of develop- 
 ment of the property, final plans were adopted in 
 December, 1891, construction was begun May i, 
 1892, and two years later, under the direction of our 
 Medical Superintendent, Dr. Samuel B. Lyon, all 
 the patients were moved from the old to this new 
 Bloomingdale. The cost of the new buildings was 
 about $1,500,000. From time to time the original 
 Bloomingdale site was sold and now supplies room, 
 among other structures, for Columbia University, 
 Barnard College, the Cathedral of St. John the 
 Divine, St. Luke's Hospital, the Woman's Hospital, 
 and the National Academy of Design. With the 
 proceeds of those sales of the old Bloomingdale, not 
 only was the cost of the new Bloomingdale met, but 
 the permanent endowment of the Society was sub- 
 stantially increased, and Thomas Eddy was proved 
 to have been both a wise humanitarian and a far- 
 sighted steward of charitable funds.
 
 HISTORICAL REVIEW 
 
 In their "Address to the Public" to which I have 
 referred, issued when Bloomingdale Hospital was 
 opened in 1821, the Governors of the Society spoke 
 of the new conception of moral treatment of the 
 mentally afflicted which had been established in 
 several European hospitals and which was sup- 
 planting the harsh and cruel usage of former days, 
 as "one of the noblest triumphs of pure and en- 
 lightened benevolence." In that same spirit those 
 founders dedicated themselves to the conduct of 
 this institution. Their devotion to the work was 
 impressive. Looking back on those early days we 
 see a constant personal attention to the details of 
 institutional life that commands admiration. The 
 standards then set have become a tradition that 
 has been preserved unbroken for a hundred years. 
 Humane methods of care, the progressively best 
 that medical science can devise, the utilization of a 
 growingly productive pursuit of research, have con- 
 sistently marked the administration of this great 
 trust. The Governors of to-day are as determined 
 as any of their predecessors to maintain that ideal 
 of "pure and enlightened benevolence." New paths 
 are opening and larger resources are becoming avail- 
 able. Under the guidance of our distinguished Medi- 
 cal Superintendent, with his able and devoted staff 
 of physicians, a broader and more intensive develop- 
 
 [is]
 
 A PSYCHIATRIC MILESTONE 
 
 ment is already under way. Animated by that re- 
 solve and cheered by that prospect, we may thus 
 confidently hope, as we begin the second century 
 of Bloomingdale's career, for results not less fruitful 
 and gratifying than those which we celebrate to-day. 
 
 [16]
 
 ADDRESS BY 
 
 DR. ADOLF MEYER
 
 The Chairman : In celebrating our centenary we 
 are naturally dealing also with the larger subject 
 of general psychiatry. Our success in this discussion 
 should be materially promoted by the presence with 
 us of Dr. Adolf Meyer, Professor of Psychiatry in 
 the Medical School of Johns Hopkins University, 
 and Director of the Phipps Psychiatric Clinic, of 
 Baltimore. Before taking up this important work 
 in that famous medical centre, Dr. Meyer was ac- 
 tively engaged for several years in psychopathic 
 work in New York. He will speak to us on "THE 
 CONTRIBUTIONS OF PSYCHIATRY TO THE UNDER- 
 STANDING OF LIFE PROBLEMS."
 
 DR. MEYER 
 
 When Dr. Russell honored me with the invitation 
 to speak at this centenary celebration of the re- 
 nowned Bloomingdale Hospital, my immediate im- 
 pulse was to choose as my topic a phase of psy- 
 chiatric development to which this Hospital has 
 especially contributed through our greatly missed 
 August Hoch and his deeply appreciated coworker 
 Amsden. I have in mind the great gain in con- 
 creteness of the physician's work with mind and 
 the resulting contribution of psychiatry to a better 
 knowledge of human life and its problems. The 
 great gain this passing century is able to hand on to 
 its successor is the clearer recognition of just what 
 the psychiatrist actually works with and works on. 
 
 Of all the divisions of medicine, psychiatry has 
 suffered longest from man's groping for a concep- 
 tion of his own nature. Psychiatry means, literally, 
 the healing of souls. What then do we actually 
 mean by soul or by psyche ? This question has 
 too long been treated as a disturbing puzzle. 
 
 To-day we feel that modern psychiatry has found 
 itself through the discovery that, after all, the 
 uncritical common-sense view of mind and soul is 
 
 [21]
 
 A PSYCHIATRIC MILESTONE 
 
 not so far remote from a critical common-sense view 
 of the individual and its life activity, freed from the 
 forbidding and confusing assumptions through which 
 the concept of mind and soul has been held in be- 
 wildering awe. 
 
 Strange to say, good old Aristotle was nearer an 
 understanding than most of the wise men and women 
 that have succeeded him for these more than two 
 thousand years. He saw in the psyche what he 
 called the form and realization or fulfilment of the 
 human organism; he would probably now say with 
 us, the activity and function as an individual or 
 person. 
 
 Through the disharmonies and inevitable disrup- 
 tion of a self-disorganizing civilization, the Greek and 
 Roman world was plunged into the dark centuries 
 during which the perils of the soul and the sacrificial 
 attainment of salvation by monastic life and cru- 
 sades threatened to overshadow all other concern. 
 This had some inevitable results: it favored all those 
 views through which the soul became like a special 
 thing or substance, in contrast to and yet a counter- 
 part of the physical body. As long as there was no 
 objective experimental science, the culminating solu- 
 tion of life problems had to be intrusted to that re- 
 markable development of religious philosophy which 
 arose from the blending of Hebrew religion and tra- 
 
 [22]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 dition and the loftiest products of the Greek mind, 
 in the form which St. Paul and the early Church 
 fathers gave to the teachings of Christ. From 
 being the form and activation, or function, of the 
 organism in life, the soul feature of man was given 
 an appearance in which it could neither be grasped 
 nor understood, nor shaped, nor guided by man 
 when it got into trouble. From the Middle Ages 
 there arose an artificial soul and an artificial world 
 of souls presented as being in eternal conflict with 
 the evil of the flesh and thus the house of human 
 nature was divided against itself. 
 
 Science of the nineteenth century came nearer 
 bringing mind and body together again. The new as- 
 tronomical conception of the world and the growing 
 objective experimental science gradually began to 
 command confidence, and from being a destroyer 
 of excessively dogmatic notions, science began to 
 rise to its modern constructive and creative position. 
 But the problem of mind remained on a wrong basis 
 and still does so even with most scientists. Too 
 much had been claimed for the psyche, and because 
 of the singling out of a great world of spirit, the 
 world of fact had been compromised and left cold 
 and dry and unattractive and unpromising. No 
 doubt it was necessary that the scientist should 
 become hardened and weaned from all misleading 
 
 [23]
 
 A PSYCHIATRIC MILESTONE 
 
 expectation, and shy of all the spurious claims of 
 sordid superstition and of childish fancy. He may 
 have been unduly radical in cutting out everything 
 that in any way recalled the misleading notions. 
 In the end, we had to go through a stage of psy- 
 chology without a "soul," and lately even a psy- 
 chology without "consciousness," so that we might 
 be safe from unscientific pretensions. All the gyra- 
 tions no doubt tended to retard the wholesome prac- 
 tical attack upon the problems in the form in which 
 we find them in our common-sense life. 
 
 The first effort at a fresh start tried to explain 
 everything rather one-sidedly out of the meagre 
 knowledge of the body. Spinoza had said in his 
 remarkable Ethics (III, Prop. II, Schol.): "Nobody 
 has thus far determined what the body can do, i. e., 
 nobody has as yet shown by experience and trial what 
 the body can do by the laws of nature alone in so 
 far as nature is considered merely as corporeal and 
 extended, and what it cannot do save when de- 
 termined by mind." 
 
 This challenge of Spinoza's had to be met. With 
 some investigators this seemed very literally all 
 there was to be done about the study of man to 
 show how far the body could explain the activity we 
 call "the mind." The unfortunate feature was that 
 they thought they had to start with a body not only
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 with mind and soul left out but also with practical 
 disregard of the whole natural setting. They studied 
 little more than corpses and experimental animals, 
 and many a critic wondered how such a corpse or 
 a frog could ever show any mind, normal or ab- 
 normal. To get things balanced again, the vision 
 of man had to expand to take a sane and practical 
 view of all of human life not only of its machinery. 
 
 The human organism can never exist without its 
 setting in the world. All we are and do is of the 
 world and in the world. The great mistake of an 
 overambitious science has been the desire to study 
 man altogether as a mere sum of parts, if possible 
 of atoms, or now of electrons, and as a machine, 
 detached, by itself, because at least some points in 
 the simpler sciences could be studied to the best 
 advantage with this method of the so-called ele- 
 mentalist. It was a long time before willingness to 
 see the large groups of facts, in their broad relations 
 as well as in their inner structure, finally gave us the 
 concept and vision of integration which now fits 
 man as a live unit and transformer of energy into 
 the world of fact and makes him frankly a con- 
 sciously integrated psychobiological individual and 
 member of a social group. 
 
 It is natural enough that man should want to 
 travel on the road he knows and likes best. The 
 
 [25]
 
 A PSYCHIATRIC MILESTONE 
 
 philosopher uses his logic and analysis and synthesis. 
 The introspectionist wants to get at the riddle of 
 the universe by crawling into the innermost depth 
 of his own self-scrutiny, even at the risk to use 
 a homely phrase of drawing the hole in after him 
 and losing all connection with the objective world. 
 The physicist follows the reverse course. He gives 
 us the appreciation of the objective world around 
 and in us. The chemist follows out the analytic 
 and synthetic possibilities of his atoms and ele- 
 ments, and the biologist the growth and reproduc- 
 tion and multiplication of cells. Each sees an open 
 world of possibilities and is ready to follow as far 
 as facts will carry and as far as the imagination will 
 soar. Each branch has created its rules of the game 
 culminating in the concept of objective science, and 
 the last set of facts to bring itself under the rules 
 of objective science, and to be accepted, has been 
 man as a unit and personality. 
 
 The mind and soul of man have indeed had a 
 hard time. To this day, investigators have suf- 
 fered under the dogma that mind must be treated 
 as purely subjective entity, something that can be 
 studied only by introspection, or at least only with 
 ultra-accurate instruments always with the idea 
 that common sense is all wrong in its psychology. 
 Undoubtedly it was, so long as it spoke of a mind 
 
 [26]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 and soul as if what was called so had to be, even 
 during life, mysterious and inaccessible, something 
 quite different from any other fact of natural-his- 
 tory study. 
 
 The great step was taken when all of life was 
 seen again in its broad relations, without any special 
 theory but frankly as common sense finds it, viz., 
 as the activities and behavior of definite individ- 
 uals very much as Aristotle had put it "living 
 organisms in their 'form' or activity and behavior/' 
 Psychology had to wake up to studying other minds 
 as well as one's own. Common sense has always 
 been willing to study other persons besides our 
 own selves, and that exactly as we study single 
 organs viz., for what they are and do and for the 
 conditions of success and failure. Nor do we have 
 to start necessarily from so-called elements. Prog- 
 ress cannot be made merely out of details. It will 
 not do merely to pile up fragments and to expect 
 the aggregates to form themselves. It also takes a 
 friend of facts with the capacity for mustering and 
 unifying them, as the general musters his army. 
 Biology had to have evolutionists and its Darwin 
 to get on a broad basis to start with, and human 
 biology, the life of man, similarly had to be con- 
 ceived in a new spirit, with a clear recognition of 
 the opportunities for the study of detail about the 
 
 [27]
 
 A PSYCHIATRIC MILESTONE 
 
 brain and about the conditions for its working and 
 its proper support, but also with a clear vision of 
 the whole man and all that his happiness and effi- 
 ciency depend upon. 
 
 All this evolution is strongly reflected in the 
 actual work of psychiatry and medicine. For a 
 time, it looked to the physician as if the physiology 
 and pathology of the body had to make it their 
 ambition to make wholly unnecessary what tradi- 
 tional psychology had accumulated, by turning it 
 all into brain physiology. The "psychological" 
 facts involved were undoubtedly more difficult to 
 control, so much so that one tried to cut them out 
 altogether. As if foreshadowing the later academic 
 "psychology without soul and consciousness," the 
 venerable Superintendent of Utica, Dr. Gray, was 
 very proud when in 1870 he had eliminated the 
 "mental and moral causes" from his statistics of the 
 Utica State Hospital, hiding behind the dogma that 
 "mind cannot become diseased, but only the body." 
 To-day "mental and moral causes" are recognized 
 again in truer form no longer as mere ideas and 
 uninvestigated suppositions taken from uncritical 
 histories, but as concrete and critically studied life 
 situations and life factors and life problems. Our 
 patients are not sick merely in an abstract mind, 
 but by actually living in ways which put their mind 
 
 [28]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 and the entire organism and its activity in jeopardy, 
 and we are now free to see how this happens since 
 we study the biography and life history, the resources 
 of adaptation and of shaping the life to success or 
 to failure. 
 
 The study of life problems always concerns itself 
 with the interaction of an individual organism with 
 life situations. The first result of a recognition of 
 this fact was a more whole-hearted and practical 
 concept of personality. 
 
 In 1903 I put together for the first time my analy- 
 sis of the neurotic personality, which was soon fol- 
 lowed by a series of studies on the influences of the 
 mental factors, and in 1908 a paper on "What Do 
 Histories of Cases of Insanity Teach Us Concerning 
 Preventive Mental Hygiene During the Years of 
 School Life ?" All this was using for psychiatry the 
 growing appreciation of a broad biological view-point 
 in its concrete application. It was a reaction against 
 the peculiar fear of studying the facts of life simply 
 and directly as we find and experience them scoffed 
 at because it looked as if one was not dealing with 
 dependable and effective data. Many of the factors 
 mentioned as causes do not have the claimed effects 
 with sufficient regularity. It is quite true that not 
 everybody is liable to any serious upset by several 
 of the handicaps sometimes found to be disastrous
 
 A PSYCHIATRIC MILESTONE 
 
 during the years of development; but we have 
 learned to see more clearly why the one person does 
 and the other does not suffer. Evidently, not every- 
 body who is reserved and retiring need be in danger 
 of mental disorder, yet there are persons of just this 
 type of make-up that are less able than others to 
 stand the strains of isolation, of inferiority feeling, 
 of exalted ambitions and one-sided longings, intol- 
 erable desires, etc. The same individual difference 
 of susceptibility holds even for alcohol. With this 
 recognition we came to lay stress again on the 
 specific factors which make for the deterioration of 
 habits, for tantrums with imaginations, and for 
 drifting into abnormal behavior, and conditions 
 incompatible with health. 
 
 It was at this point that our great indebtedness 
 to the Bloomingdale Hospital began. Dr. August 
 Hoch, then First Assistant of the Bloomingdale Hos- 
 pital, began to swing more and more toward the 
 psychobiological trend of views, and with his devoted 
 and very able friend Amsden he compiled that re- 
 markable outline,* which was the first attempt to 
 reduce the new ideals of psychobiology to a practical 
 scheme of personality study that clear and plain 
 
 * A Guide to the Descriptive Study of the Personality, with Special 
 Reference to the Taking of Anamneses of Cases with Psychoses, by 
 Dr. August Hoch and Dr. George S. Amsden. 
 
 [30]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 questionnaire going directly at human traits and 
 reactions such as we all know and can see at work 
 without any special theories or instruments. 
 
 After studying in each patient all the non-mental 
 disorders such as infections, intoxications, and the 
 like, we can now also attack the problems of life 
 which can be understood only in terms of plain and 
 intelligible human relations and activities, and thus 
 we have learned to meet on concrete ground the real 
 essence of mind and soul the plain and intelligible 
 human activities and relations to self and others. 
 There are in the life records of our patients cer- 
 tain ever-returning tendencies and situations which 
 a psychiatry of exclusive brain speculation, auto- 
 intoxications, focal infections, and internal secre- 
 tions could never have discovered. 
 
 Much is gained by the frank recognition that man 
 is fundamentally a social being. There are reac- 
 tions in us which only contacts and relations with 
 other human beings can bring out. We must study 
 men as mutual reagents in personal affections and 
 aversions and their conflicts; in the desires and satis- 
 factions of the simpler appetites for food and per- 
 sonal necessities; in the natural interplay of antici- 
 pation and fulfilment of desires and their occasional 
 frustration; in the selection of companionship which 
 works helpfully or otherwise for the moment or
 
 A PSYCHIATRIC MILESTONE 
 
 more lastingly throughout the many vicissitudes 
 of life. All through we find situations which create 
 a more or less personal bias and chances for success 
 or failure, such as simpler types of existence do not 
 produce. They create new problems, and produce 
 some individuals of great sensitiveness and others 
 with immunity and in this great field nothing will 
 replace a simple study of the life factors and the 
 social and personal life problems and their work- 
 ing the study of the real mind and the real soul 
 i. e., human life itself. Looking back then this 
 practical turn has changed greatly the general view 
 as to what should be the chief concern of psychology. 
 One only need take up a book on psychology to see 
 what a strong desire there always was to contrast 
 a pure psychology and an applied psychology, and to 
 base a new science directly on the new acquisitions 
 of the primary sciences such as anatomy and his- 
 tology of the nervous system. There was a quest 
 for the elements of mind and their immediate corre- 
 lation with the latest discoveries in the structure of 
 the brain. The centre theory and the cell and neu- 
 rone theory seemed obligatory starting-points. To- 
 day we have become shy of such postulates of one- 
 sided not sufficiently functional materialism. We 
 now call for an interest in psychobiological facts in 
 terms of critical common sense and in their own 
 
 [32]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 right largely a product of psychiatry. There al- 
 ways is a place for elements, but there certainly is 
 also a place for the large momentous facts of human 
 life just as we find and live it. 
 
 Thus psychiatry has opened to us new conceptions 
 and understandings of the relation of child and 
 mother, child and father, the child as a reagent to 
 the relations between mother and father, brothers 
 and sisters, companions and community in the 
 competitions of real concrete life. It has furnished 
 a concrete setting for the interplay of emotions and 
 their effects. 
 
 It has led us from a cold dogma of blind heredity 
 and a wholesale fatalistic asylum scheme, to an under- 
 standing of individual, familiar, and social adjust- 
 ments, and a grasp on the factors which we can con- 
 sider individually and socially modifiable. We have 
 passed from giving mere wholesale advice to a con- 
 scientious study of the problems of each unit, and 
 at the same time we have developed a new and sen- 
 sible approach to mental hygiene and prevention, 
 as expressed in the comprehensive surveys of State 
 and community work and even more clearly in the 
 development of helps to individuals in finding them- 
 selves, and in the work in schools to reach those who 
 need a special adaptation of aims and means. To 
 the terrible emergency of the war it was possible to 
 
 [33]
 
 A PSYCHIATRIC MILESTONE 
 
 bring experienced men and women as physicians 
 and nurses, and how much was done, only those 
 can appreciate who have seen the liberality with 
 which all the hospitals, and Bloomingdale among 
 the first, contributed more than their quota of help, 
 and all the assistance that could possibly be offered 
 to returning victims for their readjustment. 
 
 It is natural enough that psychiatry should have 
 erred in some respects. We had forced upon us the 
 herding together of larger numbers of patients than 
 can possibly be handled by one human working unit 
 or working group. The consequence was that there 
 arose a narrowing routine and wholesale classifica- 
 tions and a loss of contact with the concrete needs 
 of the individual case; that very often progress had 
 to come from one-sided enthusiasts or even out- 
 siders, who lost the sense of proportion and magnified 
 points of relative importance until they were sup- 
 posed to explain everything and to be cure-alls. 
 We are all inclined to sacrifice at the altar of excessive 
 simplicity, especially when it suits us; we become 
 " single-taxers " and favor wholesale legislation and 
 exclusive State care when our sense for democratic 
 methods has gone astray. Human society has dealt 
 with the great needs of psychiatry about as it has 
 dealt with the objects of charity, only in some ways 
 more stingily, with a shrewd system and unfortu- 
 
 [34]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 nately often with a certain dread of the workers 
 themselves and of their enthusiasm and demands. 
 Law and prejudice surrounded a great share of the 
 work with notions of stigma and hopelessness and 
 weirdness while to those who see the facts in terms 
 of life problems there can be but few more inspir- 
 ing tasks than watching the unfolding of the prob- 
 lematic personality, seeking and finding its proper 
 settings, and preventing the clashes and gropings 
 in maladjustments and flounderings of fancy and 
 the faulty use and nutrition of the brain and of the 
 entire organism. 
 
 What a difference between the history of a patient 
 reported and studied and advised by the well-trained 
 psychiatrist of to-day and the account drawn up 
 by the statistically minded researcher or the physi- 
 cian who wants to see nothing but infections or 
 chemistry and hypotheses of internal secretion. 
 What a different chance for the patient in his treat- 
 ment, in contrast to what the venerable Gait of 
 Virginia reports as the conception of treatment 
 recommended by a great leader of a hundred years 
 ago: "Mania in the first stage, if caused by study, 
 requires separation from books. Low diet and a 
 few gentle doses of purging physic; if pulse tense, 
 ten or twelve ounces of blood [not to be given but 
 to be taken !]. In the high grade, catch the patient's 
 
 [35]
 
 A PSYCHIATRIC MILESTONE 
 
 eye and look him out of countenance. Be always 
 dignified. Never laugh at or with them. Be truth- 
 ful. Meet them with respect. Act kindly toward 
 them in their presence. If these measures fail, 
 coercion if necessary. Tranquillizing chair. Strait 
 waistcoat. Pour cold water down their sleeves. The 
 shower bath for fifteen or twenty minutes. Threaten 
 them with death. Chains seldom and the whip 
 never required. Twenty to forty ounces of blood, 
 unless fainting occurs previously; . . . etc." 
 
