A Psychiatric Milestone Part 1

A Psychiatric Milestone.

edited by Howard Townsend, Bronson Winthrop and R. Horace Gallatin.

PREFACE

The opening of Bloomingdale Asylum on June 1, 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 opening in 1792, and the Governors had given much thought and effort to securing the facilities needed. The treatment consisted, however, princ.i.p.ally 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 directed specifically to influencing their thoughts, feelings, 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 recognized, but in practice it had been subordinated to treatment of the actual and a.s.sumed physical disorders to which the mental state of the patient was attributed, and, in the few hospitals where persons suffering from mental disorders were received, means for its application were almost or quite entirely lacking. The establishment of Bloomingdale Asylum 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 employed.

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 importance. It was decided that the princ.i.p.al place in the celebration should be given to the purely medical and scientific aspects of the work, with special reference 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 management of problems of human behavior and welfare. Arrangements were made for four addresses by physicians of conspicuous eminence in their particular fields, and invitations to attend the exercises were sent to the leading psychiatrists, psychologists, 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 Bloomingdale Asylum had its origin, it would add greatly to the interest and value of the celebration if representatives of these countries were present and made addresses. How fortunate it was, then, that it became possible to welcome from France Dr. Pierre Janet, who stands pre-eminent in the field of psychopathology, and from England Dr. Richard G. Rows, whose contributions to the study and treatment of the war neuroses and to the relation between psychic and physical reactions marked him as especially qualified to present the more advanced view-point of British psychiatry. The other two princ.i.p.al addresses were made by Dr. Adolf Meyer, who, by reason of his scientific contributions and his wonderfully 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 eminence as an internist and of the extent to which he has advocated and employed psychiatric knowledge and methods in his practice, has contributed greatly to interesting and informing physicians concerning 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 supplemented 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 concerning the medical development, made by Dr. William L.

Russell, the Medical Superintendent. The greetings 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, depicting scenes and incidents ill.u.s.trating the origin and development of the Hospital, and of psychiatry and mental hygiene. The text and the scenes displayed were prepared by Dr. Charles I. Lambert, First a.s.sistant Physician of the Hospital, and by Mrs. Adelyn Wesley, who directed the performance and acted as narrator. The performers were persons who were connected with the Hospital, twenty-two of whom were patients.

The celebration was held on May 26, 1921. The weather was exceptionally clear, with bright suns.h.i.+ne and moderate temperature. The grounds, in their Spring dress of fresh leaves and flowers, were especially beautiful. This added much to the attractiveness 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 presented 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 n.o.ble idealism of his closing words, and the distinguished character of the audience, all contributed to make the celebration 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.

THE SOCIETY OF THE NEW YORK HOSPITAL

[Ill.u.s.tration: BLOOMINGDALE ASYLUM

As it appeared when it was opened in 1821. It was located near the seven mile stone on the Bloomingdale Road, now 116th Street and Broadway.]

BLOOMINGDALE HOSPITAL CENTENARY

The One Hundredth Anniversary of the establishment of Bloomingdale Hospital as a separate department for mental diseases of The Society of the New York Hospital was celebrated at the Hospital at White Plains on Thursday, May 26, 1921. The addresses were given in the a.s.sembly 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 G.o.d, whose power is over all Thy works, who willest 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 G.o.d the Father, and to the comfort of them that love and serve him, we render thanks to Thee and glorify Thy Name, this day, which brings to completion the hundredth anniversary of this n.o.ble inst.i.tution'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 inst.i.tution--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 n.o.ble, 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 guiding of Thy Holy Spirit.

We pray for the continued blessing of this inst.i.tution and hospital, and on all those who are striving to bring out of darkness those unhappy souls, into the pure light of understanding.

Bless the Governors, physicians, and nurses, direct 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 mediation of Thy Son Jesus Christ, our Lord. Amen.

ADDRESS BY MR. EDWARD W. SHELDON

MR. SHELDON

It is with profound gratification that the Governors 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 celebration of an exclusively psychopathic hospital. A summary of its origin and development may be appropriate.

A hundred and fifty years ago the only inst.i.tutions 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 Williamsburg, Virginia, a public inst.i.tution 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 resulted in the grant, on June 11, 1771, of the Royal Charter of The Society of the New York Hospital. Soon afterward the construction of the Hospital buildings began on a s.p.a.cious tract on lower Broadway 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 buildings. 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 surrounded by fortifications. When the British captured 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 readjustment 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 admission 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 a.s.sisted this expansion 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 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 communication 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 Yorks.h.i.+re, England. This memorable communication was printed by the Governors, and const.i.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 s.e.xtupled in the second 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 immediate 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 107th and 120th Streets, were subsequently bought by the Society for about $31,000. To aid in the construction and maintenance of the necessary hospital buildings, the Legislature, by an act reciting that there was no other inst.i.tution in the State where insane patients could be accommodated, and that humanity and the interest of the State required that provision should be made for their care and cure, granted an additional annual appropriation of $10,000 to the Society from 1816 until 1857. The main Hospital, built of brownstone, stood where the ma.s.sive library of Columbia University now is, and the brick building still standing at the northeast corner of Broadway and 116th 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 on the North River to 116th Street, and from that fact our inst.i.tution a.s.sumed the name of Bloomingdale Asylum, or, as it is now called, Bloomingdale Hospital.

This beautiful elevated site overlooking the Hudson River and the Harlem River was admirably fitted for its purpose. The s.p.a.cious 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"[1] which marks so great an advance in psychiatry in our country that it deserves study. The national character of the inst.i.tution 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 Bloomingdale Hospital was successfully prosecuted for 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 pa.s.sed the asylum grounds. Foreseeing that they could not maintain that verdant oasis intact for many years longer, the Governors, in 1868, bought this 300-acre tract on the outskirts of the Village of White Plains. After prolonged consideration of the time and method of development of the property, final plans were adopted in December, 1891, construction was begun May 1, 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 substantially increased, and Thomas Eddy was proved to have been both a wise humanitarian and a far-sighted steward of charitable funds.

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 supplanting the harsh and cruel usage of former days, as "one of the n.o.blest triumphs of pure and enlightened benevolence." In that same spirit those founders dedicated themselves to the conduct of this inst.i.tution. Their devotion to the work was impressive. Looking back on those early days we see a constant personal attention to the details of inst.i.tutional 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 consistently 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 available. Under the guidance of our distinguished Medical Superintendent, with his able and devoted staff of physicians, a broader and more intensive development is already under way. Animated by that resolve 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.

FOOTNOTES:

[Footnote 1: 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 by Bloomingdale Hospital Press, White Plains, May 26, 1921. See Appendix V, p. 212.]

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 actively engaged for several years in psychopathic work in New York. He will speak to us on "THE CONTRIBUTIONS OF PSYCHIATRY TO THE UNDERSTANDING OF LIFE PROBLEMS."

DR. MEYER

When Dr. Russell honored me with the invitation to speak at this centenary celebration of the renowned Bloomingdale Hospital, my immediate impulse was to choose as my topic a phase of psychiatric 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 concreteness 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 pa.s.sing 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 conception 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.