SCENE I

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

The building to the left was erected in 1808 for the exclusive use of

patients suffering from mental disorders.]

A PSYCHIATRIC MILESTONE

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

ANNIVERSARY COMMITTEE

HOWARD TOWNSEND

BRONSON WINTHROP

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, 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 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 assumed

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

principal 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 principal

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 illustrating 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 Assistant 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 sunshine 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 noble 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.

CONTENTS

Page

PREFACE vii

INVOCATION 3

REV. FRANK H. SIMMONDS

HISTORICAL REVIEW 7

EDWARD W. SHELDON, ESQ.

President of the Society of the New York Hospital

"THE CONTRIBUTIONS OF PSYCHIATRY TO THE UNDERSTANDING OF LIFE PROBLEMS" 17

ADOLF MEYER, M.D.

Director of the Henry Phipps Psychiatric Clinic, Johns Hopkins

Hospital, and Professor of Psychiatry, Johns Hopkins University,

Baltimore, Maryland

"THE IMPORTANCE OF PSYCHIATRY IN GENERAL MEDICAL PRACTICE" 55

LEWELLYS F. BARKER, M.D.

Professor of Clinical Medicine, Johns Hopkins Medical School,

Baltimore, Maryland

GREETINGS FROM THE NEW YORK ACADEMY OF MEDICINE 79

GEORGE D. STEWART, M.D.

President of the Academy

"THE BIOLOGICAL SIGNIFICANCE OF MENTAL ILLNESS" 89

RICHARD G. ROWS, M.D.

Director of the Section on Mental Illnesses of the Special

Neurological Hospital, Tooting, London, England

"THE RELATION OF THE NEUROSES TO THE PSYCHOSES" 115

PIERRE JANET, M.D.

Professor of Psychology, College de France

"THE MEDICAL DEVELOPMENT OF BLOOMINGDALE HOSPITAL" 147

WILLIAM L. RUSSELL, M.D.

Medical Superintendent

THE TABLEAU-PAGEANT 171

NAMES OF THOSE WHO ATTENDED THE EXERCISES 177

APPENDIX I 191

COMMUNICATIONS FROM DR. BEDFORD PIERCE

Medical Superintendent of The Retreat, York, England

EXTRACT FROM MINUTES OF BOARD OF DIRECTORS OF THE RETREAT,

APRIL 30, 1921.

TRANSCRIPT FROM THE VISITORS BOOK OF THE RETREAT, 1803-17.

APPENDIX II 195

A LETTER ON PAUPER LUNATIC ASYLUMS FROM SAMUEL TUKE TO

THOMAS EDDY, 1815.

APPENDIX III 200

THOMAS EDDY'S COMMUNICATION TO THE BOARD OF GOVERNORS, APRIL, 1815.

APPENDIX IV 209

EXTRACTS FROM THE MINUTES OF THE BOARD OF GOVERNORS IN RELATION TO

ACTION TAKEN RESPECTING THOS. EDDY'S COMMUNICATION DATED

APRIL, 1815.

APPENDIX V 212

ADDRESS TO THE PUBLIC BY THE GOVERNORS, 1821.

APPENDIX VI 216

BOARD OF GOVERNORS OF THE SOCIETY OF THE NEW YORK HOSPITAL, 1821

AND 1921.

APPENDIX VII 218

ORGANIZATION OF BLOOMINGDALE HOSPITAL, 1821 AND 1921.

ILLUSTRATIONS

New York Hospital and Lunatic Asylum, 1808 _Frontispiece_

FACING 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

[Illustration: 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 Assembly Hall.

Mr. Edward W. Sheldon, the President of the Society, acted as Chairman.

MORNING SESSION

The exercises opened with an invocation by the Reverend Frank H.

Simmonds, rector of Grace Episcopal Church at White Plains:

Oh, most mighty and all-merciful God, whose power is over all Thy works,

who willest that all men shall glorify Thee in the constant bringing 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 love and serve him, we render thanks to Thee and

glorify Thy Name, this day, which brings to completion the hundredth

anniversary of this noble institution'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 guiding of Thy Holy Spirit.

