A Psychiatric Milestone by Various

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

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

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

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

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

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

FOOTNOTES:

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

THE TABLEAU-PAGEANT

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

SYNOPSIS

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

CHARACTERS AND SCENES IN TABLEAU-PAGEANT

Music: Orchestra
Overture

_Prologue_

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

Music: Orchestra
"Amaryllis"

SCENE I

COURT OF KING GEORGE III.--GRANTING OF THE CHARTER

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

Minuet

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

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

SCENE II

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

Characters:
Pinel
Patients
Aides and Attendants

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

Music: Orchestra
"Kammenoi Ostrow"

SCENE III

PORTRAITS--PERSONALITIES OF THE PAST

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

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

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

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

Music: Orchestra
"Long, Long Ago"

SCENE IV

DOROTHY LYNDE DIX BEFORE A LEGISLATIVE COMMITTEE

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

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

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

SCENE V

OCCUPATIONAL-RECREATIONAL ACTIVITIES

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

Maypole Dance

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

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

SCENE VI

INSPIRATIONS

Characters:
Hygeia
La Belle France
Britannia
Columbia

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

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

NAMES OF THOSE WHO ATTENDED THE EXERCISES[19]

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

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

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

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

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

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

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

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

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

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

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

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