 To-day an understanding of the life history, of 
 the patient's somatic and functional assets and 
 problems, likes and dislikes, the problem presented 
 by the family, etc. ! 
 
 So much for the change within and for psychiatry. 
 How about psychiatry's contribution beyond its 
 own narrower sphere ? It has led us on in philos- 
 ophy, it has brought about changes in our attitude to 
 ethics, to social study, to religion, to law, and to life 
 in general. Psychiatric work has undoubtedly in- 
 tensified the hunger for a more objective and yet 
 melioristic and really idealistic philosophical con- 
 ception of reality, such as has been formulated in 
 the modern concept of integration. 
 
 Philosophical tradition, logic, and epistemology 
 alike had all conspired to make as great a puzzle as 
 possible of the nature of mental life, of life itself, and 
 
 [36]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 of all the fundamental principles, so much so that 
 as a result anything resembling or suggesting philos- 
 ophy going beyond the ordinary traditions has got 
 into poor repute in our colleges and universities and 
 among those of practical intelligence. The conse- 
 quence is that the student and the physician are apt 
 to be hopeless and indifferent concerning any effort 
 at orderly thinking on these problems.* 
 
 Most of us grew up with the attitude of a fatalistic 
 intellectual hopelessness. How could we ever be 
 clear on the relation of mind and body? How 
 could mind and soul ever arise out of matter ? How 
 can we harmonize strict science with what we try 
 to do in our treatment of patients ? How can we, 
 with our mechanistic science, speak of effort, and 
 of will to do better ? How can we meet the invec- 
 tives against the facts of matter on the part of the 
 opposing idealistic philosophies and their uncritical 
 exploitations in "New Thought" i. e., really the 
 revival of archaic thought ? It is not merely medical 
 usefulness that forced these broad issues on many a 
 thinking physician, but having to face the facts all 
 the time in dealing with a living human world. The 
 psychopathologist had to learn to do more than the 
 so-called " elementalist " who always goes back to 
 
 * See, for instance, Moebius, The Hopelessness of All Psychology, 
 reviewed in the Psychological Bulletin, vol. IV, 1907, pp. 170-179. 
 
 [37]
 
 A PSYCHIATRIC MILESTONE 
 
 the elements and smallest units and then is apt 
 to shirk the responsibility of making an attempt 
 to solve the concrete problems of greater com- 
 plexity. The psychiatrist has to study individuals 
 and groups as wholes, as complex units, as the 
 "you" or "he" or "she" or "they" we have to 
 work with. We recognize that throughout nature 
 we have to face the general principle of unit-forma- 
 tion, and the fact that the new units need not be 
 like a mere sum of the component parts but can be 
 an actually new entity not wholly predictable from 
 the component parts and known only through ac- 
 tual experience with the specific product. Hydrogen 
 and oxygen, it is true, can form simple mixtures, 
 but when they make an actual chemical integration 
 we get a new specific type of substance, water, be- 
 having and dividing according to its own laws and 
 properties in a way not wholly predictable from just 
 what we know of hydrogen and oxygen as such. 
 Analogy prompts us to see in plants and animals 
 products of physics and chemistry and organization, 
 although the peculiarity of the product makes us 
 recognize certain specificities of life not contained in 
 the theory of mere physics and chemistry. All the 
 facts of experience prompt us to see in mentation a 
 biological function, and we are no longer surprised 
 to find this product of integration so different from 
 
 [38]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 the nature and functions of all the component parts. 
 All the apparent discontinuities in the intrinsic 
 harmony of facts, on the one hand, and the apparent 
 impossibility of accounting for new features and 
 peculiarities of the new units, are shown to be a 
 general feature of nature and of facts : integration is 
 not mere summation, but a creation of ever-new 
 types and units, with superficial discontinuities and 
 with their own new denominators of special peculi- 
 arities; hence there is no reason to think of an insur- 
 mountable and unique feature in the origin of life, 
 nor even of mentally integrated life; no need of spe- 
 cial mystical sparks of life, of a mysterious spirit, 
 etc.; but and this is the important point also no 
 need of denying the existence of all the evidence 
 there may be of facts which we imply when we use 
 the deeply felt concepts of mind and soul. In other 
 words, we do not have to be mind-shy nor body-shy 
 any longer. 
 
 The inevitable problem of having to study other 
 persons as well as ourselves necessarily leads us on 
 to efforts at solution of other philosophical problems, 
 the problem of integrating materialism and idealism, 
 mechanism and relative biological determinism and 
 purpose, etc. Man has to live with the laws of 
 physics and chemistry unbroken and in harmony 
 with all that is implied in the laws of heredity and 
 
 [39]
 
 A PSYCHIATRIC MILESTONE 
 
 growth and function of a biological organism. Yet 
 what might look like a limitation is really his strength 
 and safe foundation and stability. On this ground, 
 man's biological make-up has a legitimate sphere of 
 growth and expansion shared by no other type of 
 being. We pass into every new moment of time with 
 a preparedness shown in adaptive and constructive 
 activity as well as structure, most plastic and far- 
 reaching in the greatest feat of man, that of imagina- 
 tion. Imagination is not a mere duplication of 
 reality in consciousness and subjectivity; it is a sub- 
 stitute in a way, but actually an amplification, and 
 often a real addition to what we might otherwise 
 call the " crude world," integrated in the real activi- 
 ties of life, a new creation, an ever-new growth, seen 
 in its most characteristic form in choice and in any 
 new volition. Hence the liberating light which 
 integration and the concepts of growth and time 
 throw on the time-honored problem of absolute and 
 relative determinism and on the relation of an ultra- 
 strict "science" with common sense. 
 
 In logic, too, we are led to special assertions. We 
 are forced to formulate "open definitions," i. e., we 
 have to insist on the open formulation of tendencies 
 rather than "closed definitions." We deal with rich 
 potentialities, never completely predictable. 
 
 This background and the demands of work in 
 
 [40]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 guiding ourselves and others thus come to lead us 
 also into practical ethics, with a new conception of 
 the relation of actual and experimental determinism 
 and of what "free will" we may want to speak of, 
 with a new emphasis on the meaning of choice, of 
 effort, and of new creation out of new possibilities 
 presented by the ever-newly-created opportunities 
 of ever-new time. We get a right to the type of 
 voluntaristic conception of man which most of us 
 live by with a reasonable harmony between our 
 science and our pragmatic needs and critical com- 
 mon sense. 
 
 The extent to which we can be true to the material 
 foundations and yet true to a spiritual goal, ulti- 
 mately measures our health and natural normality 
 and the value of our morality. Nature shapes her 
 aims according to her means. Would that every man 
 might realize this simple lesson and maxim there 
 would be less call for a rank and wanton hankering 
 for relapses into archaic but evidently not wholly 
 outgrown tendencies to the assumption of "omnipo- 
 tence of thought," revived again from time to time 
 as "New Thought." Psychiatry restores to science 
 and to the practical mind the right to reinclude 
 rationally and constructively what a narrower view 
 of science has, for a time at least, handed over 
 unconditionally to uncritical fancy. But the only 
 
 [41]
 
 A PSYCHIATRIC MILESTONE 
 
 way to make unnecessary astrology and phrenology 
 and playing with mysticism and with Oliver Lodge's 
 fancies of the revelation of his son Raymond, is to 
 recognize the true needs and yearnings of man and 
 to show nature's real ways of granting appetites 
 and satisfactions that are wholesome. 
 
 Hereby we have indeed a contribution to biolog- 
 ically sound idealism: a clearer understanding of 
 how to blend fact and ambition, nature and ideal 
 an ability to think scientifically and practically and 
 yet idealistically of matters of real life. 
 
 To come back to more concrete problems again, a 
 wider grasp of what psychiatry may well furnish us 
 helps toward a new ethical goal in our social con- 
 science. The nineteenth century brought us the 
 boon and the bane of industrialism. More and 
 more of the pleasures and satisfactions of creation 
 and production and of the natural rewards of the 
 daily labor drifted away from the sight and control 
 of the worker, who now rarely sees the completed 
 result of his work as the farmer or the artisan used 
 to do. Few workers have the experience of getting 
 satisfaction from direct pride in the end result; 
 as soon as the product is available, a set of traders 
 carries it to the markets and a set of financiers de- 
 termines, in fact may already have determined, the 
 reward just as the reward of the farmer is often 
 
 [42]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 settled for him by astounding speculations long be- 
 fore the crop is at hand. There is a field for a new 
 conscience heeding the needs of fundamental satisfac- 
 tions of man so well depicted by Carlton Parker, 
 and psychiatric study furnishes much concrete ma- 
 terial for this new conscience in industrial relations 
 with a better knowledge of the human needs of all 
 the participants in the great game of economic life. 
 Psychiatry gives us also a new appreciation of 
 the religious life and needs of our race. Man's 
 religion shows in his capacity to feel and grasp his 
 relations and responsibility toward the largest unit 
 or force he can conceive, and his capacity for faith 
 and hope in a deeper and more lasting interde- 
 pendence of individual and race with the Ruler or 
 rules of the Universe. Whatever form it may take 
 expresses his capacity to feel himself in humility 
 and faith, and yet with determination, a more or 
 less responsible part of the greatest unit he can grasp. 
 The form this takes is bound to vary individually. 
 As physicians we learn to respect the religious views 
 of our fellow beings, whatever they may be; because 
 we are sure that we have the essentials in common; 
 and with this emphasis on what we have in common, 
 we can help in attaining the individually highest 
 attainable truth without having to be destructive. 
 We all recognize relations that go beyond individual 
 
 [43]
 
 A PSYCHIATRIC MILESTONE 
 
 existence, lasting and "more than biological" rela- 
 tions, and it is the realization of these conceptions 
 intellectually and emotionally true to our individual 
 and group nature that constitutes our various re- 
 ligions and faiths. Emphasizing what we have in 
 common, we become tolerant of the idea that prob- 
 ably the points on which we differ are, after all, 
 another's best way of expressing truths which our 
 own nature may picture differently but would not 
 want to miss in, or deny to, the other. One of the 
 evidences of the great progress of psychiatry is that 
 we have learned to be more eager to see what is sane 
 and strong and constructively valuable even in the 
 strange notions of our patients, and less eager to 
 call them queer and foolish. A delusion may con- 
 tain another person's attempt at stating truth. The 
 goal of psychiatry and of sound common sense is 
 truth free of distortion. Many a strange religious 
 custom and fancy has been brought nearer our under- 
 standing and appreciation since we have learned to 
 respect the essential truth and individual and group 
 value of fancy and feeling even in the myths and in 
 the religious conceptions of all races. 
 
 Among the most interesting formulations and po- 
 tential contributions of psychiatry are those reach- 
 ing out toward jurisprudence. Psychiatry deals 
 pre-eminently with the variety and differences of 
 
 [44]
 
 human personalities. To correct or supplement a 
 human system apparently enslaved by concern about 
 precedent and baffling rules of evidence inherited 
 from the days of cruel and arbitrary kings, the de- 
 mand for justice has called for certain remedies. 
 Psychiatry still plays a disgraceful role in the so- 
 called expert testimony, largely a prostitution of 
 medical authority in the service of legal methods. 
 Yet, out of it all there has arisen the great usefulness 
 of the psychiatrist in the juvenile and other courts. 
 There it is shown that if psychiatry is to help, it 
 should be taken for granted that the person indicted 
 on a charge should thereby become subject to a 
 complete and unreserved study of all the facts, 
 subject to cross-examination, to be sure, but before 
 all accessible to complete and unreserved study. 
 This would mean a substantial participation of law 
 in the promotion of knowledge of facts and con- 
 structive activity, and a conception of indetermi- 
 nate sentence not merely in the service of leniency 
 but in the service of the best protection of the public, 
 and, if necessary, lasting detention of those who 
 cannot be reformed, before they have had to do 
 their worst. Whoever is clearly indicted for break- 
 ing the laws of social compatibility should not merely 
 invite a spirit of revenge, but should, through the 
 indictment, surrender automatically to legalized au- 
 
 [45]
 
 A PSYCHIATRIC MILESTONE 
 
 thority endowed with the right and duty of an un- 
 limited investigation of the facts as they are. 
 
 Looking back then, you can see how the history 
 of the human thought about what we call mind and 
 psyche displayed some strange reactions of the prac- 
 cal man, the scientist, the philosopher, and theo- 
 logian toward one of the most important and prac- 
 tical problems. It is difficult to realize what it 
 means to arrive at ever-more-workable formulations 
 and methods of approach. We do not have to be 
 mind-shy or body-shy any longer. To-day we can 
 attack the facts as we find them, without that dis- 
 turbing obsession of having to translate them first 
 into something artificial before we can really study 
 them and work with them. Since we have reached 
 a sane pluralism with a justifiable conviction of the 
 fundamental consistency of it all, a satisfaction 
 with what we modestly call formulation rather than 
 definition and with an appreciation of relativity, we 
 have at last an orderly and natural field and method 
 from which nobody need shy. 
 
 The century that has passed since the inspiration 
 of a few men of the Society of the New York Hospital 
 to provide for the mentally sick has cleared the 
 atmosphere a great deal. We can start the second 
 century freer and unhampered in many ways. Much 
 has been added, and more than ever do we appre- 
 
 [46]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 ciate the position of just such a hospital as that of 
 Bloomingdale as a centre of healing and as a leader 
 of public opinion and as a contributor to progress. 
 
 The Bloomingdale Hospital has a remarkable 
 function. It is a more or less privileged forerunner 
 in standards and policies. Without having to carry 
 the burdens of the whole State with its sweeping 
 and sometimes distant power and its forced economy, 
 a semiprivate hospital like Bloomingdale aims to 
 minister to a slightly select group, especially those 
 who are in the difficult position of greater sensitive- 
 ness but moderate means in days of sickness. It 
 serves the part of our community which more than 
 any other sets the pace of the civilization about 
 us the intelligent aspiring workers who may not 
 have reached the goal of absolute financial inde- 
 pendence. It creates the standard of which we may 
 dream that it might become the standard of the 
 whole State. 
 
 When we review the roster of Superintendents 
 from John Neilson to Pliny Earle and from Charles 
 Nichols, Tilden Brown, and Samuel Lyon down to 
 the present head, our highly esteemed friend and co- 
 worker William L. Russell and the names of the 
 members of the staff, many of whom have reached 
 the highest places in the profession, and last, but not 
 least, the names of the Governors of The Society of 
 
 [47]
 
 A PSYCHIATRIC MILESTONE 
 
 the New York Hospital, we cannot help being im- 
 pressed by the forceful representation of both the 
 profession and the public, and we recognize the wide 
 range of influence. 
 
 Instead of depending on frequently changing poli- 
 cies regulated from the outside under the influence 
 of the greater and lesser lights and exigencies of State 
 and municipal organization, the New York Hospital 
 has its self-perpetuating body of Governors chosen 
 from the most public-spirited and thoughtful repre- 
 sentatives of our people. Bloomingdale thus has 
 always had a remarkable Board of Governors, who, 
 from contact with the General Hospital and with 
 this special division, are in an unusual position to see 
 the practical aspects of the great change that is now 
 taking place. You see how the division of psychiatry 
 has developed from practically a detention-house to 
 an asylum, and finally to a hospital with all the 
 medical equipment and laboratories of the General 
 Hospital. And you begin to see psychiatry, with its 
 methods of study and management of life problems 
 as well as of specific brain diseases, infections, and 
 gastrointestinal and endocrine conditions, become 
 more and more helpful, even a necessity, in the wards 
 and dispensary of the General Hospital on i6th 
 Street. The layman cannot, perhaps, delve profita- 
 bly into the details of such a highly and broadly 
 
 [48}
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 specialized type of work. But he can readily take a 
 share in the best appreciation of the general philos- 
 ophy and policy of it all. 
 
 The shaping of the policy of a semiprivate 
 hospital is not quite as simple as shaping that 
 of a State Hospital with its well-defined districts 
 and geographically marked zones of responsibility. 
 Bloomingdale has its sphere of influence marked by 
 qualitative selection rather than by a formal con- 
 sideration. It does not pose as an invidious con- 
 trast to the State Hospital, and yet it is intended to 
 solve in a somewhat freer and more privileged man- 
 ner the problem of providing for the mentally sick 
 of a more or less specific hospital constituency, the 
 constituency of the New York Hospital; and since 
 it reaches the most discriminating and thinking part 
 of our population, it has the most wonderful oppor- 
 tunity to shape public opinion. Like all psychi- 
 atrical institutions, it has to live down the tradi- 
 tional notions of the half-informed public; it has to 
 make conspicuous the change of spirit and the better 
 light in which we see our field and responsibilities. 
 This organization can show that it is not mere in- 
 sanity but the working out of life problems that such 
 a hospital as this is concerned with. The conditions 
 for which it cares are many. Some of them are all 
 that which tradition and law stamp as insanity. 
 
 [49]
 
 A PSYCHIATRIC MILESTONE 
 
 But see what a change. Seventy-five per cent of the 
 patients are voluntary admissions; and more and 
 more will be able to use the helps when they begin 
 to feel the need, not merely when it becomes an en- 
 forced necessity. 
 
 By creating for this Hospital a liberal foundation, 
 by completing its equipment so as to make possible 
 a free exchange of patients and of workers from the 
 Hospital in the city and this place in the country, 
 much has been done and more will be done to set a 
 living example of the very spirit of modern psycho- 
 pathology and psychiatry. We know now that from 
 10 to 40 per cent of the patients of the gynecologist, 
 the gastroenterologist, and the internist generally 
 would be better treated if a study of the life problems 
 were added to that of the special organs and func- 
 tions. To meet this need it should be possible to 
 have enough workers in this branch of the Hospital 
 to take their share of the consulting and co-opera- 
 tion work in the wards and dispensary of the General 
 Hospital, and perhaps even in the schools provided 
 for the same type of people from which you draw your 
 patients. The grouping of the patients can be such 
 that the old prejudices need not reach far into the 
 second century of the life of the Hospital. With a 
 man of the vision and practical experience of Dr. 
 Russell, there is no need for an outsider to conjure 
 
 [so]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 up a picture of special practical achievements as I 
 have done of the more general principles to-day. 
 
 An institution is more than a human life. Many 
 ambitions combine and become part of a group spirit 
 permeating the organization and reaching their ful- 
 filment in the succession of leaders. The life and 
 growth and happy self-realization of an institution is 
 not the bricks and mortar it is a living and elastic 
 entity never too stable, never too finished, a grow- 
 ing and plastic plant to use a metaphor that has 
 slipped in perhaps without arousing all the implica- 
 tions the term plant might carry and does carry. 
 
 Some years ago my wife celebrated her birthday 
 and told her colored cook jocosely: "Geneva, I am 
 a hundred years old to-day." The cook's jaw 
 dropped and then she suddenly remarked: "Lord! 
 you don't look dat ole." That is the way I feel 
 about Bloomingdale Hospital as we see it to-day 
 pulsating with ever-fresh life and ever-fresh problems ! 
 How different from a simple human being, after all ! 
 The heart and wisdom of many a man and woman has 
 gone into the perpetuation of what a few thoughtful 
 men started in 1821 and the result is that it is ever 
 renewing its youth. 
 
 Many a dream has been realized and many a dream 
 has given way to another. Here and there the past 
 may make itself felt too much. But the spirit and
 
 A PSYCHIATRIC MILESTONE 
 
 its growth show in recruiting ever-new lives to meet 
 the present day and the days to come, and this all 
 the more so if we can show the younger generation 
 that every effort is likely to have its reasonable di- 
 rect support. We all want a man like Dr. William 
 L. Russell to have the fullest opportunity to bring 
 to its best expression the rich and well-tried wisdom 
 of over twenty-five years of devoted work in the 
 field. This is no doubt a time of stress when many 
 personal and general sacrifices may be needed to 
 bring about the fruition and culmination of the 
 labors of the present generation. Yet is it not a 
 clear opportunity and duty, so that those who are 
 growing up in the ranks to-day may really be en- 
 couraged to get a solid training, always animated 
 by the conviction that one can be sure of the prac- 
 tical reward for toiling through the many years of 
 preparation in a psychiatric career, whether it be as 
 a physician or as a nurse or as an administrator ? 
 
 I cannot help feeling as I stand here that I am in 
 a way representing not only my own sentiments 
 and convictions but those of our dear old friend 
 Hoch. We all wish that he might be with us to 
 express himself the warm feelings toward the Bloom- 
 ingdale Hospital and its active representatives, from 
 the managers to the humblest workers. Hoch in 
 his modesty could probably not have been brought 
 
 [52]
 
 PSYCHIATRY AND LIFE PROBLEMS 
 
 to state fully and frankly his own share in the achieve- 
 ments of this Hospital. But I know how much he 
 would have liked to be here to express especially 
 the warmth of appreciation we all entertain of what 
 our friend William L. Russell means to us and has 
 meant to us all through the nearly twenty-five years 
 of our friendship and of working together. We de- 
 light in seeing him bring to further fruition the ad- 
 mirable work he did at Willard, and later for all the 
 State hospitals; and that which we see him do at 
 all times for sanity in the progress of practical 
 psychiatry, and now especially in the guidance of 
 this institution. We delight in seeing his master 
 mind given more and more of a master's chance for 
 the practical expression of his ideals and convictions 
 concerning the duties and opportunities of such a 
 hospital as Bloomingdale. 
 