We pray for the continued blessing of this institution 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 institutions 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 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 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 spacious

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 assisted 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 Yorkshire, England. This memorable

communication was printed by the Governors, and constitutes 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

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

institution 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 massive 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 institution assumed 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 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"[1] 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 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 passed 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

noblest triumphs of pure and enlightened 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 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 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 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.

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 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 bewildering 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 disruption 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 crusades

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 counterpart of the

physical body. As long as there was no objective experimental science,

the culminating solution of life problems had to be intrusted to that

remarkable development of religious philosophy which arose from the

blending of Hebrew religion and tradition 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 astronomical 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 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 psychology without a "soul," and lately even a psychology

without "consciousness," so that we might be safe from unscientific

pretensions. All the gyrations no doubt tended to retard the wholesome

practical 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 determined 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 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

abnormal. 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 elementalist. 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 consciously 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 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 elements, and the biologist

the growth and reproduction 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 suffered 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 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-history 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 individuals--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. Progress 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

conceived in a new spirit, with a clear recognition of the opportunities

for the study of detail about the 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 efficiency 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 traditional 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 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 analysis of the neurotic

personality, which was soon followed 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 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 everybody 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, intolerable 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 Hospital, began to swing more and more toward the

psychobiological trend of views, and with his devoted and very able

friend Amsden he compiled that remarkable outline,[2] which was the

first attempt to reduce the new ideals of psychobiology to a practical

scheme of personality study--that clear and plain 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 certain ever-returning

tendencies and situations which a psychiatry of exclusive brain

speculation, auto-intoxications, focal infections, and internal

secretions could never have discovered.

Much is gained by the frank recognition that man is fundamentally a

social being. There are reactions 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 satisfactions of the simpler appetites for

food and personal necessities; in the natural interplay of anticipation

and fulfilment of desires and their occasional frustration; in the

selection of companionship which works helpfully or otherwise--for the

moment or 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 working--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 histology of the nervous system. There was a quest for the elements

of mind and their immediate correlation with the latest discoveries in

the structure of the brain. The centre theory and the cell and neurone

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 right--largely a product of psychiatry.

There always 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 understanding of individual, familiar,

and social adjustments, and a grasp on the factors which we can consider

individually and socially modifiable. We have passed from giving mere

wholesale advice to a conscientious study of the problems of each unit,

and at the same time we have developed a new and sensible 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 themselves, 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 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

classifications 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 outsiders, who lost the sense of proportion and

magnified points of relative importance until they were supposed 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 unfortunately 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 inspiring tasks than

watching the unfolding of the problematic 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 physician who

wants to see nothing but infections or chemistry and hypotheses of

internal secretion. What a different chance for the patient in his

treatment, in contrast to what the venerable Galt 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 eye and look

him out of countenance. Be always dignified. Never laugh at or with

them. Be truthful. 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

philosophy, 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 intensified the hunger for a more objective and yet

melioristic and really idealistic philosophical conception of reality,

such as has been formulated in the modern concept of integration.

Philosophical tradition, logic, and epistemology alike had all conspired

to make as great a puzzle as possible of the nature of mental life, of

life itself, and of all the fundamental principles, so much so that as

a result anything resembling or suggesting philosophy going beyond the

ordinary traditions has got into poor repute in our colleges and

universities and among those of practical intelligence. The consequence

is that the student and the physician are apt to be hopeless and

indifferent concerning any effort at orderly thinking on these

problems.[3]

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 invectives 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 the elements and smallest units and then is apt to shirk

the responsibility of making an attempt to solve the concrete problems

of greater complexity. 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-formation, 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 actual 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, behaving 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 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 peculiarities; hence there is no

reason to think of an insurmountable and unique feature in the origin of

life, nor even of mentally integrated life; no need of special 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 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 imagination. Imagination is not a mere

duplication of reality in consciousness and subjectivity; it is a

substitute 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 activities 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 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 common sense.

