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Page 32
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."
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