 Our thanks and best wishes to those who invited 
 us to stand here to-day at the cradle of a second 
 century of Bloomingdale Hospital! It is a note- 
 worthy gathering that joins here in good wishes to 
 those who have shaped this ever-new Bloomingdale. 
 With a tribute to our thoughtful and enthusiastic 
 friend in internal medicine, Lewellys F. Barker, to 
 our English coworker, Richard G. Rows, to the 
 illustrious champion of French psychopathology, 
 Pierre Janet, to our friend and leader in practical 
 
 [53]
 
 A PSYCHIATRIC MILESTONE 
 
 psychiatry, William L. Russell, to our friends and 
 coworkers of the Bloomingdale staff, and especially 
 also to the Board of Governors who shape the policy 
 and control the finances, and exercise the leadership 
 of public opinion, I herewith express my sincerest 
 thanks and best wishes. 
 
 [54]
 
 ADDRESS BY 
 
 DR. LEWELLYS F. BARKER
 
 The Chairman : The Johns Hopkins Medical 
 School lends us also to-day Dr. Lewellys F. Barker, 
 its Professor of Clinical Medicine. Dr. Barker has 
 done so much to define and settle the contradictions 
 of mind and matter, and has clarified so much, and 
 in fields so varied, as teacher, research worker, and 
 practitioner, that we welcome this opportunity of 
 listening to his discussion of "THE IMPORTANCE OF 
 PSYCHIATRY IN GENERAL MEDICAL PRACTICE."
 
 DR. BARKER 
 
 We have met to-day to celebrate the hundredth 
 anniversary of the founding of a hospital that, in 
 its simpler beginnings and in its evolution to the 
 complex and highly organized activities of the pres- 
 ent, has served an eminently practical purpose and 
 has played an important role in the development 
 of the science and art of psychiatry in America. 
 I desire, as a representative of general medicine, and, 
 especially, of internal medicine, to add, on this oc- 
 casion, my congratulations to those of the spokes- 
 men of other groups, and, at the same time to ex- 
 press the hope that this institution, historically so 
 significant for the century just past, may maintain 
 its relative influence and reputation in the centuries 
 to come. 
 
 The interest taken in psychiatry by the general 
 practitioner and by the consulting internist has been 
 growing rapidly of late. Some of the reasons for 
 this growth of interest and heightening of apprecia- 
 tion I have drawn attention to on an earlier oc- 
 casion.* Psychiatry as a whole was for a long time 
 
 * In an address at the seventieth annual meeting of the American 
 Medico- Psychological Association, 1914, entitled "The Relations of 
 Internal Medicine to Psychiatry." 
 
 [59}
 
 A PSYCHIATRIC MILESTONE 
 
 as widely separated from general medicine as pen- 
 ology is to-day, and for similar reasons. It was a 
 long time before persons that manifested extraordi- 
 nary abnormalities of thought, feeling, and behavior 
 were regarded as deserving medical study and care, 
 and even when a humanitarian movement led to 
 their transfer from straight-jackets, chains, and 
 prison cells to "asylums for the insane," these insti- 
 tutions were, for practical reasons, so divorced from 
 the homes of the people and from general hospitals 
 that psychiatry had, and could at the time have, 
 but little intercourse with general medicine or with 
 general society. Mental disorders were moral and 
 legal problems rather than biological, social, and 
 medical problems. Their genesis was wholly mis- 
 understood, and legal, medical, social, religious, and 
 philosophic prejudices went far toward preventing 
 any rational scientific mode of approach to the ques- 
 tions involved or any formulation of investigative 
 procedures that promised to be fruitful. Even to- 
 day the same prejudices are all too inhibitory; but 
 thanks to the unprecedented development of the 
 natural sciences during the period since this hospital 
 was founded, we are witnessing, in our time, a rapid 
 transformation of thought and opinion concerning 
 both the normal and the disordered mind, a trans- 
 formation that is reaching all circles of human be- 
 
 [60]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 ings, bidding fair to compel the strongholds of tradi- 
 tion and prejudice to relax, and inviting the whole- 
 hearted co-operation of workers in all fields in a 
 common task of overcoming some of the greatest 
 difficulties by which civilization and human progress 
 are confronted. And though the brunt of this task 
 is borne and must be borne by the shoulders of medi- 
 cal men, physicians assume the burden cheerfully, 
 now that they know that they can count upon the 
 intelligent support and the cordial sympathy of an 
 ever-enlarging extra-medical aggregate. No better 
 illustration could be given, perhaps, of the change in 
 the status of psychiatry in this country and in the 
 world than the contents of the programme of our 
 meeting to-day at which a distinguished investigator 
 from London tells us of the biological significance of 
 mental disorders, an eminent authority from Paris 
 explains the relationship between certain diseases of 
 the nervous system and these disorders, and a lead- 
 ing psychiatrist of this country speaks upon the con- 
 tributions of psychiatry to the understanding of the 
 problems of life. Psychiatry, like each of the other 
 branches of medicine, has come to be recognized as 
 one of the subdivisions of the great science of biology, 
 free to make use of the scientific method, in duty 
 bound to diffuse the knowledge that it gains, and 
 privileged to contribute abundantly to the lessening 
 
 [61]
 
 A PSYCHIATRIC MILESTONE 
 
 of human suffering and the enhancement of human 
 joys. General practitioners of medicine and medi- 
 cal specialists at least the more enlightened of 
 them welcome the developing science of psychiatry, 
 are eager to hasten its progress, and will gladly 
 share in applying its discoveries to the early diagnosis, 
 the cure, and the prevention of disease. 
 
 That the majority of medical and surgical special- 
 ists and even most of the widely experienced general 
 practitioners, though constantly coming in contact 
 with major and minor psychic disturbances, are, 
 however, still far from realizing the full meaning 
 and value of the principles and technic of modern 
 psychology and of the newer psychiatry must, I 
 fear, be frankly admitted.* But dare we blame these 
 practitioners for their ignorance of, apathy regarding, 
 and even antipathy to, the psychic and especially 
 the psychotic manifestations of their patients ? 
 Ought we not rather to try to understand the reasons 
 for this ignorance, this apathy, and this aversion, 
 all three of which seem astonishing to many of our 
 well-trained psychologists and psychopathologists ? 
 Are there not definite conditions that explain and at 
 least partially excuse the defects in knowledge and 
 interest and the errors in attitude manifested by 
 
 * Cf. Polon (A.) "The Relation of the General Practitioner to the 
 Neurotic Patient," Mental Hygiene, New York, 1920, IV, 670-678. 
 
 [62]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 those whom we would be glad to see cognizant 
 and enthusiastically participant ? Psychiatrists, who 
 have taught us to understand and rescue various 
 types of "sinners" and "social offenders" will, I 
 feel sure, avoid any moralistic attitude when dis- 
 cussing the shortcomings of their brethren in the 
 general medical profession, and will, instead, seek 
 to discover and to remove their causes. 
 
 As an internist who values highly the gifts that 
 modern psychology and psychiatry have been mak- 
 ing to medicine, I have given some thought to the 
 conditions and causes that may be responsible for 
 these professional delinquencies that you deplore. 
 Though this is not the time nor the place fully to dis- 
 cuss them, the mere mention of some of the causes 
 and conditions will, perhaps, contribute to compre- 
 hension and pardon, and may serve to stimulate us 
 all to livelier corrective activity. Let me enumerate 
 some of them : 
 
 (1) A social stigma still attaches, despite all our 
 efforts to abolish it, to mental disorders and has, to 
 a certain extent, been transferred to those that study 
 and treat patients manifesting these disorders. 
 
 (2) The organization of our general education is 
 very defective since it fails to make clear to each 
 student man's place in the universe and any orderly 
 view of the world and man; it fails adequately to
 
 A PSYCHIATRIC MILESTONE 
 
 enlighten the student regarding the processes of life 
 as adaptations of organisms to their environment, 
 man, himself, being such an organism reacting physi- 
 cally and psychically to his surroundings in ways 
 either favorable or unfavorable to his own preserva- 
 tion and that of his species; it fails to teach the 
 student that the human organism represents a bun- 
 dle of instincts each with its knowing, its feeling, 
 and its striving component, that what we call 
 "knowledge" and what we call "character" are 
 gradual developments in each person, and that if we 
 know how they have developed in a particular per- 
 son we possess clues to the way that person will 
 react under a given stimulus, that is to say, what he 
 will think, how he will feel, and how he will act; and 
 it fails, again, properly to instruct students regarding 
 the interrelationships of members of different social 
 groups (familial, civic, economic, occupational, ethi- 
 cal, national, racial, etc.) ; in other words, our general 
 educational organization is as yet far from successful 
 in inculcating philosophical, biological, psychological, 
 and sociological conceptions that are adequate sym- 
 bols of reality. 
 
 (3) Though our medical schools have made phe- 
 nomenal advances in the organization and equip- 
 ment of their institutes and in provision for teach- 
 ing and research in a large number of preclinical 
 
 [64]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 and clinical sciences, they have up to now almost 
 wholly ignored normal psychology, psychiatry, and 
 mental hygiene. The majority of the professors 
 in these schools are so absorbed by the morphologi- 
 cal, physical, and chemical aspects of their subjects, 
 that students rarely get from them any inkling of 
 the psychobtological aspect, any adequate knowledge 
 of human motives, or any satisfactory data regard- 
 ing human behavior, normal or abnormal.* It is 
 only recently and only in a few schools that psy- 
 chiatric clinics have been established as parts of the 
 teaching hospitals, that medical students have been 
 able to come into direct contact over an appreciable 
 period of time with the objects of psychiatric study, 
 that the psychic manifestations of patients have 
 received any direct and particular attention in the 
 general medical and surgical wards, and that there 
 has been any free and constant reciprocal exchange 
 of thought and opinion between students of the 
 somatic on the one hand and students of the psychic 
 on the other. 
 
 (4) The language of the psychiatrist is unique 
 and formidable. The names he has applied to mo- 
 tives and impulses, to symptoms and syndromes, are 
 
 * Cf. Paton (S.) Human Behavior in Relation to the Study of 
 Educational, Social, and Ethical Problems. New York, 1921. 
 Charles Scribner's Sons, p. 465. 
 
 [65]
 
 A PSYCHIATRIC MILESTONE 
 
 foreign to the tongue of the general practitioner who 
 is so awed by them that he withdraws from them and 
 remains humbly reticent in a state of enomatophobia; 
 or, if he be more tough-minded, he may be amused 
 by, or contemptuous of, what he refers to as "psy- 
 chiatric jargon" or " pseudoscientific gibberish." 
 There is, furthermore, a dearth of concise, authori- 
 tative, well-written text-books on psychiatry, and 
 the general medical journals rarely print psychiatric 
 papers designed to interest the average practitioner. 
 The most widely diffused psychiatric reports of our 
 time are the sensational news items of the daily 
 press. 
 
 (5) The overemphasis of psychogenetic factors 
 to the apparent neglect of important somatogenic 
 factors by some psychiatrists has tended to arouse 
 suspicion regarding the soundness of the opinions 
 and methods of psychiatric workers in the minds of 
 men thoroughly imbued with mechanistic concep- 
 tions and impressed with the results of medical re- 
 searches based upon them. The ardor of the psy- 
 choanalysts, also, though in part doubtless justified 
 by experience, has, it is to be feared, excited a cer- 
 tain amount of antipathy among the uninitiated. 
 
 (6) The fears of insanity prevalent among the 
 laity and the repugnance of patients to any idea that 
 they may be "psychotic" or " psychoneurotic " 
 
 [66]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 (words that, in their opinion, refer to "imaginary 
 symptoms/' or to symptoms that they could abolish 
 if they would but "buck up" and exert their "wills") 
 undoubtedly exert a reflex influence upon practi- 
 tioners who put the "soft pedal" on the psycho- 
 biological reactions and "pull out the stop" that 
 amplifies the significance of any abnormal physical 
 findings. 
 
 (7) Psychotherapy, to the mind of the average 
 medical practitioner, is (or has been) something 
 mysterious or occult. He uses much psychotherapy 
 himself but it is nearly always applied unconsciously 
 and indirectly through some form of physical or 
 chemical therapy that he believes will cure. He is 
 sually quite devoid of insight into the effect of his 
 own expressed beliefs and bodily attitudes upon the 
 adjusting mechanisms of his patients. Conscious 
 and direct psychotherapy is left by the average 
 practitioner to New Thoughters, Christian Scien- 
 tists, quacks, and charlatans. If he were to use 
 psychotherapy consciously and were to receive a 
 professional fee for it he would feel that he was being 
 paid for a value that the patient had not received. 
 A highly respected colleague once privately criticised 
 a paper of mine (read before the Association of 
 American Physicians) on the importance of psy- 
 chotherapy. "What you said is true," he remarked;
 
 A PSYCHIATRIC MILESTONE 
 
 "we all use psychotherapy but we are a little ashamed 
 of it; and it is better not to talk about it." Even he 
 did not realize that every psychotherapy is also a 
 physical therapy. 
 
 (8) The rise of specialism, through division of 
 labor and intensification of interests restricted to 
 limited fields, in practical medicine, the necessary 
 result and to a large extent also a cause of the 
 rapid growth of knowledge and technic has brought 
 with it many advantages, but also some special 
 difficulties, among them (a) the impossibility any 
 longer of any single practitioner, unaided, to study 
 and treat a patient as well as he can be studied and 
 treated by a co-ordinated group whose special ana- 
 lytical studies in single domains are adequately 
 synthesized by a competent integrator, and (b) in 
 the absence of such group work, the tendency to 
 one-sided study, partial diagnosis, and incomplete 
 and unsatisfactory therapy. Through the rise df 
 specialism, it is true, psychiatry itself has arisen and 
 the psychiatrist, like the skilled integrating internist, 
 is interested in the synthesis of the findings in all 
 domains, for only through such synthetic studies, 
 such integration of the functional activities of the 
 whole organism, is it possible to gain a global view 
 of the patient as a person, to make a complete so- 
 matic, psychic, and social diagnosis, and to plan a 
 
 [68]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 regimen for him that will ensure the best adjust- 
 ment possible of his internal and external relation- 
 ships.* 
 
 Working in a diagnostic group myself as an inte- 
 grating internist, I have been much helped by the 
 reports of personality studies made by skilful psy- 
 chiatrists; these are linked with the special reports 
 on the several bodily domains (cardiovascular, respir- 
 atory, haemic, dental, digestive, urogenital, loco- 
 motor, neural, metabolic, and endocrine) in order 
 finally to arrive at an adequately co-ordinated and 
 (subordinated) total diagnosis from which the clues 
 for an appropriate therapeutic regimen can safely 
 be drawn. If group practice is to grow and be suc- 
 cessful in this country, as I think likely, groups must 
 see to it that psychiatry, as well as the other medical 
 and surgical specialties, is properly represented in 
 their make-up. f From now on, too, general prac- 
 
 * Cf. Meyer (A.), "Progress in Teaching Psychiatry," Journal 
 A. M. A., Chicago, 1917, LXIX, 861-863; see also his, "Objective 
 Psychobiology, or Psychobiology with Subordination of the Medically 
 Useless Contrast of Medical and Physical," Journal A. M. A., Chicago, 
 1915, LXV, 860-863; and, "Aims and Meanings of Psychiatric Diag- 
 nosis," Am. Journal of Insanity, Baltimore, 1917, LXXIV, 163-168. 
 
 f Cf. "The General Diagnostic Survey Made by the Internist Co- 
 operating with Groups of Medical and Surgical Specialists," New York 
 Medical Journal, 1918, 489, 538, 577; also, "The Rationale of Clinical 
 Diagnosis," Oxford Medicine, 1920, vol. I, 619-684; also, "Group 
 Diagnosis and Group Therapy," Journal Iowa State Medical Society, 
 113-121, Des Moines, 1921. 
 
 [69]
 
 A PSYCHIATRIC MILESTONE 
 
 titioners should, as Southard emphasized, be urged 
 to be at least as familiar with the general principles 
 and methods of the psychiatrist as they are with 
 those of the gynecologist, the dermatologist, and the 
 paediatrist.* Well organized group-diagnosis and 
 general will then help to counteract the inhibiting 
 influence of earlier isolated specialism upon the ap- 
 preciation of psychiatry. 
 
 This enumeration of some of the causes of the 
 ignorance and apathy (existent hitherto) in the gen- 
 eral profession regarding psychiatry may perhaps 
 suffice as explanation. These causes are, fortunately, 
 rapidly being removed. We are entering upon an 
 era in which psychiatry will be recognized as one of 
 the most important specialties in medicine, an era 
 that will demand alliance and close communion 
 among psychiatrists, internists, and the representa- 
 tives of the various medical and surgical specialties. 
 
 The internist and the psychiatrist will ever have 
 a common interest in the obscure problems of etiology 
 and pathogenesis of diseases and anomalies that are 
 accompanied by abnormalities of thought, feeling, 
 and behavior. Progress in this direction is bound to 
 be slow for the studies are exceptionally complex and 
 
 * Cf. Southard (E. E.), "Insanity Versus Mental Disease"; the Duty 
 of the General Practitioner in Psychiatric Diagnosis, Journal Ameri- 
 can Medical Association, LXXI, 1259-1261, Chicago, 1918. 
 
 [70]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 there are many impediments to be removed. Though 
 the problems are deep and difficult, they are doubt- 
 less soluble by the mind of man, and they exert an 
 uncommon fascination upon those who visualize 
 them. Causes may be internal or external, and are 
 often a combination of both. The tracing of the 
 direct and indirect relationships between these 
 causes and the abnormal cerebral functioning upon 
 which the disturbances of psychobiological adjust- 
 ment seem to depend is the task of pathogenesis. 
 The internist who has studied the infantile cere- 
 bropathies with their resulting imbecilities, syphilis 
 followed by general paresis, typhoid fever and its 
 toxic delirium, chronic alcoholism with its character- 
 istic psychoses, cerebral thrombosis with its aphasias, 
 agnosias, and apraxias, thalmic syndromes due to 
 vascular lesions with their unilateral pathological 
 feeling-tone, frontal-lobe tumors with joke-making, 
 uncus tumors with hallucinations of taste and smell, 
 lethargic encephalitis with its disturbance of the 
 general consciousness and its psychoneurotic se- 
 quelae (lesions in the globus pallidus and their motor 
 consequences), pulmonary tuberculosis with its eu- 
 phoria, and endocrinopathies like myxoedema and 
 exophthalmic goitre with their pathological mental 
 states, is encouraged to proceed with his clinical- 
 pathological-etiological studies in full assurance that
 
 A PSYCHIATRIC MILESTONE 
 
 they will steadily contribute to advances in psy- 
 chiatry. The eclectic psychiatrist who is examining 
 mental symptoms and symptom-complexes ever 
 more critically, who is seeking for parallel distur- 
 bances in physiological processes and who considers 
 both psychogenesis and somatogenesis in attempting 
 to account for psychobiological maladjustments will 
 welcome, we can feel sure, any help that internal 
 medicine and general and special pathology can 
 yield. 
 
 These studies in pathogenesis and etiology are 
 fundamentally necessary for the development of a 
 rational therapy and prophylaxis. Already much 
 that is of applicable value in practice has been 
 achieved. The internist shares with the psychiatrist 
 the desire that knowledge of the facts regarding care, 
 cure, and prevention of mental disorders may be- 
 come widely disseminated among medical men and 
 at least to some extent among the laity. Experts 
 in psychiatry firmly believe that at least half of the 
 mental disturbances now prevalent could have been 
 prevented, if, during the childhood and adolescence 
 of those afflicted, the facts and principles of existing 
 knowledge and the practical resources now available 
 could have been applied. 
 
 We have recently had an excellent illustration of 
 the benefits of applied psychiatry in the remarkable 
 
 [72]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 results achieved during the great war through the 
 activities of the head of the neuropsychiatric 
 division of the Surgeon General's office and his staff * 
 and those of the senior consultant in neuropsy- 
 chiatry and his divisional associates in the Ameri- 
 can Expeditionary Force. In no other body of re- 
 cruits and in no other army than the American was a 
 comparable success arrived at, and the credit for 
 this is due to American applied psychiatry and its 
 wisely chosen official representatives. 
 
 The active campaign for the preservation of the 
 mental health of our people and for a better under- 
 standing and care of persons presenting abnormal 
 mental symptoms carried on during the past decade 
 by the National Committee for Mental Hygiene 
 marks a new epoch in preventive medicine.t 
 
 The prevention of at least a large proportion of 
 abnormal mental states through the timely applica- 
 
 * Cf. Bailey (P.), "The Applicability of Findings of Neuro-psy- 
 chiatric Examinations in the Army to Civil Problems," Mental Hy- 
 giene, New York, 1920, IV, 301; also "War and Mental Diseases," 
 Am. J. Pub. Health, IX, i, Boston, 1919. 
 
 f Cf. Salmon (T. W.), "War Neuroses and Their Lesson," New York 
 Medical Journal, CIX, 993, 1919; also, "The Future of Psychiatry in 
 the Army," Mil. Surgeon, XLVII, 200, Washington, 1920. 
 
 Cf. "Origin, Objects, and Plans of the National Committee for 
 Mental Hygiene" (Publication No. i, of the National Committee, 
 New York City) ; and, " Some Phases of the Mental Hygiene Movement 
 and the Scope of the Work of the National Committee for Mental 
 Hygiene," in Trans., XV, Internat. Congr. for Hygiene and Demog- 
 raphy, III, 468-476, (1912), Washington 1913. 
 