The extent to which we can be true to the material foundations and yet

true to a spiritual goal, ultimately 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 "omnipotence 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 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 biologically 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 conscience. 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

determines, in fact may already have determined, the reward--just as the

reward of the farmer is often settled for him by astounding

speculations long before the crop is at hand. There is a field for a new

conscience heeding the needs of fundamental satisfactions of man so well

depicted by Carlton Parker, and psychiatric study furnishes much

concrete material 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 interdependence 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 existence, lasting

and "more than biological" relations, and it is the realization of these

conceptions intellectually and emotionally true to our individual and

group nature that constitutes our various religions and faiths.

Emphasizing what we have in common, we become tolerant of the idea that

probably 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 contain 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 understanding 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 potential contributions of

psychiatry are those reaching out toward jurisprudence. Psychiatry deals

pre-eminently with the variety and differences of 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 demand for justice has called for

certain remedies. Psychiatry still plays a disgraceful rôle 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 constructive activity, and a

conception of indeterminate 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

breaking the laws of social compatibility should not merely invite a

spirit of revenge, but should, through the indictment, surrender

automatically to legalized authority endowed with the right and duty of

an unlimited 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 practical man, the scientist, the philosopher, and theologian toward

one of the most important and practical 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

disturbing 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 appreciate 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 sensitiveness 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 independence. 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 coworker 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 the New York Hospital, we

cannot help being impressed 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 policies 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 representatives of our people.

Bloomingdale thus has always had a remarkable Board of Governors, who,

from contact with the General Hospital and with this special division,

are in an unusual position to see the practical aspects of the 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 16th Street. The layman cannot,

perhaps, delve profitably into the details of such a highly and broadly

specialized type of work. But he can readily take a share in the best

appreciation of the general philosophy 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 consideration. It does not pose as an invidious

contrast to the State Hospital, and yet it is intended to solve in a

somewhat freer and more privileged manner 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 opportunity to shape public opinion. Like all psychiatrical

institutions, it has to live down the traditional 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 insanity 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. 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 enforced 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 psychopathology 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 functions. 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-operation 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 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 fulfilment 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 growing and plastic plant--to use a metaphor that has

slipped in perhaps without arousing all the implications 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 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 direct 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 encouraged to get a solid training, always animated by the

conviction that one can be sure of the practical 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 Bloomingdale Hospital and its active

representatives, from the managers to the humblest workers. Hoch in his

modesty could probably not have been brought to state fully and frankly

his own share in the achievements 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 delight in seeing him

bring to further fruition the admirable 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

noteworthy 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

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.

FOOTNOTES:

[Footnote 2: 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.]

[Footnote 3: See, for instance, Moebius, The Hopelessness of All

Psychology, reviewed in the Psychological Bulletin, vol. IV, 1907, pp.

170-179.]

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 present,

has served an eminently practical purpose and has played an important

rôle 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 occasion, my congratulations to those

of the spokesmen of other groups, and, at the same time to express 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 appreciation I

have drawn attention to on an earlier occasion.[4] Psychiatry as a whole

was for a long time as widely separated from general medicine as

penology is to-day, and for similar reasons. It was a long time before

persons that manifested extraordinary 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 institutions 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 misunderstood, and legal, medical, social, religious, and

philosophic prejudices went far toward preventing any rational

scientific mode of approach to the questions 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 transformation that is reaching all circles of human

beings, bidding fair to compel the strongholds of tradition 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 medical 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 leading psychiatrist of this country speaks upon the

contributions 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 of human suffering and the enhancement of

human joys. General practitioners of medicine and medical

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 specialists 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.[5] 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 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 discussing 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 making 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 discuss them, the mere mention of some of the causes and

conditions will, perhaps, contribute to comprehension 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 enlighten the

student regarding the processes of life as adaptations of organisms to

their environment, man, himself, being such an organism reacting

physically and psychically to his surroundings in ways either favorable

or unfavorable to his own preservation and that of his species; it fails

to teach the student that the human organism represents a bundle 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 person 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, ethical, 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 symbols of reality.

