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Page 35
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.
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