 [73]
 
 A PSYCHIATRIC MILESTONE 
 
 tion of the principles of mental hygiene is now recog- 
 nized as a practically realizable ideal. Many im- 
 portant reforms are now in process throughout the 
 United States, no small part of them directly attrib- 
 utable to the active efforts of our leading psy- 
 chiatrists and to our National Committe's work. 
 The old "asylums" are being changed into "hospi- 
 tals." Psychiatric clinics are becoming attached 
 to teaching hospitals and psychiatric instruction in 
 the medical schools is being vastly improved. The 
 mental symptoms of disease now receive attention 
 in hospitals and in private practice and at a much 
 earlier stage than formerly. Even the courts, the 
 prisons, and the reformatories are awakening to the 
 importance of scientific psychiatry; before long 
 penology may be brought more into accord with our 
 newer and juster conceptions of the nature and ori- 
 gin of crime, dependency, and delinquency. That 
 schools of hygiene and the public health services 
 must soon fall into line and consider mental hygiene 
 seriously is obvious. The objection sometimes made 
 that the practical problems are too vague, not suffi- 
 ciently concrete, to justify attack by public health 
 officials is no longer valid. In no direction, proba- 
 bly, could money and energy be more profitably 
 spent during the period just ahead than in the sup- 
 port of a widely organized campaign for Mental 
 
 [74]
 
 PSYCHIATRY IN GENERAL MEDICINE 
 
 Hygiene.* Psychiatrists can count upon internists 
 and general practitioners to aid them in educating 
 the public regarding the nature and desirability of 
 this campaign. 
 
 Man is now consciously participating in the direc- 
 tion of his own evolution. To cite England's poet 
 laureate, who, you will recall, is a physician: "The 
 proper work of his (man's) mind is to interpret the 
 world according to his higher nature, and to conquer 
 the material aspects of the world so as to bring 
 them into subjection to the spirit." 
 
 *Cf. Russell (W. L.) "Community Responsibilities in the Treat- 
 ment of Mental Disorders." Canad. J. Ment. Hygiene, 1919, 
 
 I 155 - 
 
 Hincks (C. M.), "Mental Hygiene and Departments of Health," 
 Am. J. Pub. Health, Boston, IX, 352, 1919; Haines (T. H.), "The 
 Mental Hygiene Requirements of a Community: Suggestions Based 
 upon a Personal Survey," Mental Hygiene, IV, 920-931, New York, 
 1920. 
 
 Beers (C. W.), "Organized Work in Mental Hygiene," Mental 
 Hygiene, 567, New York, 1917, also, Williams (F. E.)> "Progress in 
 Mental Hygiene," Modern Hospital, XIV, 197, Chicago, 1920. 
 
 [75]
 
 The Chairman : We had hoped to receive to-day 
 the greetings of our sole elder sister among Ameri- 
 can institutions, the Pennsylvania Hospital, of 
 Philadelphia, which since its foundation in 1751 
 has pursued a career much like our own, treating 
 mental cases in the general hospital from the very 
 beginning, and since 1841 maintaining a separate 
 department for mental diseases in West Philadelphia. 
 Dr. Owen Copp, the masterly physician-in-chief 
 and administrator of that department, was to have 
 been here, but unfortunately has been detained. 
 Our morning exercises having come to an end, Dr. 
 Russell asks me to say that your inspection of the 
 occupational buildings and other departments of 
 the Hospital is cordially invited; a pageant illus- 
 trative of the origin and aspirations of the Hos- 
 pital will be given on the adjoining lawn; and that 
 after the pageant our guests are desired to return to 
 the Assembly Hall, where we shall have the privi- 
 lege of listening to addresses by Dr. Richard G. 
 Rows, of London, and Dr. Pierre Janet, of Paris, 
 who have come across the Atlantic especially to 
 take part in this anniversary celebration.
 
 ADDRESS BY 
 
 DR. GEORGE D. STEWART
 
 AFTERNOON SESSION 
 
 The Chairman: For the first seventy-five years 
 of its existence the New York Hospital was the 
 nearest approach to an academy of medicine that 
 the city possessed. When the now famous New 
 York Academy of Medicine was established in 1847, 
 a friendly and cordial co-operation between the 
 two institutions arose, and while the activity of 
 this co-operation is not as pronounced as it was, we 
 still cherish in our hearts a warm regard for that 
 ancient ally in the cause of humanity. Its Presi- 
 dent, Dr. George D. Stewart, the distinguished 
 surgeon, has come to extend the greetings of the 
 medical profession of New York City.
 
 DR. STEWART 
 
 The emotions that attend the birthday celebra- 
 tions of an individual are often a mixture of joy 
 and sadness, of laughter and of tears. In warm 
 and imaginative youth there is no sadness and there 
 are no tears, because that cognizance of the com- 
 mon end which is woven into the very warp and 
 woof of existence is then buried deep in our sub- 
 conscious natures, or if it impresses itself at all, is 
 too volatile and fleeting to be remembered. But 
 as the years fall away and there is one less spring to 
 flower and green, the serious man "tangled for the 
 present in some parcels of fibrin, albumin, and 
 phosphates" looks forward and backward and takes 
 in both this world and the next. In the case of 
 institutions, however, the sadness and the tears do 
 not obtain for a century of anniversaries may 
 merely mean dignified maturity, as in the case of 
 Bloomingdale, with no hint of the senility and decay 
 that must come to the individual who has lived so 
 long. This institution was founded one hundred 
 years ago to-day; the parent, the New York Hos- 
 pital, has a longer history. Bloomingdale, as a 
 
 [83]
 
 A PSYCHIATRIC MILESTONE 
 
 separate and independent concern, had its birthday 
 a century ago. 
 
 It is curious to let the mind travel back, and con- 
 sider what was happening about that time. Just 
 two years before the news had flashed on the philo- 
 sophical and scientific world that Oersted, a Danish 
 philosopher, had caused a deflection of the magnetic 
 needle by the passage near it of an electric current. 
 The relation between the two forces was then and 
 there confirmed by separate observations all over 
 the civilized world. This discovery probably cre- 
 ated more interest at that time than Professor 
 Einstein's recent announcement which, if accepted, 
 may be so disturbing to the principia of Newton 
 and to our ideas of time and space. There can be 
 no doubt that the practical significance of Oersted's 
 experiment was much more widely appreciated than 
 the theory of Einstein, for an understanding of the 
 latter is confined, we are told, to not many more 
 men than was necessary to save Sodom and Gomor- 
 rah. Its immense practical significance, however, 
 could have been foreseen by no man, no matter with 
 what vision endowed. Just two years prior to the 
 founding of this institution the first steamboat had 
 crossed the Atlantic and in the same year that great 
 conqueror, who had so disturbed the peace of the 
 world which was even then as now slowly recovering
 
 GREETINGS FROM THE PROFESSION 
 
 from the ravages of war, breathed his last in Saint 
 Helena, yielding to death as utterly as the poorest hind. 
 
 In 1815, Bedlam Hospital in South London was 
 converted into an asylum for the insane who were at 
 the time called "lunatics." The name Bedlam is a 
 corruption of the Hebrew "Bethlehem" meaning 
 the House of Bread and while the name popularly 
 came to signify a noisy place it was the beginning of 
 really scientific treatment for the tragically afflicted 
 insane. While the treatment of the insane in Europe 
 was being steadily raised to a higher plane of effi- 
 ciency, America has also reason to be proud of her 
 record in this respect. During all the years that 
 have followed, Bloomingdale has been an important 
 factor in the medical world of New York. 
 
 There are two phases of its existence which might 
 be emphasized first, it was founded by physicians; 
 even then and, of course, long before doctors had 
 proven that they were in the forefront in the pro- 
 motion of humanitarian activities. Medicine has 
 always carried on its banners an inscription to the 
 Brotherhood of Man. It is worthy of note that 
 when Pinel and Tuke had begun to regard mental 
 aberration as a disease and to provide scientific hos- 
 pital treatment therefor, American physicians, pre- 
 pared by study and experimentation, were ready to 
 accept and apply the new teachings. 
 
 [85]
 
 A PSYCHIATRIC MILESTONE 
 
 A second phase of great importance is that insti- 
 tutions like Bloomingdale have promoted the study 
 of psychology far more than any other factor, par- 
 ticularly because in them the personality stripped 
 of some of its intricacies, the diseased personality, 
 permits analysis, which the normal complex has so 
 long defied. That it is high time that mankind was 
 undertaking this knowledge of himself is particularly 
 emphasized by the unrest and aberrance of human 
 behavior now startling and disturbing the whole 
 world. If mankind does not take up this self study 
 as Trotter has said, Nature may tire of her experi- 
 ment man, that complex multicellular gregarious 
 animal who is unable to protect himself even from 
 a simple unicellular organism, and may sweep him 
 from her work-table to make room for one more 
 effort of her tireless and patient curiosity. Psy- 
 chology should be taught to every doctor and to 
 every lettered man. 
 
 Digressing for a moment, to every one capable 
 of understanding it, there should be imparted a 
 knowledge of that simple economic law announced 
 from the Garden of Eden after the grounds had 
 been cleared and the gates closed: "By the sweat of 
 thy brow thou shalt earn thy bread." The economic 
 phase indeed constitutes a highly important aspect 
 of modern psychology, for abnormal elements are 
 
 [86]
 
 GREETINGS FROM THE PROFESSION 
 
 antisocial, and from pickpockets to anarchists flour- 
 ish on the soil of pauperism. The key-note of the 
 future is responsibility. To the educated and en- 
 lightened man who still asks, "Am I my brother's 
 keeper?" Cain has bequeathed a drop of his frat- 
 ricidal blood; and he who spurns to do his share of 
 the world's work, electing instead to fall a burden 
 upon the community, deserves the fate of the barren 
 fig-tree. 
 
 However, amidst the social unrest, buffeted and 
 perplexed by the cross currents of our time, we 
 should not be pessimistic but should look forward 
 with courage, parting reluctantly with whatever of 
 good the past contained and living hopefully in the 
 present. As Ellis says: "The present is in every age 
 merely the shifting point at which past and future 
 meet, and we can have no quarrel with either. 
 There can be no world without traditions; neither 
 can there be any life without movement. As 
 Heraclitus knew at the outset of modern philosophy, 
 we cannot bathe twice in the same stream, though 
 as we know to-day, the stream still flows in an un- 
 ending circle. There is never a moment when the 
 new dawn is not breaking over the earth, and never 
 a moment when the sunset ceases to die. It is well 
 to greet serenely even the first glimmer of the dawn 
 when we see it, not hastening toward it with undue
 
 A PSYCHIATRIC MILESTONE 
 
 speed, nor leaving the sunset without gratitude for 
 the dying light that once was dawn." 
 
 So to-day I bring to you from the New York 
 Academy of Medicine felicitations on your one 
 hundredth anniversary and greetings to your guests 
 who have come from all over the world to join in 
 your birthday celebration. 
 
 [88]
 
 ADDRESS BY 
 
 DR. RICHARD G. ROWS
 
 The Chairman: Besides the Royal Charter, the 
 New York Hospital is indebted to Great Britain for 
 invaluable encouragement and financial aid in our 
 natal struggle in Colonial days. Dr. Rows has 
 added charmingly to that debt by journeying from 
 London to take part in these exercises. His sub- 
 ject will be, "THE BIOLOGICAL SIGNIFICANCE OF 
 MENTAL ILLNESS." 
 
 As Director of the British Neurological Hospital 
 for Disabled Soldiers and Sailors, at Tooting, he is 
 giving the community and the medical world the 
 benefit of his rich professional experience in the 
 trying years of war as well as in peace, and gaining 
 fresh laurels as he marches, like Wordsworth's 
 warrior, "from well to better, daily self-surpast."
 
 DR. ROWS 
 
 I must first express to you my keen appreciation 
 of the high honor you have conferred on me by invit- 
 ing me to come from England to address you on the 
 occasion of the centenary celebration of the opening 
 of this Hospital. 
 
 It is perhaps difficult for us to realize what re- 
 sistances lay in the way of reform at that time, 
 resistances in the form of long-established but some- 
 what limited views as to the nature of mental ill- 
 nesses, as to whether the sufferer was not reaping 
 what he had sown in angering the supreme powers 
 and in making himself a fit habitation for demons 
 to dwell in; in the form of a lack of appreciation 
 of the need of sympathy for those who, while in a 
 disturbed state, offended against the social organism 
 or in the form of an exaggerated fear which com- 
 pelled the adoption of vigorous methods of protect- 
 ing the social organism against those who exhibited 
 such anti-social tendencies. The men and women 
 of the different countries of the world who recognized 
 this and made it the chief of their life's duties to 
 spread a wider view of such conditions and to insist 
 
 [93]
 
 A PSYCHIATRIC MILESTONE 
 
 that the unfortunate people should be regarded and 
 treated as fellow human beings will ever command 
 our admiration. 
 
 By the courtesy of Dr. Russell I have had an op- 
 portunity of seeing the pamphlet in which are re- 
 corded the efforts of Mr. Thomas Eddy in the year 
 1815 to move his colleagues to consider this matter.* 
 The result of those efforts was the establishment of 
 an institution on Bloomingdale Road. 
 
 Various changes followed until we arrived at the 
 Bloomingdale Hospital of to-day with its large and 
 trained staff of medical officers, who, while still 
 recognizing the difficulties of the task, are imbued 
 with a hope of success which has arisen on a basis of 
 wider knowledge, but which was unknown to many 
 of their predecessors. To have the opportunity of 
 joining with you in celebrating the big advance made 
 a hundred years ago, of exchanging ideas with you 
 with regard to the difficulties which still confront us, 
 whether in America or in England, and which de- 
 mand a united effort on the part of all who are 
 interested in the scientific investigation of the sub- 
 ject, cannot fail to afford one the liveliest satisfac- 
 tion. 
 
 In the brief history of the Hospital prepared by 
 Dr. Russell we find the recommendations of another 
 
 * See Appendix III, p. 200. 
 
 [94]
 
 BIOLOGICAL SIGNIFICANCE 
 
 reformer, Dr. Earle, who in 1848 was evidently still 
 not satisfied with the treatment provided for the 
 sufferers from mental illness. 
 
 Both Mr. Eddy and Dr. Earle were influenced by 
 their observation that even in those suffering from 
 mania much of their behavior could not be described 
 as irrational. If you will allow me I will quote a 
 sentence of two from each. 
 
 Mr. Eddy said : " It is to be observed that in most 
 cases of insanity, from whatever cause it may have 
 arisen or to whatever it may have proceeded, the 
 patient possesses small remains of ratiocination and 
 self-command; and although they cannot be made 
 sensible of the irrationality of their conduct or opin- 
 ions, yet they are generally aware of those partic- 
 ulars for which the world considers them proper 
 objects of confinement." With reference to treat- 
 ment Dr. Earle said: "The primary object is to treat 
 patients, so far as their condition will possibly per- 
 mit, as if they were still in the enjoyment of the 
 healthy exercise of their mental faculties." 
 
 To superficial observation these suggestions might 
 well have appeared as the phantasies of dreamers 
 and perhaps at the present day their importance is 
 not always fully appreciated. Recent advances in 
 knowledge, however, have led us beyond the moral 
 treatment recommended a hundred years ago and 
 
 [95]
 
 A PSYCHIATRIC MILESTONE 
 
 have enabled us to see that a more important truth 
 underlay these suggestions. 
 
 We are all familiar with the frequent difficulty 
 we encounter in our efforts to discover the actual 
 mental disturbance which is supposed to exist in 
 our patients. It is often a question of wit against 
 wit as between patient and doctor, and not infre- 
 quently a rational and intelligent conversation may 
 be maintained on an indifferent subject. The fact 
 too that the disturbance is so frequently only tempo- 
 rary suggests that the loss of rational control is a 
 less serious phenomenon than was generally sup- 
 posed and we know that the control can be frequently 
 restored by a period of rest or by a helpful stimulus. 
 Quite recently a patient who in hospital had been 
 confused, undisciplined, abusive, and threatening, 
 was removed to a house of detention. The shock 
 of finding himself, as he said, amongst a lot of luna- 
 tics, led him to face reality from a fresh point of 
 view. He admitted that it had taught him a lesson 
 and when he revisited the hospital, if not entirely 
 grateful to us for the experience, he evidently bore 
 no ill will. 
 
 But not only is it necessary to recognize what 
 rational powers remain to the patient, we must also 
 inquire how much in their disturbed mental activity 
 can be considered a rational reaction to the stimuli 
 
 [96]
 
 BIOLOGICAL SIGNIFICANCE 
 
 which have operated, and still may be operating, 
 on them. 
 
 In connection with this I would suggest that there 
 are two aspects to be considered. First, what is the 
 standard according to which we are to judge them ? 
 Secondly, to what extent are the reactions of the 
 patient abnormal in kind to the driving stimulus ? 
 They may perhaps be reckoned abnormal in degree, 
 but, to what extent, if at all, are they abnormal in 
 kind ? 
 
 It may be readily admitted that the behavior of 
 those suffering from mental illness offends against 
 conventional usages and is anti-social. It must also 
 be recognized that amongst human beings living 
 in aggregates some conventional usages must be 
 evolved and insisted on in order to insure the great- 
 est good of the greatest number. These usages are 
 regarded not merely as protective measures for the 
 body corporate, but they are also supposed to indi- 
 cate a beneficial standard for the individual. But 
 such a standard being adopted, observation is liable 
 to be limited so much to results without sufficient 
 attention being given to the causes which had led to 
 those results. 
 
 By the recent advances in scientific knowledge 
 and in methods of investigation we have been led to 
 see that the conditions under consideration cannot 
 
 [97]
 
 A PSYCHIATRIC MILESTONE 
 
 be understood without a study of the mechanisms 
 on which mental activity depends and without dis- 
 covering the psychic and physical causes, arising 
 from without and from within, which have disturbed 
 the function of these mechanisms. We have learned 
 that these illnesses do not arise from one cause alone 
 and that they are the result of influences to which 
 we all may be subject to some degree. 
 
 The originator of these modern methods, Prof. 
 Freud, has stimulated us to regard the ordinary 
 symptoms of mental illnesses as directing posts 
 indicating lines to be investigated, and he and others 
 have suggested various methods which may usefully 
 be employed. 
 
 It is essential that we carefully distinguish what 
 are primary from what are secondary symptoms. 
 Two thousand years ago a physican, Areteus, pointed 
 out that mania frequently commenced as melan- 
 cholia, and he drew attention to the extreme fre- 
 quency of an initial depression in cases of mental 
 illnesses. But he did not offer any explanation of 
 this initial state. 
 
 Such an initial state may perhaps be, to a certain 
 extent, understood if we assume that the first evi- 
 dences of mental disturbance consist in some diffi- 
 culty in carrying out ordinary mental processes, some 
 difficulty in exercise of the function of perceiving, 
 
 [98]
 
 BIOLOGICAL SIGNIFICANCE 
 
 thinking, feeling, judging, and acting, and that any 
 disturbance of the harmonious activity of these func- 
 tions must give rise to an emotional condition of 
 anxiety and depression. Some such disharmony 
 will, by adequate investigation, be found in a large 
 number of cases to exist in the early states of the 
 illness and will be appreciated by the patient before 
 there occur any obvious signs, any outward manifes- 
 tations of disability. 
 
 But in any disharmony which may occur it must 
 be recognized that the mental mechanisms affected 
 are those with which the patient was originally en- 
 dowed, which he has gradually trained throughout 
 his past experience and which he has employed more 
 or less successfully up to the time the illness com- 
 menced. There is no new mechanism introduced 
 to produce a mental illness, but a putting out of 
 gear of those common to the race and their distur- 
 bance is the result of the action of influences which 
 may befall any one of us, unbearable ideas with 
 which some intense emotional state is intimately 
 associated. The normal function of these mech- 
 anisms, simple at first and remaining fundamentally 
 unaltered, although possibly much modified grad- 
 ually by added experiences from within and with- 
 out, depends on the maintenance of a harmonious 
 balance between stimuli received and emotional re- 
 
 [99]
 
 A PSYCHIATRIC MILESTONE 
 
 action and motor response to those stimuli so that 
 the feeling of well-being may arise. 
 
 If from any cause there occurs a failure to appre- 
 ciate the stimuli clearly, if the emotional reactivity 
 be disturbed, if the sense of value becomes biassed 
 in one direction or another so that the response is 
 recognized by the patient as abnormal there will 
 result a disharmony and a feeling of ill-being of the 
 organism. Under these conditions the processes of 
 facilitation along certain definite lines and inhibi- 
 tion of all other lines processes which are essential 
 to clear consciousness will become difficult or per- 
 haps impossible and a mental illness will develop. 
 In the slighter degrees the disharmony may be 
 known to the patient without there being any out- 
 ward manifestation to betray the conflict going on 
 within. In the severe degrees the mental activity 
 of the patient may be under the control of some 
 dominant emotional state so that it may be impossi- 
 ble for him to adapt himself to his surroundings in 
 a normal manner although his behavior may not 
 appear so irrational when we know the stimuli 
 affecting him. Within these extremes we discover 
 all degrees of disturbance, and all varieties of signs 
 and symptoms may be encountered. 
 
 But the signs which become obvious to superficial 
 observation are, to a large extent, secondary prod-
 
 BIOLOGICAL SIGNIFICANCE 
 
 ucts. The primary symptoms are felt by the pa- 
 tient as a disturbance of the capacity to perceive, 
 to think, to feel, to judge, and to act, and with these 
 disabilities there will be associated a certain degree 
 of confusion and anxiety which cannot fail to appear 
 as the result of such alterations of function. 
 