(3) Though our medical schools have made phenomenal advances in the

organization and equipment of their institutes and in provision for

teaching and research in a large number of preclinical 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 morphological, physical, and chemical

aspects of their subjects, that students rarely get from them any

inkling of the psychobiological aspect, any adequate knowledge of human

motives, or any satisfactory data regarding human behavior, normal or

abnormal.[6] It is only recently and only in a few schools that

psychiatric 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 motives and impulses, to symptoms and syndromes, are

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 "psychiatric jargon" or

"pseudoscientific gibberish." There is, furthermore, a dearth of

concise, authoritative, 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 conceptions and impressed with the results of medical

researches based upon them. The ardor of the psychoanalysts, also,

though in part doubtless justified by experience, has, it is to be

feared, excited a certain 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"

(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 practitioners

who put the "soft pedal" on the psychobiological 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 usually 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 Scientists, 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 psychotherapy.

"What you said is true," he remarked; "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 analytical 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

of 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 somatic, psychic, and social diagnosis, and

to plan a regimen for him that will ensure the best adjustment possible

of his internal and external relationships.[7]

Working in a diagnostic group myself as an integrating internist, I have

been much helped by the reports of personality studies made by skilful

psychiatrists; these are linked with the special reports on the several

bodily domains (cardiovascular, respiratory, hæmic, dental, digestive,

urogenital, locomotor, 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 successful 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.[8] From now on, too, general practitioners

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

pædiatrist.[9] Well organized group-diagnosis and general will then help

to counteract the inhibiting influence of earlier isolated specialism

upon the appreciation of psychiatry.

This enumeration of some of the causes of the ignorance and apathy

(existent hitherto) in the general 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 representatives 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 there are many impediments to be removed.

Though the problems are deep and difficult, they are doubtless 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 adjustment seem to

depend is the task of pathogenesis. The internist who has studied the

infantile cerebropathies with their resulting imbecilities, syphilis

followed by general paresis, typhoid fever and its toxic delirium,

chronic alcoholism with its characteristic 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 sequelæ (lesions in the

globus pallidus and their motor consequences), pulmonary tuberculosis

with its euphoria, 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 they will steadily contribute to advances in psychiatry. The

eclectic psychiatrist who is examining mental symptoms and

symptom-complexes ever more critically, who is seeking for parallel

disturbances 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 become

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 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[10] and those of the

senior consultant in neuropsychiatry and his divisional associates in

the American Expeditionary Force. In no other body of recruits 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 understanding 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.[11]

The prevention of at least a large proportion of abnormal mental states

through the timely application of the principles of mental hygiene is

now recognized as a practically realizable ideal. Many important reforms

are now in process throughout the United States, no small part of them

directly attributable to the active efforts of our leading psychiatrists

and to our National Committee's [Transcriber's note: original reads

'Committe's'] work. The old "asylums" are being changed into

"hospitals." Psychiatric clinics are becoming attached to 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 origin 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 sufficiently concrete, to justify attack by public health officials

is no longer valid. In no direction, probably, could money and energy be

more profitably spent during the period just ahead than in the support

of a widely organized campaign for Mental Hygiene.[12] 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 direction 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."

FOOTNOTES:

[Footnote 4: In an address at the seventieth annual meeting of the

American Medico-Psychological Association, 1914, entitled "The Relations

of Internal Medicine to Psychiatry."]

[Footnote 5: _Cf._ Polon (A.) "The Relation of the General Practitioner

to the Neurotic Patient," Mental Hygiene, New York, 1920, IV, 670-678.]

[Footnote 6: _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.]

[Footnote 7: _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 Diagnosis,"

Am. Journal of Insanity, Baltimore, 1917, LXXIV, 163-168.]

[Footnote 8: _Cf._ "The General Diagnostic Survey Made by the Internist

Cooperating 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.]

[Footnote 9: _Cf._ Southard (E.E.), "Insanity Versus Mental Disease";

the Duty of the General Practitioner in Psychiatric Diagnosis, Journal

American Medical Association, LXXI, 1259-1261, Chicago, 1918.]

