|
Main
- books.jibble.org
My Books
- IRC Hacks
Misc. Articles
- Meaning of Jibble
- M4 Su Doku
- Computer Scrapbooking
- Setting up Java
- Bootable Java
- Cookies in Java
- Dynamic Graphs
- Social Shakespeare
External Links
- Paul Mutton
- Jibble Photo Gallery
- Jibble Forums
- Google Landmarks
- Jibble Shop
- Free Books
- Intershot Ltd
|
books.jibble.org
Previous Page
| Next Page
Page 33
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.
Previous Page
| Next Page
|
|