 The obvious signs may represent merely a more 
 intense degree of the primary affection, disturbed 
 capacity together with some confusion and anxiety; 
 or they may represent efforts on the part of the pa- 
 tient to overcome or to escape from the disturbance 
 or to explain it to himself. And now the total lack 
 of knowledge of the processes on which mental ac- 
 tivity depends, the altered standard of judgment due 
 to some degree of dissociation, and the necessity of 
 obtaining relief in some way or other will have much 
 to do with determining the character of the symp- 
 toms with which we are all familiar. So many fac- 
 tors are concerned in the production of these secon- 
 dary characters that it is difficult to assign to the 
 symptoms their true value or to decide whether they 
 possess much value at all with regard to the funda- 
 mental disturbance which constituted the primary 
 illness. So often they appear to be mere rationali- 
 zations, mere false judgments on the part of the 
 patient; they thus form subjects for investigation 
 rather than fundamental constituents of the illness. 
 
 [101]
 
 A PSYCHIATRIC MILESTONE 
 
 We, therefore, must not accept the outward and 
 visible signs at their face value but attempt to dis- 
 cover what past experiences in the life of the patient 
 have led to such disturbance of function, to such a 
 change in his mental activity. 
 
 It will possibly be of some assistance to provide 
 one or two examples in order to demonstrate the 
 importance of the past experiences as agents capable 
 of producing such alterations. 
 
 The first case will illustrate the results produced 
 by the development of a dominant emotional ten- 
 dency during early childhood. The patient up to 
 the fifth year of her life had been an ordinary, nor- 
 mal child, attached to her mother, fond of her nurse, 
 interested in her toys. During the next two years 
 she endured much bad treatment at the hands of a 
 new nurse which produced such an impression on 
 her that she felt she was a changed child. This 
 nurse, described to me by the patient as a handsome 
 woman, having met the inevitable man, used fre- 
 quently to meet him clandestinely. The child was 
 neglected, was sometimes left alone, on one occasion 
 in a graveyard, but she was forbidden to mention 
 the subject to any one under threats of being carried 
 away by a "bogey-man." The child became very 
 frightened by this, to such an extent that one night 
 she had a severe nightmare in which a " bogey-man " 
 
 [ 102]
 
 BIOLOGICAL SIGNIFICANCE 
 
 came to carry her away. At the end of two years a 
 profound change had taken place in her which she 
 now describes thus: "I was a changed child; I was 
 separated from my mother and could no longer con- 
 fide in her nor did I wish to do things for her as I 
 had done before; I could not enjoy my toys; I had 
 no confidence in myself; I was not like other chil- 
 dren." And from that time on, as girl and as woman, 
 she has never felt that she has been like others of her 
 sex. Such a condition, being started and confined 
 by repetition, interfered with her free development 
 and it was remarkable how many incidents occurred 
 in her life to confirm the disability, but the germ of 
 her serious breakdown thirty years later was laid 
 in her fifth and sixth years. 
 
 The second case is that of a patient who, as a 
 child, had some convulsive attacks. She was there- 
 fore considered delicate and was thoroughly spoiled. 
 When nearly thirty she lived through a sexual exper- 
 ience which caused extreme anxiety; she broke down 
 and was admitted to an asylum. After admission 
 she looked across the dormitory and saw a head 
 appearing above the bed-clothes, the hair of which 
 had been cut short for hygienic reasons. With a 
 memory of her sexual indiscretion still vivid in her 
 mind she jumped to the conclusion that she was in a 
 place where men and women were crowded together 
 
 [ 103 ]
 
 A PSYCHIATRIC MILESTONE 
 
 in the same room. She got out of bed, refused to 
 return to it, fought against the nurses and was trans- 
 ferred to a single room, with the mattress on the 
 floor and the window shuttered. She wondered 
 where she was and came to the conclusion that she 
 was in a horse-box. Then arose a feeling of terror 
 that she would be at the disposal of the grooms 
 when they returned from work. The sound of 
 heavy footsteps of the patients passing along the 
 corridor to the tea-room suggested that the grooms 
 were returning and that her room would soon be 
 invaded. The feeling of terror increased and she 
 tried to hide in the corner, drawing the mattress and 
 clothes over her. And so on. 
 
 Months later when I had my first interview with 
 her, her sole remark during the hour was "How can 
 I speak in a place like this?" This was repeated 
 almost without intermission throughout the hour. 
 It formed a good example of the origin of the process 
 of perseveration, a process frequently adopted by 
 the patient to guard against the disclosure of a 
 troublesome secret. 
 
 If we attempt to trace out some of the mecha- 
 nisms employed in these two cases we shall see that 
 in response to definite stimuli each reacted in a 
 manner which cannot be considered abnormal in 
 kind. It was normal reaction for the child to be dis- 
 
 [ 104]
 
 BIOLOGICAL SIGNIFICANCE 
 
 tressed at being separated from her mother in such 
 a way, to be frightened by being left in the grave- 
 yard alone, or at the threat of her being carried away 
 by a "bogey-man" if she dared to mention any- 
 thing of the clandestine meetings to her mother. 
 It was not very abnormal that after her sexual 
 experience the other patient while still in a confused 
 state caused by the intense emotional condition of 
 anxiety, should, on seeing a head with the hair 
 cropped short, jump to the conclusion that there was 
 a man in a bed in the same ward with herself, or 
 that she should feel frightened and wish to leave 
 the room. 
 
 The mental activity in each case depended on 
 mental content, that is, memory of past experiences 
 with their intense emotional states which acted as 
 the driving force and also made the recall of the 
 experience go extremely easy. The further develop- 
 ments after being placed in the single room with 
 mattresses on the floor and the window shuttered 
 were rationalizations also based on mental content, 
 i. e. y on the memory of rooms somewhat similar to 
 that in which she found herself and of the use of 
 such rooms. It is interesting to note also in the 
 first case that in her wildest delirium during an acute 
 attack she lived through episodes of her past life. 
 One example may be given. In the course of her 
 
 [105]
 
 A PSYCHIATRIC MILESTONE 
 
 delirium she thought that a "blackbird" had flown 
 to her, touched her left wrist and taken away all 
 her vitality. This depended on an experience of 
 her going to Germany when a girl and meeting a 
 young German officer whom she did not like. A few 
 years later she went to Germany and met the officer 
 again. Without going into full details I may say 
 that on one occasion when walking with him he 
 seized her left wrist with his right hand and at- 
 tempted to kiss her; she struggled fiercely and ran 
 from him. Here we see that not only is her delirium 
 based on a past experience, but that the whole mem- 
 ory is symbolized in the "blackbird" which was 
 the emblem of the German nation in whose army the 
 officer was then serving. Connected with this there 
 was also another unpleasant episode which dated 
 from her tenth year. Much of her delirium was 
 worked out in such a way that most of the details 
 could be traced back to experiences of her earlier life. 
 But however absurd her statement regarding her 
 being touched by a " blackbird " and all her vitality 
 removed might appear to superficial observation, 
 it must be admitted that when we know the mental 
 content of that patient, we cannot but see that at 
 any rate it was not so irrational. And not only was 
 this recognized by the doctor, but, and this is much 
 more important, by the patient herself. 
 
 [106]
 
 BIOLOGICAL SIGNIFICANCE 
 
 It is, therefore, the mental content which must 
 be discovered before doctor or patient can under- 
 stand the disability and before any common ground 
 between the two can be found. And when the men- 
 tal content is known it will be easy to recognize 
 the affective condition of the patient to be a normal 
 response. It will also be specific and if intense will 
 dominate the patient. " Why is it I can never feel 
 joy as I used to do ? " was the pathetic inquiry of 
 the patient dominated by a feeling of misery and 
 fear. Was it not for the reason that being domi- 
 nated by misery and fear, joy could find no place ? 
 The emotion of misery because of its intensity could 
 more or less inhibit the feeling of joy, but joy could 
 not inhibit the misery. 
 
 No repetition of the memory of the unpleasant 
 experiences with their associated emotion of misery 
 and fear led to the formation of a habit of mind and 
 feeling. And when once such a habit of mind is 
 established it is remarkable by what a host of stimuli 
 received in ordinary daily life the cause of the dis- 
 turbance can be recalled. 
 
 This question of stimuli deserves further notice. 
 It is not so difficult to realize the mechanism by 
 which a stimulus which clearly crosses the threshold 
 of consciousness can lead to a given reaction. But 
 it is perhaps difficult to imagine how so many stimuli 
 
 [ 107]
 
 A PSYCHIATRIC MILESTONE 
 
 which do not cross the threshold of consciousness or 
 which, if they do, are not recognized by the patient 
 at the time as having any reference whatever to the 
 special memory can yet set the memory mechanism 
 into action. The result may not be seen till after 
 the relapse of some considerable period of time, as in 
 the case of a man who for years had been disturbed 
 by terrific nightmares, based on the idea of snakes 
 coming out of the ground and attacking him. He 
 complained one day that he was much worse, that 
 three nights before he had had the worst night- 
 mare of his life. On being questioned as to what 
 could have suggested snakes to him he could not 
 tell. A few minutes later he said : " I think I know 
 the cause now. I spent the evening before I had 
 that nightmare with a sergeant who had returned 
 from the service in India." This friend amongst 
 other things had mentioned that whenever they were 
 about to bivouac they had to search every hole 
 under a stone and every tuft of grass to see that 
 there were no snakes there. This, which had been 
 received as an ordinary item of information, had 
 been the stimulus which had set his memory me- 
 chanism into action and the nightmare between two 
 and three o'clock in the morning had been the re- 
 sult. 
 
 The result in many instances is evidenced by an 
 
 [108]
 
 BIOLOGICAL SIGNIFICANCE 
 
 emotional state alone and the actual memory of the 
 original experience may not come into conscious- 
 ness. Many examples of this might be given. The 
 sound of a trolley wheel on a tram wire in one case 
 gave rise to terror instead of its normal reaction, 
 viz., that of satisfaction at getting to the destination 
 quickly and without effort. This terror was pro- 
 duced because the sound on the wire resembled that 
 of a shell which came over, blew in a dugout, killed 
 three men, and buried the patient. No memory 
 of this incident came into consciousness, only a 
 terror similar to that experienced at the time of the 
 original incident was experienced. Or, the time 
 four o'clock in the afternoon could act as a stimulus 
 to arouse an emotional state of misery similar to 
 that experienced at the same time of day during 
 an illness some years previously. Or, passing the 
 house of a doctor when on a bus could produce a 
 sudden outburst of anxiety, giddiness, and confusion; 
 the patient had been taken into that house at the 
 time of an epileptic attack. Or, showing photo- 
 graphs of the front could lead to an epileptic attack 
 which was based on the memory of the time when 
 the patient was wounded in the head; this has oc- 
 curred on two separate occasions separated by an 
 interval of some months. Or, noticing a familiar 
 critical tone in a remark made at a dinner-table 
 
 [ 109]
 
 A PSYCHIATRIC MILESTONE 
 
 could lead to an acute change of feeling so that the 
 subject who, before dinner, had felt she would like 
 to play a new composition on the piano so as to 
 obtain the opinion of the guest who had exhibited 
 the critical tone, after dinner felt incapable of doing 
 so. Her feelings had been hurt on many former 
 occasions by critical remarks made by him in that 
 tone. The critical remarks were not called to mem- 
 ory but there arose the feeling that under no cir- 
 cumstances could she play that piece to him. 
 
 Of special importance also are the experiences of 
 childhood. An unhappy home or unjust treatment 
 as a child may warp the development of the per- 
 sonality, lead to a lack of self-confidence, to the 
 predominance of one emotional tendency, and so 
 prevent that balanced equilibrium which will allow 
 a rapid and suitable emotional reaction such as we 
 may consider normal. This may lead to a failure 
 of development or a loss of the sense of value, be- 
 cause the existence of one dominating emotional 
 tendency so often produces a prejudiced view which 
 may render a just appreciation of our general ex- 
 perience almost impossible and may seriously dis- 
 turb our mental activity. 
 
 And if, as Bianchi suggests, all mental activity 
 depends on a series of reflex actions, or, as Bechterew 
 and Pavlov have insisted, a series of conditioned 
 
 [no]
 
 BIOLOGICAL SIGNIFICANCE 
 
 reflexes becomes established, it will assist us to 
 understand how such stimuli can give rise to men- 
 tal disturbances, to mental illnesses. We shall see 
 that there may be something of real importance 
 underlying such remarks as "I felt I was a changed 
 child"; or "It is because of the treatment I received 
 from my father that I have taken life so seriously." 
 "I have never imagined that what I went through 
 in my childhood could so influence me now"; or "I 
 have never had confidence in myself and often when 
 I have appeared vivacious and interested I have 
 had an awful feeling of incapacity and dread within 
 myself." 
 
 The outward and obvious manifestations, there- 
 fore, are not necessarily a true index of our mental 
 and emotional conditions. This is true of all men- 
 tal illnesses, even the most severe. 
 
 One patient who had been in an asylum more than 
 ten years illustrated this in a most striking manner. 
 His outward manifestations led one to feel that he 
 thought he possessed the institution in which he 
 was confined and also the surrounding property 
 and that the authorities were a set of usurpers and 
 thieves who kept him incarcerated in order that 
 they might enjoy what was really his money and his 
 property. On one occasion I said to him, "George, 
 what is that incident in your life which you cannot 
 
 [in]
 
 A PSYCHIATRIC MILESTONE 
 
 forget and which has troubled you so seriously?" 
 The reply was a flood of abuse. I put the question 
 to him several times without getting any further 
 answer, but when I came to leave the ward, George 
 came up behind me and whispered over my shoulder, 
 "Who told you about it ?" No abuse, no shouting 
 as usually occurred, but a whisper, "Who told you 
 about it ?" Was not George running away from a 
 memory with its emotion which was unbearable to 
 an idea which allowed him to be angry with others 
 instead of with himself? Many examples of this 
 might be given and really might be found by us in 
 our own experience. It is the mental content which 
 is important, a mental content which can be recalled 
 by various stimuli, and which will be more persis- 
 tently with us the more intense is the emotion asso- 
 ciated with it. 
 
 But the basis of the condition is not completely 
 understood when we have apparently arrived at the 
 psychic cause of the disturbance. 
 
 It is recognized that the emotions are accompanied 
 by physical changes, changes which are specific for 
 each emotional state. The physical changes which 
 normally are associated with fear differ from those 
 of joy or anger. This has been appreciated for a 
 long time but recent researches have recalled other 
 reactions to us. Reactions in the internal glands 
 
 [112}
 
 BIOLOGICAL SIGNIFICANCE 
 
 which further knowledge will probably prove to be 
 of great importance, in fact to form an integral part 
 of the sum of activities, connect with mental proc- 
 esses. The secretions of the glands exert an influ- 
 ence on the sensibility and reaction of the organs 
 connected with psychic phenomena and their func- 
 tions themselves are affected by reactions occurring 
 in the nervous system. Revival of a memory may 
 thus affect the functions of these glands, and the 
 changes produced in them may react on the sensi- 
 bility and reactivity of the nervous mechanisms. 
 If this be so, it will be evident that the organism 
 works as a whole, that a disturbance of one organ 
 may interfere with the function of another and that 
 in the repetition of all these influences we may find 
 an explanation of the chronicity of many of these 
 illnesses. A study of the activities and interactivi- 
 ties of all the organs of the body is therefore essen- 
 tial and must be made before we shall understand 
 the biological significance of mental illness.
 
 ADD RE S S BY 
 
 DR. PIERRE JANET
 
 The Chairman : Our country may be hesitating a 
 little I hope it will not be for long in joining a 
 league of nations to prevent war, but there can be 
 no doubt of our immediate readiness to co-operate 
 internationally to prevent and reduce disease. Our 
 distinguished guest from gallant France, Dr. Pierre 
 Janet, professor in the College of France, evidently 
 feels confident of our sympathy and willingness to 
 collaborate in this latter respect, for he has ven- 
 tured across the ocean, with Madame Janet, in 
 response to our urgent invitation. His introduc- 
 tion to an audience of American psychiatrists would 
 be quite out of place. His fame as a pathological 
 psychologist has circled the world. In the science 
 of medicine he is a modern Titan. For to-day's 
 address he has chosen as a subject, "THE RELATION 
 OF THE NEUROSES TO THE PSYCHOSES."
 
 DR. JANET 
 
 Mr. President, my dear colleagues, ladies, and 
 gentlemen: The Americans and the French have 
 met on the battle-fields and they have faced together 
 the same sufferings for the defense of their common 
 ideal of civilization and liberty; it is right that they 
 should meet likewise where Science stands up for 
 the protection of health and human reason, and 
 that they should celebrate together the Festivals of 
 Peace. The President and the organizers of this 
 Congress have greatly honored me in asking me to 
 represent France at the celebration of the centenary 
 of the Bloomingdale Hospital; but above all they 
 have procured me a great pleasure in offering me the 
 opportunity of coming again to this beautiful land, 
 of meeting once more friends who had welcomed us 
 kindly in former days; our old friends of past happy 
 days who have become still dearer to us since they 
 have been tried during the bad days. 
 
 Allow me, in the first place, to present you with 
 the best wishes of the French Government who have 
 had the kindness to charge me to interpret the senti- 
 ments of sympathy which they feel for all mani- 
 festations tending to render the relations that unite
 
 A PSYCHIATRIC MILESTONE 
 
 our two countries closer and more fruitful. The 
 Academy of Moral and Political Sciences has equally 
 charged me to assure you that it is happy to be 
 represented by one of its members at the commemo- 
 ration of the centenary of Bloomingdale Hospital 
 that has so brilliantly and generously continued the 
 tradition of Pinel and Esquirol. The Academy takes 
 a lively interest in the psychological and moral 
 studies of this Congress that seek the cure of diseases 
 of the mind and the lessening of mental disorders. 
 The Medico-Psychological Society, the Society of 
 Neurology, the Society of Psychology, the Society 
 of Psychiatry of Paris are happy to take part in 
 these festivals and are desirous of associating still 
 more closely their work to that of the scientific 
 societies of the United States. 
 
 The celebration of the centenary of a lunatic 
 asylum gives birth to-day to a national festivity in 
 which all civilized nations participate. This is a 
 fact that would have well astonished the first founders 
 of lunatic asylums, the Pinels, the Esquirols, the 
 William Tukes, and the first organizers of Blooming- 
 dale. The public opinion respecting the diseases of 
 the mind, the care to be given to lunatics, is vastly 
 different to what it was a century ago. This trans- 
 formation of ideas has taken place, in a great measure, 
 as a result of the studies devoted to neuroses and 
 
 [ 120]
 
 NEUROSES AND PSYCHOSES 
 
 that is why it seems to me interesting to present 
 you to-day with a few reflections on the connections 
 which unite neuroses and psychoses; for it is the dis- 
 covery of these connections that has shown to the 
 man sound in mind, or who imagines himself to be 
 so, how near he always was to being a lunatic and 
 how wise it was always to consider the lunatic as a 
 brother. 
 
 Formerly a lunatic was considered as a separate 
 being, quite apart from other members of society. 
 The old prejudices which banished the patient from 
 the tribe as a useless and dangerous individual had 
 diminished no doubt with respect to the diseases of 
 the body, which were more and more regarded as 
 frequent and natural things to which each of us 
 might be exposed. But these prejudices persisted 
 with respect to some sexual diseases that were still 
 considered ignominious and chiefly with respect to 
 diseases of the mind. No doubt some intelligent 
 and charitable physicians took interest in the luna- 
 tic, endeavored to spare him many sufferings, to 
 defend him, to take care of him. But the people 
 feared the lunatic and despised him as if he had 
 been struck by some malediction which excommuni- 
 cated him. I have seen lately a patient's parents 
 upset with emotion, as they had to cross the gardens 
 of the asylum to visit their daughter, at the single 
 
 [121]
 
 A PSYCHIATRIC MILESTONE 
 
 thought that they might catch sight of a lunatic. 
 This individual, in fact, had lost in the eyes of the 
 public the particular quality of man, reason, which, 
 it appears, distinguishes us from beasts; he seemed 
 still living, but he was morally dead; he was no longer 
 a man. 
 
 No doubt it was a dreadful misfortune when some 
 member of a family became insane, but this terrible 
 calamity, which nothing could make one anticipate 
 or avoid, was happily exceptional, like thunderbolts. 
 The other men and even the members of the family 
 presented nothing similar and regarded themselves 
 with pride as very different to this wretched being 
 transformed into a beast. This victim of heavenly 
 curse was pitied, settled comfortably in a nice pa- 
 vilion at Bloomingdale and never more spoken of. 
 People still preserve on this point ideas similar to 
 those they had formerly about tuberculosis, known 
 only under the form of terrible but exceptional 
 pulmonary consumption. Now it has at last been 
 understood that there are slight tuberculoses, cura- 
 ble, but tremendously frequent. It will be the same 
 with mental disorders; one day it will be recognized 
 that under diverse forms, more or less attenuated 
 they exist to-day on all sides, among a crowd of 
 individuals that one does not feel inclined to con- 
 sider as insane. 
 
 [ 122]
 
 NEUROSES AND PSYCHOSES 
 
 Little by little, in fact, men have had to state with 
 astonishment that all lunatics were not at Bloom- 
 ingdale. Outside the hospital, in the family of the 
 unfortunate lunatic, or even in other groups, one 
 observed strange complaints, moanings relating to 
 lesions which were not visible, inability to move 
 notwithstanding the apparent integrity of the organs, 
 contradictory and incomprehensible affirmations; in 
 one word, abnormal behaviors, very different to 
 normal behaviors, regularized by the laws and by 
 reason. 
 