[Footnote 10: _Cf._ Bailey (P.), "The Applicability of Findings of

Neuro-psychiatric Examinations in the Army to Civil Problems," Mental

Hygiene, New York, 1920, IV, 301; also "War and Mental Diseases," Am. J.

Pub. Health, IX, 1, Boston, 1919.]

[Footnote 11: _Cf._ Salmon (T.W.), "War Neuroses and Their Lesson," 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. 1, 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,

Internal. Congr. for Hygiene and Demography, III, 468-476, (1912),

Washington 1913.]

[Footnote 12: _Cf._ Russell (W.L.) "Community Responsibilities in the

Treatment 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.]

_The Chairman_: We had hoped to receive to-day the greetings of our

sole elder sister among American 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 illustrative of the origin and

aspirations of the Hospital 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 privilege 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

[Illustration: BLOOMINGDALE ASYLUM

As it appeared in 1894 when it was discontinued and replaced by

Bloomingdale Hospital at White Plains, New York.]

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

President, 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 celebrations 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 common end which is woven into the very

warp and woof of existence is then buried deep in our subconscious

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 Hospital,

has a longer history. Bloomingdale, as a separate and independent

concern, had its birthday a century ago.

It is curious to let the mind travel back, and consider what was

happening about that time. Just two years before the news had flashed on

the philosophical 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 created 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 Gomorrah. 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 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 efficiency, 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 promotion 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 hospital treatment therefor, American physicians,

prepared by study and experimentation, were ready to accept and apply

the new teachings.

A second phase of great importance is that institutions like

Bloomingdale have promoted the study of psychology far more than any

other factor, particularly 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 experiment 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. Psychology 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 antisocial, and from pickpockets

to anarchists flourish on the soil of pauperism. The key-note of the

future is responsibility. To the educated and enlightened man who still

asks, "Am I my brother's keeper?" Cain has bequeathed a drop of his

fratricidal 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 unending 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

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.

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

subject 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 inviting 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 resistances lay in the

way of reform at that time, resistances in the form of long-established

but somewhat limited views as to the nature of mental illnesses, 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 compelled the

adoption of vigorous methods of protecting 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 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 opportunity of seeing the

pamphlet in which are recorded the efforts of Mr. Thomas Eddy in the

year 1815 to move his colleagues to consider this matter.[13] 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 demand a

united effort on the part of all who are interested in the scientific

investigation of the subject, cannot fail to afford one the liveliest

satisfaction.

In the brief history of the Hospital prepared by Dr. Russell we find the

recommendations of another 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 opinions, yet they are generally aware

of those particulars for which the world considers them proper objects

of confinement." With reference to treatment Dr. Earle said: "The

primary object is to treat patients, so far as their condition will

possibly permit, 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 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 infrequently a rational and

intelligent conversation may be maintained on an indifferent subject.

The fact too that the disturbance is so frequently only temporary

suggests that the loss of rational control is a less serious phenomenon

than was generally supposed 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 lunatics, 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 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 greatest good of the greatest number. These usages

are regarded not merely as protective measures for the body corporate,

but they are also supposed to indicate 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 be understood without a study of the mechanisms on

which mental activity depends and without discovering 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 physician,

[Transcriber's note: original reads 'physican'] Areteus, pointed out

that mania frequently commenced as melancholia, and he drew attention to

the extreme frequency 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 evidences of mental disturbance consist in some

difficulty in carrying out ordinary mental processes, some difficulty in

exercise of the function of perceiving, thinking, feeling, judging, and

acting, and that any disturbance of the harmonious activity of these

functions 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 manifestations 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 endowed, which he has gradually trained throughout his past

experience and which he has employed more or less successfully up to the

time the illness commenced. 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 disturbance 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

mechanisms, simple at first and remaining fundamentally unaltered,

although possibly much modified gradually by added experiences from

within and without, depends on the maintenance of a harmonious balance

between stimuli received and emotional reaction and motor response to

those stimuli so that the feeling of well-being may arise.

