nt 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