 What was the meaning of these queer behaviors ? 
 At first they were very badly understood; they were 
 supposed to have some connection with being pos- 
 sessed (with the devil), with miasmata, vapors, 
 unlikely perturbations of the body and animal 
 spirits that circulated in the nerves. One spoke, 
 as did still Prof. Pomme at the end of the eigh- 
 teenth century, "of the shrivelling up of the nerves."* 
 But above all, one preserved the conviction that 
 these queer disorders were very different to the 
 mental disorders of lunacy. These peculiar indi- 
 viduals had, it was said, all their reason; they 
 remained capable of understanding their fellow 
 creatures and of being understood by them; they 
 were not to be expelled from society like the poor 
 
 * Cf. Janet, P., Les nevroses, 1909, p. 370. 
 [ 123 ]
 
 A PSYCHIATRIC MILESTONE 
 
 lunatics; therefore their illness should be anything 
 but the mental disorders of lunacy. 
 
 Physicians, as it is just, watched their patients 
 and only confirmed their opinion by fine scientific 
 theories. They christened these new disorders by 
 the name of neuroses, reserving the name of psychoses 
 for the mental disorders of lunatics. During the 
 whole of the nineteenth century the radical division 
 of neuroses and psychoses was accepted as a dogma; 
 on the one side, one described epilepsies, hysterias, 
 neurasthenias; on the other, one studied manias, 
 melancholias, paranoias, dementias, without pre- 
 occupying oneself in the least with the connections 
 those very ill-defined disorders might have the ones 
 with the others. This division was accentuated by 
 the organization of the studies and the treatment 
 of the patients. The houses that received the 
 neurotic patients and the insane were absolutely 
 distinct. The physicians who attended the ones 
 and the others were different, and even supplied 
 by different competitions. In France, even now, 
 the recruiting of asylum house pupils and hospital 
 house pupils, the recruiting of asylum doctors and 
 that of hospital doctors, give an opportunity for 
 different competitions. One might almost say that 
 these two categories of house pupils and doctors 
 have quite a different education. The result was 
 
 [ 124]
 
 NEUROSES AND PSYCHOSES 
 
 that the examination of the patients, the study there- 
 of, and even their treatment, were for the most part 
 often conceived in quite a different manner. For 
 example, neuroses were studied publicly; the exami- 
 nation was on elementary sensibilities, the move- 
 ments of the limbs, and especially reflexes; the in- 
 sane were more closely examined in the mental 
 point of view, in conversations held with them by 
 the physician alone. Their arguments, their ideas 
 were noted more than their elementary movements. 
 Strange to say, just when the psycho-therapeutic 
 treatments by reasoning and moralizing with the 
 patients were being developed, they stood out the 
 contrary of what one might have supposed that 
 this treatment should be applied to neurotic patients 
 alone. It was admitted that lunatics were probably 
 not able to feel this moral and rational influence; 
 they were treated by isolation, shower-baths, and 
 purgatives. 
 
 This complete division did not fail to bring about 
 singular and unfortunate consequences. In a hos- 
 pital such as La Salpetriere the tic sufferers, the 
 impulsive, those beset with obsessions, the hysteri- 
 cal with fits and delirium were placed near the or- 
 ganic hemiplegics and the tabetics who did not 
 resemble them in the least, and completely separated 
 from the melancholic, the confused, the systematical
 
 A PSYCHIATRIC MILESTONE 
 
 raving, notwithstanding evident analogies. If Char- 
 cot who, moreover, has brought about so much prog- 
 ress in these studies, committed some serious errors 
 in the interpretation of certain phenomena of hys- 
 teria, is it not greatly due to his having studied these 
 neurotic patients with the neurology methods with- 
 out ever applying psychiatry methods ? Is it not 
 strange to refuse psychological treatment precisely 
 to those who present psychological disorders to the 
 highest degree, and to place the insane who thinks 
 and suffers altogether outside of psychology ? 
 
 In fine, this distinction between the neurotic 
 sufferer and the mental sufferer was mostly arbi- 
 trary and depended more than was believed on the 
 patient's social position and fortune. Important 
 and rich families could not be resigned to see one of 
 their members blemished by the name of lunatic, 
 and the physician very often qualified him as neu- 
 rasthenic to please the family. A few years ago this 
 distinction of the patients and of the physicians 
 gave rise to a very amusing controversy in the 
 newspapers. The professor of the clinic for diseases 
 of the nervous system asserted that neurotic suf- 
 ferers should be patients set apart for neurologist 
 physicians alone, whereas the alienist should con- 
 tent himself with real lunatics. The professor of 
 the clinic for mental diseases protested with much
 
 NEUROSES AND PSYCHOSES 
 
 wit and claimed the right of attending equally the 
 neurotic patients. All this proved a great confusion 
 in the ideas. 
 
 Notwithstanding these difficulties, Charcot's stud- 
 ies themselves on hysterical accidents began to make 
 people's minds uneasy and to modify conceptions 
 of neuroses. They showed that neurotic suffer- 
 ers presented disorders in their thoughts, that many 
 of their accidents, in all appearance physical, were 
 in connection with ideas, with the conviction of 
 paralysis, of illness, with the remembrance of such 
 or such an event which had determined some 
 great emotion. Without doubt, this interpretation 
 of hysteria, which I have myself contributed to 
 extend, must never be exaggerated, and it must 
 not be concluded from this that every neuropathic 
 accident always and solely depends on some remem- 
 brance or some emotion. In my opinion, this is 
 only exact in a very limited number of cases; and 
 then it only explains the particular form of such or 
 such an accident and not the entire disease. With- 
 out doubt it seems to me exaggerated to-day to see 
 in neuroses those psychological disorders alone, 
 whereas the disorders of the circulation, the disorders 
 of internal secretions, the disorders of the functions 
 of the sympathetic which will be spoken of just 
 here must also have a great importance. But, 
 
 [ 127]
 
 A PSYCHIATRIC MILESTONE 
 
 however, this observation proved very useful at 
 that moment. A remembrance, an emotion, are 
 evidently psychological phenomena, and to connect 
 neuropathic disorders with facts of the kind is to 
 include the study thereof with that of mental dis- 
 orders. At this time, in fact, they began to repeat 
 on all sides a notion that had already been indicated 
 in a more vague manner; it is that neuroses were at 
 the root, were in reality diseases of the mind. 
 
 If such is the case, what becomes of the classical 
 distinction between neuroses and psychoses ? No 
 one can deny that the latter are above all diseases 
 of the mind and we have here to review the reasons 
 which seem to justify their complete separation. 
 Will it be said that with psychoses the disorders 
 of the mind last very much longer ? But some pa- 
 tients who enter the asylum with a certificate of 
 insanity are very frequently cured in a few months 
 and some neuropathic disorders may last years. I 
 could name you patients who since thirty years keep 
 the same obsessions, and who at the age of fifty 
 still ask themselves questions upon their pact with 
 heaven, as they did at the age of twenty. Shall we 
 speak of the consciousness the patient has of his 
 state ? But this consciousness may be complete in 
 certain melancholies and very incomplete in certain 
 impulsions. 
 
 [128]
 
 NEUROSES AND PSYCHOSES 
 
 Is it necessary to insist on the presence or absence 
 of anatomical lesions which one tries to ascertain 
 at the post-mortem examination ? Shall we say 
 with Sandras, Axenfeld, Huchard, Hack, Tuke, that 
 neuroses are diseases without lesions ? One finds 
 lesions in general paralysis which is ranged with 
 insanity and we find some also in epilepsies which are 
 considered as neuroses; one no more finds lesions in 
 melancholic conditions than in conditions of obses- 
 sions. Besides, as I have often repeated, this ab- 
 sence of lesions is of no importance; it is quite in 
 keeping with our ignorance. Every one admits that 
 organic alterations more or less momentary, but 
 actually not suspected, must exist in neuroses as in 
 other diseases. Neuroses as well as psychoses are 
 much more likely to be diseases with unknown lesions 
 than diseases without lesions, and it is impossible 
 to take this characteristic into account to distin- 
 guish the ones from the others. 
 
 In reality, the notion of lunatic has lost its former 
 superstitious signification and it has taken no pre- 
 cise medical signification. That word is now the 
 term of the police language. It indicates only an 
 embarrassment felt by the police before certain 
 persons' conduct. When an individual shows him- 
 self to be dangerous for others, the public adminis- 
 tration has the habit of defending us against him by 
 
 [ 129]
 
 A PSYCHIATRIC MILESTONE 
 
 the system of threats and punishments. As a rule, 
 in fact, when a normal mind is in question, threats 
 can stop him before the execution of crime, and 
 punishments, when crime has been committed, can 
 prevent him from beginning again; that is the psy- 
 chological fact which has given birth to the idea of 
 responsibility. But in certain disorders it becomes 
 evident that neither threats nor punishments have 
 a favorable effect, for the individual seems to have 
 lost the phenomenon of responsibility. When an 
 individual shows himself to be dangerous for others 
 or for himself, and that he has lost his responsibility, 
 we can no longer employ the ordinary means of 
 defense; we are obliged to defend ourselves against 
 him, and defend him against himself by special 
 means which it is useless to apply to other men; we 
 are obliged to modify legal conduct toward him. 
 All disorders of the mind oblige us to modify our 
 social conduct toward the patient, but only in a 
 few cases are we obliged to modify at the same time 
 our legal conduct; and these are the sort of cases 
 that constitute lunacy. 
 
 This important difference in the police point of 
 view is of no great importance in the psychological 
 point of view nor in the medical point of view, for 
 the danger created by the patient is extremely va- 
 ried. It is impossible to say that such or such a dis- 
 
 [ 130]
 
 NEUROSES AND PSYCHOSES 
 
 order defined by medicine leaves always the patient 
 inoffensive and that such another always renders 
 him dangerous. There are melancholies, general 
 paralytics, insane who are inoffensive, and whom 
 one should not call lunatics; there are impulsive 
 psychasthenics who are dangerous and whom one 
 shall have to call lunatics. The danger created by 
 a patient depends a great deal more upon the social 
 circumstances in which he lives than upon the na- 
 ture of his psychological disorders. If he is rich, if 
 he has no need to earn his living, if he is surrounded 
 by devoted watchfulness, if he lives in the country, 
 if his surroundings are simple, the very serious men- 
 tal disorders he may have do not constitute a dan- 
 ger. If he is poor, if he has to earn his living, if he 
 lives alone in a large town and his position is deli- 
 cate and complex, the same mental disorders, exactly 
 at the same degree, will soon constitute a danger, 
 and the physician will be forced to place him in an 
 asylum with a good certificate. This is a practical 
 distinction, necessary for order in towns, which has 
 no importance in the point of view of medical 
 science.* If we put these accidental and slightly 
 important differences on one side, we certainly see a 
 common ground in neuroses and psychoses. The 
 question is always an alteration in the conduct, and, 
 
 * Cf. Les Medications psychologiques, 1920, I, p. 112. 
 
 [131]
 
 A PSYCHIATRIC MILESTONE 
 
 above all, in the social conduct, an alteration which 
 tends, if I am not mistaken, toward the same part 
 of the conduct. 
 
 The conduct of living beings is a special form of 
 reaction by which the living being adapts himself to 
 the society to which he belongs. The primitive 
 adaptations of life are characterized by the organiza- 
 tion of internal physiological functions. Later on 
 they consist in external reactions, in displacements, 
 in uniform movements of the body which either 
 keep him from or draw him near to the surrounding 
 bodies. The first of these movements are the reflex 
 movements, then are developed those combinations 
 of movements which we called perceptive or suspen- 
 sive actions in keeping with perceptions. Later 
 came the social acts, the elementary intellectual 
 acts which gave birth to language, the primitive 
 voluntary acts, the immediate beliefs, then the re- 
 flected acts, the rational acts, experimental, etc. As 
 I said formerly, there is, in each function, quite a 
 superior part which consists in its adaptation to the 
 particular circumstance existing at the present mo- 
 ment. The function of alimentation, for instance, 
 has to exercise itself at this moment when I am to 
 take aliments on this table in the midst of new peo- 
 ple, that is to say, among whom I have not yet 
 found myself in this circumstance, wearing a spe- 
 
 [ 132]
 
 NEUROSES AND PSYCHOSES 
 
 cial dress and submitting my body and my mind to 
 very particular social rites. In reality it is never- 
 theless the function of alimentation, but it must be 
 noted that the act of dining, when wearing a dress 
 suit and talking to a neighbor, is not quite the same 
 physiological phenomenon as the simple secretion 
 of the pancreas. Certain patients lose only the 
 superior part of this function of alimentation which 
 consists in eating in society, in eating in new and 
 complex circumstances, in eating while being con- 
 scious of what one is doing, and in submitting to 
 rules. Although the physiologist does not imagine 
 that these functions are connected with the exercise 
 of sexual functions in humanity, there is a pathology 
 of the betrothal and of the wedding-tour. 
 
 It is just on this superior part of the functions, on 
 their adaptation to present circumstances, that the 
 disorders of conduct (self-government) which occupy 
 us to-day bear. If one is willing to understand by 
 the word "evolution" the fact that a living being 
 is continually transforming himself to adapt him- 
 self to new circumstances, neuroses and psychoses 
 are disorders or halts in the evolution of functions, 
 in the development of their highest and latest part.* 
 
 This halt in evolution can be connected with differ- 
 ent physiological causes, hereditary weaknesses of 
 
 *"Les Nevroses," 1909, p. 384. 
 [ 133 ]
 
 A PSYCHIATRIC MILESTONE 
 
 origin, infections, intoxications, disorders of internal 
 secretions, disorders of the sympathetic system. 
 These diverse etiologies will most likely be of use later 
 to distinguish between forms of these diseases; but 
 to-day the common character of neuroses and psy- 
 choses is that this diminution of vitality bears upon 
 the highest functions of self-government. 
 
 Whatever be the disorders you may consider, 
 aboulias, hysterical accidents, psychasthenic ob- 
 sessions, periodical depressions, melancholies, sys- 
 tematized deliriums, asthenic insanity, you will al- 
 ways find a number of facts resulting from this 
 general perturbation. 
 
 In plenty of cases, the acts, far from being di- 
 minished, appear exaggerated; the patient moves 
 about a great deal, he accomplishes acts of defense, 
 of escape, of attack, he speaks enormously, he seems 
 to evoke many remembrances and combine all sorts 
 of stories during interminable reveries. But pray 
 examine the value and the level of all these acts; 
 they are mere gestures, shocks of limbs, laughter, 
 sobs, reactions simply reflex or perceptive, in con- 
 nection with immediate stimulation, with inhibi- 
 tion, without choice, without adaptation by reflec- 
 tion. The thoughts that fill these ruminations are 
 childish and stupid, just as the acts are vulgar and 
 awkward; there is a manifest return to childhood
 
 NEUROSES AND PSYCHOSES 
 
 and barbarism. The behavior of the agitated indi- 
 vidual is well below that which he should show nor- 
 mally. It is easy to explain these facts in the lan- 
 guage we have adopted. The agitation consists in 
 an activity, more less complete, in inferior tenden- 
 cies very much below those the subject should nor- 
 mally utilize. 
 
 It is that in reality the agitation never exists 
 alone, it is accompanied by another very important 
 phenomenon which it dissimulates sometimes, I 
 mean the depression characterized by the diminu- 
 tion or the disappearance of superior actions, apper- 
 taining to the highest level of our hierarchy. It is 
 always observed that with these patients certain 
 actions have disappeared, that certain acts executed 
 formerly with rapidity and facility can no longer 
 be accomplished. The patients seem to have lost 
 their delicacy of feeling, their altruism, their intelli- 
 gent critique. The stopping of tendencies by stimu- 
 lation, the transformation of tendencies into ideas, 
 the deliberation, the endeavor, the reflection; in 
 one word, both the moral effort and the call upon 
 reserves for executing painful acts are suppressed. 
 There exists visibly a lowering of level, and it is 
 right to say that these patients are below themselves. 
 
 The two phenomena, agitation and depression, 
 are almost always associated in neuroses as well as
 
 A PSYCHIATRIC MILESTONE 
 
 in psychoses. It is likely that their union depends 
 upon some very general law, relating to the exhaus- 
 tion of psychological forces. It is probable that the 
 superior phenomena exact under a form of concen- 
 tration, of particular tension, much more power 
 than acts of an inferior order, although the latter 
 seem more violent and more noisy. "When the 
 force primitively destined to be spent for the pro- 
 duction of a certain superior phenomenon has be- 
 come impossible, derivations happen, that is to say, 
 that this force is spent in producing other useless 
 and especially inferior phenomena." * 
 
 A very great number of phenomena observed in 
 neuroses and psychoses are in connection with de- 
 pression and agitation. Convulsive attacks, di- 
 verse fits of agitation, prove to us that before the fit 
 there existed disproportion between the quantity 
 and the tension of the psychological forces, and that 
 the spending of forces during the fit re-establishes 
 the equilibrium. But at the same time, after this 
 spending, one observes a notable lowering of the 
 mental level, a real psycholepsy. It is very likely 
 that studies of this kind will produce some day the 
 key of the epilepsy problem, for vertigos and cer- 
 tain epileptic fits are certainly phenomena of re- 
 laxation, the meaning of which we do not compre- 
 
 * Cf. Janet, P., "Obsessions et Psychestenic," 1903, vol. I, p. 997. 
 
 [136]
 
 NEUROSES AND PSYCHOSES 
 
 hend because we do not study sufficiently the state 
 of psychological tension before and after the acci- 
 dents. 
 
 The difficulty of accomplishing superior acts, the 
 exhaustion resulting from their accomplishment, 
 renders them fearful to the patient who has the fear, 
 the phobia of these acts, just as he has the terror of 
 that depression which gives the feeling of the dimi- 
 nution of life. The shrinking of activity and con- 
 science, phobias, negativisms, generally take their 
 starting point in this fear of exhaustion caused by 
 some difficult action. In other cases the patient 
 feels incapable of accomplishing correctly the re- 
 flected acts necessary to social and moral life, and 
 feeling no longer protected by reflection, he is afraid 
 of willing or believing something, as one is afraid of 
 walking in a dangerous path, when one cannot see. 
 The vertigo of life produces itself like the vertigo 
 of heights, when one is not sure of oneself. 
 
 Depressed patients have felt, wrongly or rightly, 
 a certain excitation after a certain action. Through 
 some curious mechanism, certain acts, instead of 
 exhausting them, have raised their psychological 
 tension. The need, the desire to raise themselves 
 inspires them with the wish to renew such acts, and 
 we behold the impulsions to absorb poisons, impul- 
 sions to command, to theft, to aggression, to extraor- 
 
 [ 137]
 
 A PSYCHIATRIC MILESTONE 
 
 dinary acts, varied impulsions which play a great 
 part in psychoses as well as in neuroses. 
 
 I shall not insist any more on a very interesting 
 phenomenon in connection with the oscillations of 
 the mind and which still plays a great part in these 
 diseases. I am speaking of the change of feeling 
 which may accompany the same action in the course 
 of the oscillations of the mind. At the level with 
 the reflected action, more or less complete, the 
 thought of an action which appears important and 
 of which one often thinks, determines interroga- 
 tions, doubts, scruples. If the individual descends 
 one degree, if he becomes quite incapable of reflect- 
 ing and therefore of doubting, the same action 
 he continues to think about may present itself 
 under the form of an impulsion more or less irresist- 
 ible. 
 
 There are patients who in the first stage have the 
 fear and horror of committing an act and who in the 
 second stage are driven to accomplish it. In other 
 cases a subject may make use of an action as a means 
 of exciting and raising himself; he seeks it, and the 
 thought of this action is accompanied by love and 
 desire. Let him become depressed and he will no 
 longer be able to accomplish this same action with- 
 out exhausting himself; he is then reduced to dread 
 it and take an aversion to it. That which was an
 
 NEUROSES AND PSYCHOSES 
 
 object of love becomes an object of hatred. Thence 
 these turnings of mind that are so often to be ob- 
 served in the course of neuroses and psychoses. In 
 a score of my observations the frenzy of persecution 
 and hatred presents itself as an evolution of those 
 obsessions of love and domination. 
 
 These are very curious facts that one observes in 
 the oscillations of the mind, in particular when the 
 psychasthenic depression becomes more serious and 
 transforms itself in psychasthenic delirium, which 
 is more frequent than one generally imagines. As 
 a rule the properly so-called psychasthenic has only 
 disorders of the reflection; he doubts but he does not 
 rave. But under different influences, his depression 
 may augment, and when he drops below reflection 
 he has no longer the doubts, the hesitations, he no 
 longer shows manias of love and of direction, he 
 transforms his obsessions into deliriums and often 
 his loves into hatreds. 
 
 These are a few examples of the perturbations of 
 conduct common to neurotic sufferers and the dis- 
 eased in mind. One perceives that the same laws 
 relating to the diminution of force and the lowering 
 of the psychological tension intervene in the same 
 way with the one as with the others. The distinctions, 
 which have been established for social reasons and 
 practical conveniences, no longer exist when one 
 
 [ 139]
 
 A PSYCHIATRIC MILESTONE 
 
 tries to find, by analysis of the symptoms, the na- 
 ture of neuroses and psychoses. 
 