If from any cause there occurs a failure to appreciate 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 inhibition of

all other lines--processes which are essential to clear

consciousness--will become difficult or perhaps impossible and a mental

illness will develop. In the slighter degrees the disharmony may be

known to the patient without there being any outward 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 impossible 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 products. The primary symptoms are felt by the

patient 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 patient 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

activity 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 symptoms with

which we are all familiar. So many factors are concerned in the

production of these secondary 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 fundamental disturbance which

constituted the primary illness. So often they appear to be mere

rationalizations, mere false judgments on the part of the patient; they

thus form subjects for investigation rather than fundamental

constituents of the illness.

We, therefore, must not accept the outward and visible signs at their

face value but attempt to discover 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 tendency during early childhood. The patient up

to the fifth year of her life had been an ordinary, normal child,

attached to her mother, fond of her nurse, interested in her toys.

During the next two years she endured much bad treatment at the hands 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 frequently 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" 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 confide 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 children." 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 therefore considered delicate and was

thoroughly spoiled. When nearly thirty she lived through a sexual

experience 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 in the same room. She

got out of bed, refused to return to it, fought against the nurses and

was transferred 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 mechanisms 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 distressed at being separated from her

mother in such a way, to be frightened by being left in the graveyard

alone, or at the threat of her being carried away by a "bogey-man" if

she dared to mention anything 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 developments 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._, 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

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 attempted 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 memory 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.

It is, therefore, the mental content which must be discovered before

doctor or patient can understand the disability and before any common

ground between the two can be found. And when the mental 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 dominated 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 disturbance 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 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 nightmare 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

mechanism into action and the nightmare between two and three o'clock in

the morning had been the result.

The result in many instances is evidenced by an emotional state alone

and the actual memory of the original experience may not come into

consciousness. 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 produced 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 photographs 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 occurred 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

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 memory but there

arose the feeling that under no circumstances 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

personality, 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, because the existence of one dominating emotional

tendency so often produces a prejudiced view which may render a just

appreciation of our general experience almost impossible and may

seriously disturb 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 reflexes becomes established, it will assist us to

understand how such stimuli can give rise to mental 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, therefore, are not necessarily a

true index of our mental and emotional conditions. This is true of all

mental 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 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 persistently with us

the more intense is the emotion associated 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 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 processes. The secretions of the glands

exert an influence on the sensibility and reaction of the organs

connected with psychic phenomena and their functions 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 sensibility 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 interactivities of all the organs of the

body is therefore essential and must be made before we shall understand

the biological significance of mental illness.

FOOTNOTES:

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

ADDRESS 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 ventured across the

ocean, with Madame Janet, in response to our urgent invitation. His

introduction 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 sentiments of sympathy which they feel for all manifestations

tending to render the relations that unite 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 commemoration 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 Bloomingdale. 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 transformation of ideas has taken place,

in a great measure, as a result of the studies devoted to neuroses and

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 discovery 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 lunatic, 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 excommunicated 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 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 pavilion 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, curable, 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 consider as insane.

Little by little, in fact, men have had to state with astonishment that

all lunatics were not at Bloomingdale. 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

possessed (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 eighteenth

century, "of the shrivelling up of the nerves."[14] But above all, one

preserved the conviction that these queer disorders were very different

to the mental disorders of lunacy. These peculiar individuals 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 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 preoccupying 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 that the examination of the patients, the study thereof, and even

their treatment, were for the most part often conceived in quite a

different manner. For example, neuroses were studied publicly; the

examination was on elementary sensibilities, the movements of the limbs,

and especially reflexes; the insane 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 hospital such as La Salpetrière the tic

sufferers, the impulsive, those beset with obsessions, the hysterical

with fits and delirium were placed near the organic hemiplegics and the

tabetics who did not resemble them in the least, and completely

separated from the melancholic, the confused, the systematical raving,

notwithstanding evident analogies. If Charcot who, moreover, has brought

about so much progress in these studies, committed some serious errors

in the interpretation of certain phenomena of hysteria, is it not

greatly due to his having studied these neurotic patients with the

neurology methods without 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 arbitrary 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 neurasthenic 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 sufferers should be patients set apart for

neurologist physicians alone, whereas the alienist should content

himself with real lunatics. The professor of the clinic for mental

diseases protested with much 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 studies themselves on

hysterical accidents began to make people's minds uneasy and to modify

conceptions of neuroses. They showed that neurotic sufferers 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

remembrance 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. Without 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, 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 disorders. 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

patients 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.