 The latter reflection shows us, however, that in 
 certain cases, at least, there is a certain difference in 
 degree between neuroses and psychoses. The evo- 
 lution of the human mind has been formed by de- 
 grees, by successive stages, and we possess in our- 
 selves a series of superposed layers which correspond 
 to diverse stages of the psychological development; 
 when our forces diminish we lose successively these 
 diverse layers commencing with the highest. It is 
 the superior floors of the buildings that are reached 
 first by the bombardments of the war and the cellars 
 are not destroyed at first; they acquire even more 
 importance, as people are beginning to inhabit 
 them. Well, according as the depression descends 
 more or less deeply, the disorders which result from 
 the loss of the superior functions and the exaggerated 
 action of the inferior ones become more and more 
 serious and are appreciated differently. The su- 
 perior psychological functions are, in my opinion, 
 experimental tendencies and rational tendencies. 
 They are tendencies to special actions in which man 
 takes in account remembrances of former acts and of 
 their results, in which he enforces on himself by a 
 special effort obedience to logical and moral laws. 
 A little fatigue and a slight degree of exhaustion are 
 
 [
 
 NEUROSES AND PSYCHOSES 
 
 sufficient for such an action to become difficult and 
 impossible to prolong for a long time. Furthermore, 
 the disorders of the experimental conduct or of the 
 rational conduct are very frequent. These dis- 
 orders only reach the superior actions which are not 
 absolutely necessary to the conservation of social 
 order. They can be easily repaired by inferior acts: 
 if the man does not obey pure moral principles, at 
 least he can conduct himself in appearance in an 
 analogous manner through fear of the prison. Also, 
 these disorders of the superior functions are con- 
 sidered as slight; they are called errors, or faults, 
 and it is admitted that the subjects remain normal 
 beings. 
 
 At the other extremity of the hierarchical series 
 of tendencies the acts are simply reflex. When the 
 disease descends to this level, when the elementary 
 acts can no longer be executed correctly, we do not 
 hesitate either, and we consider these disorders 
 (related with known lesions) as organic diseases of 
 the nervous system. But between these two terms 
 we note disorders in behavior which are more diffi- 
 cult to interpret. These disorders are too grave 
 and too difficult to modify by our usual processes of 
 education and punishment for us to consider them as 
 mere errors or as moral faults; they are variable; 
 they are not accompanied by actually visible lesions
 
 A PSYCHIATRIC MILESTONE 
 
 and we have trouble in classing them among the 
 acknowledged deteriorations of the organism. There 
 is the province of neuroses and psychoses, inter- 
 medium between that of rational errors and that of or- 
 ganic diseases of the nervous system. It corresponds 
 to the disorders of medium psychological functions, 
 to the group of these operations which establish a 
 union more or less solid between the language and 
 the movements of limbs and which give birth to our 
 wills and beliefs. 
 
 Can one establish, in this group, a distinction 
 between neuroses and psychoses that rests on some 
 more precise notion and that is not limited to dis- 
 tinguishing them in a legal point of view ? A more 
 profound knowledge of the mechanisms of the will 
 and belief would perhaps permit us to do so. We 
 are capable of wills and beliefs of a superior order 
 when we reach decision after reflection. The oper- 
 ation of reflection which hinders tendencies and 
 maintains them in the shape of ideas, which com- 
 pares ideas and which only decides after this deliber- 
 ation, constitutes the highest form of the medium 
 operations of the human mind. Lower, still, there 
 exists will and belief, but they are formed without 
 reflection, without stoppage of ideas, without de- 
 liberation; they are the result of an immediate 
 assent which transforms verbal formulas into wills 
 
 [ 142]
 
 NEUROSES AND PSYCHOSES 
 
 and beliefs as soon as they strike the attention, as 
 soon as they are accompanied by a powerful senti- 
 ment. The immediate assent is the inferior form of 
 these tendencies. 
 
 If one wished to establish a scientific distinction 
 between neuroses and psychoses, I should say, in 
 a summary fashion, that in neuroses the reflection 
 alone is disturbed, that in psychoses the immediate 
 assent itself is affected. The shrinkage of the con- 
 science, doubts, aboulias, obsessions, scruples are 
 always disorders of the reflected will and belief. On 
 the contrary, irresistible impulsions, deliriums, in- 
 differences which suppress desires and only allow 
 elementary agitations to subsist, show alterations in 
 the immediate assent, in the will, and the primitive 
 belief and must be considered as psychoses. Below 
 could be placed the disorders of elementary intelli- 
 gence, the disorder of the perceptive and social 
 functions which characterize the mental deficiencies 
 of imbeciles and idiots. One might also distinguish 
 these disorders according to the degree of depth the 
 destruction of the edifice has reached, according to 
 the more or less distant state of evolution to which 
 the patient goes back. But these psychological 
 classifications are purely theoretical, and in prac- 
 tice many other factors intervene which oblige us 
 to consider such a patient as incapable of doing any 
 
 [143]
 
 A PSYCHIATRIC MILESTONE 
 
 harm and such another as dangerous; this is the only 
 difference to-day between neuroses and psychoses. 
 Later on, without doubt, we shall be able to sub- 
 stitute for these simply symptomatical and psy- 
 chological diagnostics, some etiological and physio- 
 logical diagnostics. We shall be able from the very 
 outset to recognize that a disorder, in all appearance 
 slight and which is not deeply set, presents a bad 
 prognosis, and we shall be able to foresee a serious 
 and deep psychosis in the future. To-day, without 
 doubt, one can often distinguish from the outset 
 the future general paralytic from the simple neuras- 
 thenic. But in the actual state of science this abil- 
 ity to distinguish is not frequent and the future 
 evolution of a depressed state can scarcely be fore- 
 seen with precision. 
 
 Certain individuals pass in a few years from psy- 
 chasthenic depression with doubts and obsessions to 
 psychasthenic deliriums with stubbornness and nega- 
 tivism, then to asthenic insanity with irremediable 
 and complete want of power. Is it necessary to say 
 that we made a mistake in our diagnostic and that 
 from the first demential psychosis should have been 
 recognized ? I am not convinced of this : these dis- 
 eases, excepting a few cases with rapid evolution, 
 are not characterized from the outset. Without 
 doubt we must note that these depressions which 
 disturb the reflective tendencies of young patients in 
 
 [ 144]
 
 NEUROSES AND PSYCHOSES 
 
 full period of formation, are dangerous and can bring 
 on still deeper depressions of the psychological 
 tension. But that evolution is rarely fatal; it can 
 very often be checked, and it seems to me fair to 
 preserve the distinction between neuroses and psy- 
 choses considered as different degrees of psychologi- 
 cal decadence. 
 
 Neuroses are, therefore, the intermedium between 
 the errors and the faults which appeared to us al- 
 most normal, and alienation which seemed excep- 
 tional and distant from us. The first appearances of 
 that depression which in a continuous manner de- 
 scends to alienation are to be found already in the 
 disorders of character which seemed to be quite 
 insignificant. The miser, the misanthrope, the hypo- 
 crite are described by the writer before they are 
 claimed by the physician. A great number of 
 neuropathic disorders which I have described are 
 related to the popular type of mother-in-law. This 
 type is not necessarily that of a woman whose 
 daughter has married, but the type of a depressed 
 woman of about fifty, aboulic, discontented with 
 herself and others, domineering, and jealous, be- 
 cause she suffers from the mania of being loved 
 though she is incapable of acquiring any one's affec- 
 tion. All exhaustions, all moral failings have the 
 closest connection with neuroses and psychoses. 
 
 These reflections prove to us that the alienist
 
 A PSYCHIATRIC MILESTONE 
 
 physician should interest himself more and more in 
 the treatment of neuroses even slight, to rectifying 
 the disorders of temper, to the education of the 
 young, to the direction of the moral hygiene of his 
 country. On many of these points America leads 
 the way; your works of social hygiene, the good 
 battle you are fighting against alcoholism, are exam- 
 ples for us. You are the new world, younger, not 
 rendered so inactive by secular habits. You can 
 act more easily than we. We may have the advan- 
 tage, in the old world, of the experience of old people 
 and the habit of observation, but we are slack in 
 reform and action. "If youth had experience and 
 old age ability," says one of our proverbs. We must 
 remain united and join your strength to our experi- 
 ence for the greater progress of the studies which 
 are dear to us and for the greater good benefit of 
 our two countries.
 
 ADDRESS BY 
 
 DR. WILLIAM L. RUSSELL
 
 The Chairman: The year 1921 is rich in anni- 
 versaries for the New York Hospital. Next October 
 we plan to celebrate the one hundred and fiftieth 
 anniversary of the granting of our charter. To-day 
 we are occupied with the Bloomingdale Centenary. 
 A fortnight ago the twenty-fifth annual graduating 
 exercises of our Training School for Nurses were 
 held in this room. This year also marks the decen- 
 nial of Dr. Russell's term of office as Medical Super- 
 intendent. When his devoted predecessor, Dr. Sam- 
 uel B. Lyon, asked in 1911 to be relieved from active 
 duty and became our first Medical Superintendent 
 Emeritus, we were most fortunate in securing as his 
 successor Dr. Russell. Coming to this institution 
 after a broad psychiatric and administrative experi- 
 ence, he has taken up our special problems with deep 
 insight and gratifying success. He has selected for 
 his subject this afternoon "THE MEDICAL DEVELOP- 
 MENT OF BLOOMINGDALE HOSPITAL." No one can 
 speak with greater authority on a theme of which 
 it may be said quorum magna pars fortunately not 
 only fuit but est and erit as well.
 
 DR. RUSSELL 
 
 The object of this celebration is not merely to 
 glorify the past and least of all is it to laud the 
 present. What we hope from it is that it will es- 
 tablish a milestone, not only to mark the progress 
 thus far made but to point the way to a path of 
 greater usefulness. The advances in medical sci- 
 ence and practice and in the specialty of psychiatry 
 during the past hundred years fill one with wonder 
 and hope. It is worth while to review them merely 
 to obtain this help. The outlook for the century to 
 come is, however, so far as can be anticipated, still 
 brighter. 
 
 To review the past is, at a time like this, not un- 
 profitable. It may prevent us, in our zeal for the 
 new, from discarding what is valuable in the old, 
 and from overvaluing some things which may have 
 outlived their usefulness. We must be careful that 
 we do not fall into errors similar to those from which 
 the medical profession was rescued by the movement 
 of which Bloomingdale Asylum was an offspring. 
 It should be recalled that the establishment of the 
 asylum was due to the initiative of the Governors of 
 the New York Hospital, especially Mr. Eddy, rather
 
 A PSYCHIATRIC MILESTONE 
 
 than to the active interest and direction of physicians. 
 The object of the establishment was, according to 
 Mr. Eddy, to afford an opportunity of ascertaining 
 how far insanity may be relieved by moral treatment 
 alone, which, he says, "it is believed, will, in many 
 instances, be more effective in controlling the mani- 
 acs than medical treatment." The moral manage- 
 ment he referred to, though advocated by Pinel and 
 a few others, some of whom were benevolent and 
 intelligent laymen, had not been accepted by physi- 
 cians as a distinct form of medical treatment. Few 
 physicians of the period had accepted management 
 of the mind as described and practised by Pinel as 
 being a distinct medical procedure, as having the 
 same value in overcoming mental disorders as the 
 drastic medical remedies which they were accustomed 
 to employ, or as having any exclusive healing power. 
 This is clearly shown by the case records of the men- 
 tal department of the New York Hospital which have 
 been preserved since 1817, and of those of Blooming- 
 dale Asylum for some years after its opening in 
 1821. It is plainly set forth in Dr. Rush's book on 
 diseases of the mind, which was first published in 
 1810 and again in a fourth edition in 1830. Rush 
 was physician to the Pennsylvania Hospital and his 
 book was the principal, if not the only, one of the 
 period by an American author. American physi-
 
 DEVELOPMENT OF HOSPITAL 
 
 cians like their European brothers, had, as Pinel 
 observes, "allowed themselves to be confined within 
 the fairy circle of antiphlogisticism, and by that 
 means to be deviated from the more important 
 management of the mind." Rush believed that 
 madness was a disease of the blood-vessels of the 
 brain of the same nature as fever, of which it was a 
 chronic form. "There is," he says, "not a single 
 symptom that takes place in an ordinary fever, 
 except a hot skin, that does not occur in an acute 
 attack of madness." He found in his autopsy 
 observations confirmation of this view and concludes 
 that "madness is to phrenitis what pulmonary con- 
 sumption is to pneumony, that is, a chronic state 
 of an acute disease." The reason for believing that 
 madness was a disease of the blood-vessels, which 
 seemed to him most conclusive, was "from the reme- 
 dies which most speedily and certainly cure it being 
 exactly the same as those which cure fever or disease 
 in the blood-vessels from other causes and in other 
 parts of the body." The treatment he recommended 
 and which was generally employed was copious 
 blood-letting, blisters, purges, emetics, and other 
 severe depleting measures. When Bloomingdale 
 Asylum was established, therefore, the provision for 
 moral treatment did not contemplate that this 
 should be applied by the physician or that he should
 
 A PSYCHIATRIC MILESTONE 
 
 have full control of the resources by means of which 
 it could be applied. The records do not indicate 
 that either the physicians or the Governors realized 
 that this might be necessary or advantageous. The 
 present system of administration in which the chief 
 physician is also the chief executive officer of the 
 institution was a result of an evolution which took 
 many years to reach its full consummation. 
 
 Pinel, many years before Bloomingdale Asylum 
 was opened, had shown by the most careful observa- 
 tion and practice that the management and disci- 
 pline of the hospital was a most powerful agent in 
 the treatment of the patients. The manner in 
 which he was led to this conclusion is a remarkable 
 example of the scientific method. When he became 
 physician to the Bicetre he found that the methods 
 of classification and treatment recommended in the 
 books seemed to be inadequate, and, desiring further 
 information, he says: "I resolved to examine myself 
 the facts which were presented to my attention; 
 and, forgetting the empty honor of my titular dis- 
 tinction as a physician, I viewed the scene that 
 opened to me with the eye of common sense and 
 unprejudiced observation. . . . From systems of 
 nosology, I had little assistance to expect; since the 
 arbitrary distributions of Sauvages and Cullen were 
 better calculated to impress the conviction of their
 
 DEVELOPMENT OF HOSPITAL 
 
 insufficiency than to simplify my labor. I, there- 
 fore, resolved to adopt that method of investigation 
 which has invariably succeeded in all the depart- 
 ments of natural history, viz., to notice successively 
 every fact, without any other object than that of 
 collecting materials for future use; and to endeavor, 
 as far as possible, to divest myself of the influence, 
 both of my own prepossessions and the authority 
 of others. With this view, I first of all took a general 
 statement of the symptoms of my patients. To 
 ascertain their characteristic peculiarities, the above 
 survey was followed by cautious and repeated ex- 
 aminations into the condition of individuals. All 
 our new cases were entered at great length upon the 
 journals of the house." Having thus studied care- 
 fully the course of the disease in a number of patients 
 who were subjected only to the guidance and con- 
 trol made possible by the management of the hos- 
 pital under the direction of a remarkably highly 
 qualified Governor, it came to him with the force of a 
 new discovery that this man who was not a physician 
 was doing more for the patients than he was, and 
 that insanity was curable in many instances by mild- 
 ness of treatment and attention to the state of mind 
 exclusively. "I saw with wonder," he says, "the 
 resources of nature when left to herself, or skilfully 
 assisted in her efforts. My faith in pharmaceutic
 
 A PSYCHIATRIC MILESTONE 
 
 preparations was gradually lessened, and my scepti- 
 cism went at length so far as to induce me never to 
 have recourse to them, until moral remedies had 
 completely failed." So convinced did he become of 
 the significance and importance of the management 
 and discipline of the hospital in the treatment of 
 the patients, that, when a few years later, he wrote 
 his "Treatise on Insanity," he states that one of the 
 objects of his writing it was, "to furnish precise 
 rules for the internal police and management of 
 charitable establishments and asylums; to urge the 
 necessity of providing for the insulation of the differ- 
 ent classes of patients at houses intended for their 
 confinement; and to place first, in point of conse- 
 quence, the duties of a humane and enlightened 
 superintendency and the maintenance of order in 
 the services of the Hospitals." 
 
 Pinel's views had apparently not been fully under- 
 stood or adopted by the physicians of America at 
 the time Bloomingdale Asylum was planned and 
 established. Dr. Rush did not mention him in his 
 book, and Mr. Eddy, in his communication to the 
 Governors of the New York Hospital, referred only 
 to the writings of Drs. Creighton, Arnold, and 
 Rush and the Account of the York Retreat by Sam- 
 uel Tuke. 
 
 When Bloomingdale Asylum was opened, the form
 
 DEVELOPMENT OF HOSPITAL 
 
 of organization introduced was that under which the 
 department at the New York Hospital had been 
 conducted. Mr. Laban Gardner was made Superin- 
 tendent or Warden with two men and three women 
 keepers to aid him in the control and management 
 of the seventy-five patients. There was an Attending 
 Physician who visited once a week and a Resident 
 Physician, neither of whom received salaries. There 
 is nothing in the records to indicate that in the be- 
 ginning, the Governors of the Hospital looked upon 
 the moral treatment of the patients, which was the 
 object for which the institution was established, as 
 the task of the Physicians. The aim was to furnish 
 employment, diversion, discipline, and social en- 
 joyment, without much attempt at precision or close 
 medical direction and control. For a time the re- 
 sults were considered to be satisfactory. In 1824, 
 however, a joint Committee of the Board reported 
 that they were impressed by the necessity of improv- 
 ing the moral treatment, and recommended that two 
 discreet persons be appointed to take charge of such 
 of the patients as might from time to time be in a 
 condition to be amused or employed on the farm or 
 in walking exercises in the open or in classes to be 
 designated by the Resident Physician "with," how- 
 ever, "the approbation of the Superintendent," who 
 you will recall was not a physician. These patients
 
 A PSYCHIATRIC MILESTONE 
 
 were, the report recommends, to be particularly 
 under the charge of the Resident Physician when thus 
 employed or amused "out of the Asylum." At this 
 time, the Attending and Resident Physicians were 
 placed on a small salary, and the Resident Physician 
 was instructed to "devote a greater portion of his 
 time and attention to the moral part of the establish- 
 ment and to communicate to the Committee such 
 improvements as his experience shall suggest to be 
 useful and necessary in carrying into more complete 
 effect the system of moral treatment and to report 
 from time to time to the Committee the effect of 
 the measure adopted." This seems to have been 
 the beginning of a realization that the moral manage- 
 ment of the patients was inseparable from medical 
 treatment and must necessarily be the task of the 
 physician. Seven years after this, in 1831, the 
 Committee found it advisable to spread upon the 
 minutes an "interpretation and regulations," relat- 
 ing to the Superintendent and Matron of the Asylum 
 and to the Asylum physicians, to the effect that the 
 Committee understood that the regulations "placed 
 the moral treatment on the physician alone, under 
 the direction of the Asylum Committee, and that 
 the responsibility remains with him alone, that this 
 treatment commenced with the reception of the pa- 
 tient, the ward where he shall be placed, his exercises, 
 
 [158]
 
 DEVELOPMENT OF HOSPITAL 
 
 amusement, admission of friends, the time of dis- 
 charge from the house. . . . And that all orders 
 to nurses and keepers which the physicians may think 
 necessary to carry these orders into effect shall 
 be communicated through the Superintendent" (or 
 Warden). In 1832, the Resident Physician, Dr. 
 James Macdonald, who had just returned from Eu- 
 rope after having spent a year in visiting the insti- 
 tutions for mental disorders there, made a report in 
 which he rather significantly referred to the impracti- 
 cability of making a sharp distinction between the 
 medical and moral treatment of the patients, it 
 being difficult to say where the one ended and the 
 other began, or to put one into successful operation 
 without bringing in the other. At this time the 
 position of Attending Physician was abolished and 
 the Resident Physician was made the Chief Medical 
 Officer of the Asylum. It was not until 1837 that 
 an amendment to the by-laws regulating the powers 
 of the physician and the Warden was adopted which 
 gave to the physician the power of appointing and 
 discharging at pleasure all the attendants on the 
 patients, while to the Warden was reserved the power 
 of appointing and dismissing all other employees. 
 Fourteen years had thus elapsed since the opening 
 of the Asylum before the physician was given con- 
 trol of even the nursing service. The first Annual 
 
 [159]
 
 A PSYCHIATRIC MILESTONE 
 
 Report of the Resident Physician of the Asylum to 
 be published appeared in 1842. In this, Dr. William 
 Wilson makes a general statement in regard to the 
 beneficial effects of the moral as well as the medical 
 treatment pursued in the institution, and refers 
 particularly to occupations, exercise in the open air, 
 amusement, religious services, and he asks that a 
 workshop be erected for the men. It is evident that 
 by this time the authority of the physician in the 
 management of the institution had been extended 
 and it is perhaps significant that in his report of 
 the following year Dr. Wilson refers to a plan for 
 distribution of food which had been evolved in co- 
 operation with the Warden. Under the direction of 
 Dr. Pliny Earle, who was appointed physician to the 
 Asylum in 1844, treatment directed to the mind 
 was further elaborated and systematized, and the 
 place of the physician in the management of the 
 hospital was more firmly established. 
 