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 obsessions. Besides, as I have often

repeated, this absence 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 distinguish the ones from the others.

In reality, the notion of lunatic has lost its former superstitious

signification and it has taken no precise 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 himself to be dangerous for others, the public

administration has the habit of defending us against him by 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 psychological 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 varied. It

is impossible to say that such or such a disorder 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

nature 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

mental disorders he may have do not constitute a danger. If he is poor,

if he has to earn his living, if he lives alone in a large town and his

position is delicate 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.[15] 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, 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 organization 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 suspensive

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 reflected 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 moment. 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 people, that is to

say, among whom I have not yet found myself in this circumstance,

wearing a special dress and submitting my body and my mind to very

particular social rites. In reality it is nevertheless 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 conscious 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 himself to new circumstances,

neuroses and psychoses are disorders or halts in the evolution of

functions, in the development of their highest and latest part.[16]

This halt in evolution can be connected with different physiological

causes, hereditary weaknesses of origin, infections, intoxications,

disorders of internal secretions, disorders of the sympathetic system.

These diverse etiologies will most likely be of use later to distinguish

between forms of these diseases; but to-day the common character of

neuroses and psychoses 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 obsessions, periodical depressions,

melancholics, systematized deliriums, asthenic insanity, you will always

find a number of facts resulting from this general perturbation.

In plenty of cases, the acts, far from being diminished, 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 connection with immediate

stimulation, with inhibition, without choice, without adaptation by

reflection. 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 and barbarism. The behavior of the agitated

individual is well below that which he should show normally. It is easy

to explain these facts in the language we have adopted. The agitation

consists in an activity, more less complete, in inferior tendencies very

much below those the subject should normally 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 diminution or the

disappearance of superior actions, appertaining 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

intelligent critique. The stopping of tendencies by stimulation, 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 in psychoses. It is likely that their

union depends upon some very general law, relating to the exhaustion of

psychological forces. It is probable that the superior phenomena exact

under a form of concentration, 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

production of a certain superior phenomenon has become impossible,

derivations happen, that is to say, that this force is spent in

producing other useless and especially inferior phenomena."[17]

A very great number of phenomena observed in neuroses and psychoses are

in connection with depression and agitation. Convulsive attacks, diverse

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 certain epileptic fits are certainly

phenomena of relaxation, the meaning of which we do not comprehend

because we do not study sufficiently the state of psychological tension

before and after the accidents.

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 diminution of life. The

shrinking of activity and conscience, 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 reflected 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,

impulsions to command, to theft, to aggression, to extraordinary 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 interrogations, doubts, scruples. If the individual

descends one degree, if he becomes quite incapable of reflecting and

therefore of doubting, the same action he continues to think about may

present itself under the form of an impulsion more or less irresistible.

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 without

exhausting himself; he is then reduced to dread it and take an aversion

to it. That which was an object of love becomes an object of hatred.

Thence these turnings of mind that are so often to be observed in 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 diseased 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 tries to find, by

analysis of the symptoms, the nature 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 evolution of the human mind has been formed by degrees,

by successive stages, and we possess in ourselves 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 superior 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 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 disorders 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 considered as slight; they are called errors,

or faults, and it is admitted that the subjects remain normal beings.

At the other extremity of the hierarchical series of tendencies the 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 difficult 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 and we have trouble in classing them among

the acknowledged deteriorations of the organism. There is the province

of neuroses and psychoses, intermedium between that of rational errors

and that of organic 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 distinguishing 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 operation of reflection

which hinders tendencies and maintains them in the shape of ideas, which

compares ideas and which only decides after this deliberation,

constitutes the highest form of the medium operations of the human mind.