 This brief survey indicates how, in the develop- 
 ment 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 treat- 
 ment 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, 
 
 [160]
 
 DEVELOPMENT OF HOSPITAL 
 
 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 execu- 
 tive officer of the institution. This was, however, 
 not fully accomplished until 1877. It is now uni- 
 versally 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 re- 
 quired for the treatment of physical conditions. 
 The use of the organized agencies which were re- 
 garded by the founders as the main reliance in moral 
 treatment, namely occupations, physical exercises 
 and games, diversion, social contacts, and enjoy- 
 ment, and management of behavior has been greatly 
 
 [161]
 
 A PSYCHIATRIC MILESTONE 
 
 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 dis- 
 orders and the means of restoring their capacity for 
 adjustment to healthy thinking and acting. Psy- 
 chiatry has been furnished with a body of well-ar- 
 ranged facts, and with a technic which is not in- 
 ferior in system and precision to that of many other 
 branches of medicine. In the study and manage- 
 ment 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 prac- 
 tice 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 de- 
 partments, 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
 
 DEVELOPMENT OF HOSPITAL 
 
 of the patient, including his original physical and 
 mental constitution, the physical as well as the men- 
 tal 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 treat- 
 ment 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 favor- 
 ite remedy than with the natural history of the dis- 
 ease, "as if," he says, "the treatment of every dis- 
 ease without accurate knowledge of its symptoms in- 
 volved 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 ex- 
 clusion 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 dis- 
 order 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 mea-
 
 A PSYCHIATRIC MILESTONE 
 
 sures 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 hospi- 
 tal for mental disorders furnishes the means of pro- 
 viding social as well as individual treatment. It is 
 a medical mechanism and for its proper manage- 
 ment 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 inter- 
 ests. Like Pinel, one must be willing to forget the 
 empty honor of one's titular distinction as a phy- 
 sician, and do whatever may be necessary to make 
 the institution a truly medical agency for the heal- 
 ing 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 atten- 
 tion. This question might, with great advantage,
 
 DEVELOPMENT OF HOSPITAL 
 
 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 treat- 
 ment 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 se- 
 clusion. Psychiatry is extending out from the insti- 
 tutions into the communities by means of out- 
 patient clinics and social workers, through newly 
 created organized agencies, through informed indi- 
 viduals, 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
 
 A PSYCHIATRIC MILESTONE 
 
 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 pre- 
 vention of mental disorders, the informed public is 
 likely to start a campaign which the medical profes- 
 sion 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 ex- 
 perience 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 depart- 
 ment. Much emergency work and preliminary ob- 
 servation 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 
 
 [166]
 
 DEVELOPMENT OF HOSPITAL 
 
 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 exten- 
 sions and developments which could be as closely 
 connected with, or as widely separated and dis- 
 tinguished from, the present provision as circum- 
 stances required. In this way much needed pro- 
 vision for the treatment of persons suffering from the 
 psychoneuroses and minor psychoses could be fur- 
 nished. Better provision for a further period of read- 
 justment after a patient is ready to leave the Hospital 
 but not yet ready to face the risk of ordinary condi- 
 tions 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 ser- 
 vice throughout the Hospital. 
 
 The lines of further development are, perhaps,
 
 A PSYCHIATRIC MILESTONE 
 
 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 re- 
 garded 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 be- 
 yond 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 audi- 
 ence. 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 dis- 
 orders. 
 
 [168]
 
 The Chairman : This, ladies and gentlemen, con- 
 cludes our exercises. As the representative of the 
 Governors, I find it quite impracticable, in supple- 
 menting 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 pag- 
 eant 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,* which formed the text for Dr. Samuel 
 
 * Homines enim ad Decs nulla re proprius accedunt, quam salutem 
 hominibus dando.
 
 THE TABLEAU-PAGEANT 
 
 S YNO P S I S 
 
 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 fa- 
 miliar picture of Pinel at Salpetriere depicts condi- 
 tions in that period. Several portraits of personali- 
 ties 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.
 
 A PSYCHIATRIC MILESTONE 
 
 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 Court Ladies 
 
 Queen Charlotte Emissaries 
 
 Prince of Wales Cherokee Chief 
 
 Court Chamberlain 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 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 
 
 [174]
 
 TABLEAU- PAGE ANT 
 
 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 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 
 
 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 Com- 
 mittee 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 Men's Sports 
 
 Women's Crafts 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 
 
 [175]
 
 A PSYCHIATRIC MILESTONE 
 
 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 Britannia 
 
 La Belle France 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" 
 
 [176]
 
 NAMES OF THOSE WHO ATTENDED 
 THE EXERCISES
 
 NAMES OF THOSE WHO ATTENDED 
 THE EXERCISES* 
 
 E. Stanley Abbot, M.D. . . . Philadelphia, Pa. 
 
 Louise Acton White Plains, N. Y. 
 
 Elizabeth I. Adamson, M.D. . . White Plains, N. Y. 
 
 William H. Alice, 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. 
 
 * If any names are omitted it is because these names and addresses were not 
 obtained. 
 
 [ 179]
 
 A PSYCHIATRIC MILESTONE 
 
 Helen Brown, M.D New York City. 
 
 Sanger Brown, 2d, M.D. . . . New York City. 
 
 Miss Elizabeth O. Buckingham . Chicago, 111. 
 
 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 Ser- 
 vice 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. 
 
 [180]
 
 GUESTS AT EXERCISES 
 
 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. 
 
 [181]
 
 A PSYCHIATRIC MILESTONE 
 
 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. L, 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. 
 
 [182]
 
 GUESTS AT EXERCISES 
 
 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. Ken worthy, 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. 
 
 [183]
 
 A PSYCHIATRIC MILESTONE 
 
 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. 
 
 [184]
 
 GUESTS AT EXERCISES 
 
 Guy Payne, M.D 
 
 Arthur M. Phillips, M.D. . . . 
 
 Charles W. Pilgrim, M.D., Chair- 
 man, State Hospital Commission, 
 N. Y 
 
 Mason Pitman, M.D 
 
 Miss Leah Pitman 
 
 Miss Adele S. Poston, R.N. . . 
 
 Howard W. Potter, M.D. . . . 
 
 Wilson M. Powell 
 
 Mrs. Margaret J. Powers . 
 
 Miss Nina Prey 
 
 W. B. Pritchard, M.D 
 
 Morton Prince, M.D 
 
 Rose Pringle, M.D 
 
 Sylvanus Purdy, M.D 
 
 Paul R. Radosvljevich, M.D. . . 
 E. Benjamin Ramsdell, M.D. . 
 Edwin G. Ramsdell, M.D. . . . 
 Mortimer W. Raynor, M.D. . 
 Lawrence F. Rainsford, M.D. . 
 Mrs. Lawrence F. Rainsford . 
 
 Henry A. Riley, M.D 
 
 Miss Elise Reilly 
 
 Frank W. Robertson, M.D. . . 
 
 M. A. Robinson, M.D 
 
 William C. Roden, R.N. . . . 
 
 A. J. Rosanoff, M.D 
 
 Miss Catherine Ross, R.N. 
 
 John T. W. Rowe, M.D. . . . 
 
 Richard G. Rows, M.D. . . . 
 
 Frederick D. Ruland, M.D. . . 
 
 William L. Russell, M.D. . . . 
 
 Mrs. William L. Russell 
 
 Earnest F. Russell, M.D. . . . 
 
 Paul L. Russell 
 
 Mrs. Paul L. Russell .... 
 
 Walter G. Ryon, M.D 
 
 Miss Helen K. Ryce .... 
 
 Cedar Grove, N. J. 
 New York City. 
 
 Central Valley, N. Y. 
 Riverdale-on-Hudson, N. Y. 
 White Plains, N. Y. 
 White Plains, N. Y. 
 Thiells, N. Y. 
 New York City. 
 New York City. 
 New York City. 
 New York City. 
 Boston, Mass. 
 White Plains, N. Y. 
 White Plains, N. Y. 
 
 New York City. 
 New York City. 
 White Plains, N. Y. 
 New York City. 
 Rye, N. Y. 
 Rye, N. Y. 
 New York City. 
 White Plains, N. Y. 
 New York City. 
 New York City. 
 White Plains, N. Y. 
 Kings Park, N. Y. 
 White Plains, N. Y. 
 New York City. 
 London, England. 
 Westport, Conn. 
 White Plains, N. Y. 
 White Plains, N. Y. 
 New York City. 
 White Plains, N. Y. 
 White Plains, N. Y. 
 Poughkeepsie, N. Y. 
 Poughkeepsie, N. Y. 
 
 [185]
 
 A PSYCHIATRIC MILESTONE 
 
 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. 
 
 [186]
 
 GUESTS AT EXERCISES 
 
 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. 
 
 [187]
 
 A PSYCHIATRIC MILESTONE 
 
 G. Howard Wise 
 Miss Frances E. Wood . 
 Robert C. Woodman, M.D. 
 Robert S. Woodworth, Ph.D. 
 
 Rev. John C. York . . . 
 
 Edwin G. Zabriskie, M.D. . 
 Charles C. Zacharie, M.D. 
 
 New York City. 
 White Plains, N. Y. 
 Middletown, N. Y. 
 New York City. 
 
 Brooklyn, N. Y. 
 
 New York City. 
 White Plains, N. Y. 
 
 [188]
 
 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 fac- 
 simile of Thomas Eddy's communication* is especially interest- 
 ing 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 in- 
 sane, 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 Re- 
 treat to present your Hospital with one of them. I have al- 
 ready sent you a copy of an address of my own dealing with 
 Psychiatry in England at about the time your Hospital was 
 instituted. 
 
 * Bloomingdale Hospital Press. 
 
 [191]
 
 APPENDIX I 
 
 The use of the term "moral treatment" as opposed to treat- 
 ment of physical disease has in recent years become especially 
 interesting. It is clear that Tuke and Pinel foresaw that psy- 
 chotherapeutic treatment is necessary, and their efforts were 
 directed towards providing effective "sublimation" of mis- 
 directed psychical energy. 
 
 One is pleased to see in your report the extent to which organ- 
 ized occupations are developed at Bloomingdale a pleasure 
 not unmixed with envy at seeing the picture of the men's occu- 
 pational 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, to- 
 gether 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 congratu- 
 lates 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. 
 
 [ 192]
 
 GREETINGS FROM YORK RETREAT 
 
 EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE 
 
 RETREAT 
 
 The Retreat, York 
 
 Meeting of Directors held on April the 3Oth, 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 sec- 
 tion 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 cor- 
 respondence 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 impor- 
 tance. We send our hearty congratulations to the Blooming- 
 dale 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 nth. Abrm. Barker, New Bedford, Massachu- 
 
 sits, 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 
 
 [ 193 ]
 
 APPENDIX I 
 
 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 op- 
 portunity 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. i Mon 4. Sharon Carter, Philadelphia. 
 
 1816. I mon. Wm. S. Warder, from Philadelphia. 
 
 1816. 2 mon 21. Rev. Thomas H. Gallaudet, who visits 
 Europe for the purpose of qualifying himself to superin- 
 tend 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 Grade, Junr., New York. 
 
 1816. April 29th. George F. Randolph, Philadelphia. 
 John Hastings, Baltimore. 
 
 1816. 6 mon igth. Charles Longstreth, from Philadelphia. 
 
 1816. 6 mon igth. Jacob Smedley, from Philadelphia. 
 
 1817. 7 mon. Henry Kollock, of Savannah, Georgia. 
 
 Dr. Wm. Parker, Savannah. 
 
 G. C. Fersslanchi, of New York. 
 1817. 11/24. Hannah Field, North America, with Elizabeth 
 
 Fry. 
 1817. 12 Mo. G. /. Browne, United States of America 
 
 (Cincinnati). 
 
 194]
 
 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.
 
 APPENDIX II 
 
 A LETTER ON PAUPER LUNATIC ASYLUMS* 
 
 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 re- 
 publication 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 appli- 
 cation to the subscriber, 
 
 THOMAS EDDY. 
 
 New-York, I2th month, soth, 1815. 
 
 YORK, ymo. lyth, 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.f He has 
 wished me to make any remarks which may occur to me on the 
 
 * A letter on Pauper Lunatic Asylums, by Samuel Tuke, New York, 1815. 
 Reprinted Bloomingdale Hospital Press, June 3, 1919. 
 f Appendix III. 
 
 [195]
 
 APPENDIX II 
 
 perusal; but, having just published a few hints on the construc- 
 tion 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 poor- 
 est 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, in- 
 tended to occupy the new building, I conclude you are provid- 
 ing 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 ob- 
 jection 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 in- 
 tend 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 communica- 
 tion 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 
 
 [196]
 
 SAMUEL TUKE TO THOMAS EDDY 
 
 I hope it will not be altogether useless. Should it be thought 
 too expensive, I think the rooms, I, 2, and 3, might be dispensed 
 with, and rooms marked "attendants, sick and bath," might 
 be appropriated to the patients during the day. The atten- 
 dants 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 ac- 
 commodate 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 gen- 
 eral 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 im- 
 portance 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 horti- 
 cultural 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 
 
 [ 197]
 
 APPENDIX II 
 
 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 feel- 
 ing 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 use- 
 ful 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 appoint- 
 ments in this country, it appears desirable, to render the per- 
 formance 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 pamph- 
 let, that the importance of moral treatment in the cure of in- 
 sanity, 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 dis- 
 ease of the mind. All the varieties, included under this general 
 term, have been produced by physical causes: by external acci- 
 dents, by intoxication, the improper use of medicines, repelled 
 eruptions, obstructed secretions, &c. In some instances, dis- 
 section has discovered, after death, the cause of the mental 
 
 [I 9 8]
 
 SAMUEL TUKE TO THOMAS EDDY 
 
 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 dis- 
 covered 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. 
 
 [ 199]
 
 APPENDIX III 
 
 THOMAS EDDY'S COMMUNICATION TO THE 
 BOARD OF GOVERNORS, APRIL, 1815 * 
 
 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 
 
 * "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. 
 
 [ 2OO ]
 
 MORAL TREATMENT OF INSANE 
 
 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 ob- 
 servations 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 what- 
 ever 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 con- 
 duct or opinions, yet they are generally aware of those particu- 
 lars for which the world considers them proper objects of con- 
 finement. 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. 
 
 [201 ]
 
 APPENDIX III 
 
 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 pun- 
 ishments. 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, there- 
 fore, 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 es- 
 teem. 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 con- 
 ducing to a salutary habit of self-restraint, an object, no doubt, 
 
 [ 2O2 ]
 
 MORAL TREATMENT OF INSANE 
 
 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* 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 se- 
 duce the mind from unhappy and favourite musings; and par- 
 ticularly 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 
 
 * 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: 
 A 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. 
 
 [203 ]
 
 APPENDIX III 
 
 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 en- 
 
 [204]
 
 MORAL TREATMENT OF INSANE 
 
 deavours; nor should we too readily be disheartened by occa- 
 sional 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 con- 
 dition, 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 fol- 
 lowing 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 ap- 
 pears 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 exer- 
 cised, 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 pa- 
 tient; yet it may be proper sometimes, by way of punishment, 
 to use the shower bath. 
 
 4th. The common attendants shall not apply any extraordi- 
 nary coercion by way of punishment, or change in any degree 
 the mode of treatment prescribed by the physician; on the con- 
 
 [205]
 
 APPENDIX III 
 
 trary, it is considered as their indispensable duty, to seek by 
 acts of kindness the good opinion of the patients, so as to gov- 
 ern 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 re- 
 straint, such an ample force should be employed as will preclude 
 the idea of resistance from entering the mind of the patient. 
 
 yth. 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 occa- 
 sioned by religious melancholy, or a fondness for ardent spirits, 
 if owing to an injury received on any part of the body, or sup- 
 posed to arise from any other known cause, hereditary or ad- 
 ventitious, and the name of the physician who may have at- 
 tended him, and his manner of treating the patient while under 
 his direction. 
 
 8th. Such of the patients as may be selected by the physi- 
 cian, 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 man- 
 ner, 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. 
 
 loth. 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. 
 
 nth. It shall be the duty of the physician to keep a book, 
 
 [206]
 
 MORAL TREATMENT OF INSANE 
 
 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 apportunity of ascertaining how far that disease 
 may be removed by moral management alone, which it is be- 
 lieved, 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 
 
 [207]
 
 APPENDIX III 
 
 might be necessary to be advanced, for the purchase of the 
 ground and erecting the buildings. The board of patients (sup- 
 posing 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 es- 
 tablishment; 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 ad- 
 ditional 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. 
 
 [208]
 
 APPENDIX IV 
 
 EXTRACTS FROM THE MINUTES OF THE BOARD 
 OF GOVERNORS IN RELATION TO ACTION 
 TAKEN RESPECTING THOS. EDDY'S COM- 
 MUNICATION 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) ist, 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 ac- 
 cepted, and ordered to be inserted in the minutes. 
 
 [209]
 
 APPENDIX IV 
 
 "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 per- 
 sons 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 Asy- 
 lum, 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 other- 
 wise destroy him. 
 
 That such additional Building, from the want of room, can- 
 not 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 privi- 
 lege of walking, or taking other kinds of exercise. 
 
 That considering the various kinds of insanity, your Com- 
 mittee, 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. 
 
 [210]
 
 PURCHASE OF FIRST SITE 
 
 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 distin- 
 guished City's in the old Continent. 
 
 Wherefore it is recommended, that a Committee be ap- 
 pointed, 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 suita- 
 ble Lot of Land for the erection of a House for the accommoda- 
 tion 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, 37^ per cent on ist November and 37^ per cent 
 on ist February next, with interest. 
 
 THOMAS EDDY, Chairman 
 
 August ist, 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. 
 
 [211]
 
 APPENDIX V 
 
 ADDRESS TO THE PUBLIC BY THE GOVERNORS 
 
 1821* 
 
 The Governors of the New- York Hospital have the satis- 
 faction to announce to the public, the completion of the Asy- 
 lum 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 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 demon- 
 strated 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 
 
 * 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. 
 
 [212]
 
 ADDRESS TO THE PUBLIC, 1821 
 
 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 at- 
 tempt to cure or mitigate the disease of insanity. 
 
 In the construction of the edifice and in its interior arrange- 
 ments, 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 refer- 
 ence 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, varius less active amusements will be pro- 
 vided. 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 Col- 
 lege, have been arranged in a handsome green-house, prepared 
 for their reception. 
 
 The apartments of the house are adapted to the accommoda- 
 
 [213 ]
 
 APPENDIX V 
 
 tion 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 regula- 
 tions 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 insti- 
 tution, will be moderate, and proportioned to the different cir- 
 cumstances of the patients, and the extent of the accommoda- 
 tions 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 Asy- 
 lum 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, loth May, 1821. 
 
 [214]
 
 ADDRESS TO THE PUBLIC, 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 practi- 
 cable, should be drawn up by a physician. 
 
 Applications from abroad, for information relative to the ad- 
 mission of patients, may be made by letters addressed to 
 THOMAS BUCKLEY, Secretary of the New- York Hospital.
 
 APPENDIX VI 
 
 BOARD OF GOVERNORS OF THE 
 SOCIETY OF THE NEW YORK HOSPITAL 
 
 l82I 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 
 
 William 
 
 Cadwallader D. Golden 
 Robert H. Bowne 
 Robert I. Murray 
 Thomas C. Taylor 
 John Adams, Treasurer 
 John McComb 
 
 Benjamin W. Rogers, Assis- 
 tant Treasurer 
 William Bayard 
 Nathan Comstock 
 Duncan P. Campbell 
 Rev. F. C. Schaeffer 
 John Clark, Jr. 
 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 Presi- 
 dent 
 
 G. Beekman Hoppin 
 Lewis Cass Ledyard, Jr. 
 Henry R. Taylor 
 R. Horace Gallatin 
 Walter Jennings 
 
 [216]
 
 BOARD OF GOVERNORS 
 
 BLOOMINGDALE COMMITTEE 
 1821 
 
 Thomas Eddy John Adams 
 
 Cadwallader D. Golden Thomas Buckley 
 
 Thomas C. Taylor John B. Lawrence 
 
 1921 
 
 Frank K. Sturgis Henry G. Barbey 
 
 Augustine J. Smith Walter Jennings 
 
 Henry R. Taylor Howard Townsend 
 
 [217]
 
 APPENDIX VII 
 
 ORGANIZATION OF BLOOMINGDALE HOSPITAL 
 
 1821 AND 1921 
 
 1821 
 
 Superintendent or Warden I 
 
 Housekeeper I 
 
 Keepers, Men 3 
 
 Keepers, Women 2 
 
 Chambermaids I 
 
 Cooks 3 
 
 Baker i 
 
 Assistant Baker i 
 
 Dairymaid I 
 
 Washerwoman I 
 
 Assistant washerwoman i 
 
 Yard Keeper i 
 
 Waitresses 2 
 
 Gardener I 
 
 Farmer I 
 
 Assistant farmer I 
 
 Total 22 
 
 Number of patients 75 
 
 [218]
 
 ORGANIZATION OF HOSPITAL 
 1921 
 
 Officers and employees: Patients: 
 
 Men 217 Men 132 
 
 Women 195 Women 156 
 
 Total 412 Total 288 
 
 General Administration : 
 
 Medical Superintendent I 
 
 Steward I 2 
 
 Clinical and Laboratory Service : 
 Physicians : 
 
 Resident 9 
 
 Consultants 3 
 
 Dentist I 
 
 Assistant i 
 
 Apothecary i 
 
 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 
 
 Hydr other apy and Massage 5 
 
 Dietary Department 25 
 
 Housekeeping and Laundry Departments 60 
 
 Financial, Purchasing, and Supplies 10 
 
 Engineering Department 1 8 
 
 Building Department 20 
 
 Industrial Department 5 
 
 Farm and Grounds 38 
 
 Miscellaneous 8 
 
 Chaplain, Librarian, Watchmen, Telephonists, 
 Postal Clerk, Barber. 
 
 [219]
 
 ORGANIZATION OF HOSPITAL 
 
 STATISTICS: 1821-1921 
 
 Number of cases admitted 1821 to 1921 13,41 1 
 
 Number discharged recovered 1821 to 1921 .... 4,651 
 
 Number discharged improved 1821 to 1921 .... 3,873 
 
 [ 220 ]
 
 UNIVERSITY OF CALIFORNIA LIBRARY 
 
 Los Angeles 
 This book is DUE on the last date stamped below. 
 
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 Form L9-40m-5,'67(H2161s8)4939
 
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