Lower, still, there exists will and belief, but they are formed without

reflection, without stoppage of ideas, without deliberation; they are

the result of an immediate assent which transforms verbal formulas into

wills and beliefs as soon as they strike the attention, as soon as they

are accompanied by a powerful sentiment. 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 conscience, doubts, aboulias,

obsessions, scruples are always disorders of the reflected will and

belief. On the contrary, irresistible impulsions, deliriums,

indifferences 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 intelligence, 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 practice many other

factors intervene which oblige us to consider such a patient as

incapable of doing any 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 substitute for these simply symptomatical and

psychological diagnostics, some etiological and physiological

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

neurasthenic. But in the actual state of science this ability to

distinguish is not frequent and the future evolution of a depressed

state can scarcely be foreseen with precision.

Certain individuals pass in a few years from psychasthenic depression

with doubts and obsessions to psychasthenic deliriums with stubbornness

and negativism, 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 diseases, 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 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 psychoses considered as different degrees of

psychological decadence.

Neuroses are, therefore, the intermedium between the errors and the

faults which appeared to us almost normal, and alienation which seemed

exceptional and distant from us. The first appearances of that

depression which in a continuous manner descends to alienation are to be

found already in the disorders of character which seemed to be quite

insignificant. The miser, the misanthrope, the hypocrite 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, because she suffers from the mania of being loved though

she is incapable of acquiring any one's affection. All exhaustions, all

moral failings have the closest connection with neuroses and psychoses.

These reflections prove to us that the alienist 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 righting against alcoholism, are examples 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 advantage, 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 experience for the greater progress of the studies which

are dear to us and for the greater good benefit of our two countries.

FOOTNOTES:

[Footnote 14: _Cf._ Janet, P., Les névroses, 1909, p. 370.]

[Footnote 15: _Cf._ Les Médications psychologiques, 1920, I, p. 112.]

[Footnote 16: "Les Nevroses," 1909, p. 384.]

[Footnote 17: _Cf._ Janet, P., "Obsessions et Psychestenic," 1903, vol.

I, p. 997.]

ADDRESS BY

DR. WILLIAM L. RUSSELL

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

_The Chairman_: The year 1921 is rich in anniversaries 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 decennial of Dr.

Russell's term of office as Medical Superintendent. When his devoted

predecessor, Dr. Samuel 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

experience, he has taken up our special problems with deep insight and

gratifying success. He has selected for his subject this afternoon "THE

MEDICAL DEVELOPMENT 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 establish 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 science 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 unprofitable. 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 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 maniacs than medical treatment." The moral

management he referred to, though advocated by Pinel and a few others,

some of whom were benevolent and intelligent laymen, had not been

accepted by physicians 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 mental department of the New York Hospital which have been preserved

since 1817, and of those of Bloomingdale 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 physicians 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 consumption 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 remedies 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 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 observation and practice that the management and

discipline 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

distinction 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 insufficiency than to simplify my labor. I,

therefore, resolved to adopt that method of investigation which has

invariably succeeded in all the departments 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 examinations into the condition of

individuals. All our new cases were entered at great length upon the

journals of the house." Having thus studied carefully the course of the

disease in a number of patients who were subjected only to the guidance

and control made possible by the management of the hospital 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 mildness 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 preparations was gradually lessened, and my scepticism

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 different

classes of patients at houses intended for their confinement; and to

place first, in point of consequence, 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 understood 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 Samuel Tuke.

When Bloomingdale Asylum was opened, the form of organization

introduced was that under which the department at the New York Hospital

had been conducted. Mr. Laban Gardner was made Superintendent 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 beginning, 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 enjoyment,

without much attempt at precision or close medical direction and

control. For a time the results were considered to be satisfactory. In

1824, however, a joint Committee of the Board reported that they were

impressed by the necessity of improving 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," however, "the

approbation of the Superintendent," who you will recall was not a

physician. These patients 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 establishment 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 management 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," relating 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 patient, the ward where he shall be placed,

his exercises, amusement, admission of friends, the time of discharge

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

Europe after having spent a year in visiting the institutions for mental

disorders there, made a report in which he rather significantly referred

to the impracticability 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 control of even the nursing

service. The first Annual 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 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 Salpetrière 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"