History of Medicine
19th-Century Psychiatrists of Note
- Isaac Ray, M.D. (1807-1881)- Medical Jurisprudence
- Thomas Kirkbride, M.D. (1809-1883)- Asylum Architecture
- John P. Gray, M.D. (1825-1886) - Psychiatric Leader
- Pliny Earle, M.D. (1809-1892) - Hospital Statistics
- Edward Jarvis, M.D. (1803-1884) - Psychiatric Epidemiology
- George Beard, M.D. (1837-1883) - Neurologist
- Bernard Sachs, M.D. (1858-1944) - Neurologist
Isaac Ray, M.D. (1807-1881)
Isaac Ray was the foremost forensic psychiatrist of his time. In 1838, he published A Treatise on the Medical Jurisprudence of Insanity (Boston), which served as an authoritative text for many years.
Ray received his medical degree in 1827 from Bowdoin and spent the following year visiting medical facilities in New England, England, and France. After several years in private practice in Maine, he became Superintendent of the State Hospital for the Insane in Augusta in 1841, and in 1845 he moved to Providence, R.I., to supervise the building of the private Butler Hospital and became its first Superintendent. In 1867, he moved to an active retirement in Philadelphia.
One of the founding members of the Superintendents’ Association, he served as President from 1855 to 1859. Between 1828 and 1880, except for one year he published at least one article every year, mainly dealing with insanity and its legal implications. Ray also published several important monographs, including Mental Hygiene (Boston, 1863) and Contributions to Mental Pathology (Boston, 1873).
In 1868, the Superintendents’ Association adopted his "Project of a Law," (see pages 17-22) which recommended statutory enactment to secure the rights of the mentally ill and define the civil and criminal relationships of the insane.
Selected works by Isaac Ray:
Insanity of King George III: read before the Association of Superintendents of Insane Hospitals, May 22, 1855. (Utica, N.Y., 1855).
Thomas Kirkbride, M.D. (1809-1883)
Thomas Kirkbride provided the major influences during the 19th century on the building and organization of mental hospitals. In 1854, he published his book, On the Construction, Organization, and General Arrangements of Hospitals for the Insane (Philadelphia), which influenced the architecture and construction particularly of state asylums, known as "Kirkbride Hospitals," some of which were still in use into the mid-20th century.
Kirkbride had been influenced by the Quaker-founded York Retreat in England whose leader, Samuel Tuke, had published an account entitled, Practical Hints on the Construction and Economy of Pauper Lunatic Asylums (York, England, 1815). The Tuke family had instituted in their hospital a "moral treatment" approach to care for patients, which centered upon humane and kindly behavior. The Superintendents’ Association made efforts to institute this approach in their hospitals.
Thomas Kirkbride came from a Pennsylvania Quaker family. He received his medical training by preceptorship and gained a medical degree from the University of Pennsylvania in 1832, following which he joined the staff at Friends Hospital in Philadelphia. He later moved to the Pennsylvania Hospital before entering private practice in 1840. He was eventually invited to become Superintendent of the Mental Division of the Pennsylvania Hospital, which had gradually increased in size since its establishment.
When a new hospital was planned in North Philadelphia, Kirkbride provided the layout for the construction. Kirkbride’s hospital plan was linear with a central building to house administrative offices, kitchens and staff living quarters with wings extending on either side. Each ward had a wide central corridor with sitting alcoves, single patient rooms, and small dormitories. Multiple wards allowed for classification of patients according to their condition. Kirkbride paid much attention to details such as ventilation, heating, sanitary arrangements, and space for patient occupation and recreation.
In 1851, the Superintendents’ Association adopted 26 propositions written by Kirkbride for hospital design which served as official policy for 40 years, and Kirkbride served as President of the Association from 1862 to 1870. After 1870, as the average hospital size increased (to over 10,000 beds in the 20th century), Kirkbride’s influence declined. In 1888, the Association voted to "not affirm" Kirkbride’s propositions.
John P. Gray, M.D. (1825-1886)
John P. Gray was a formidable leader in forensic American psychiatry during the second half of the 19th century. He often served as a forensic psychiatrist and was the editor of The AJI for 32 years where he had a ready avenue to express his views. He was President of The Superintendents’ Association from 1883 to 1884.
Gray was born in Halfmoon, Pennsylvania, attended Dickinson College as an undergraduate, and received his medical training at The University of Pennsylvania in 1848. He was a resident at the public Blockley Asylum in Philadelphia and later taught at the medical school. In 1850, he moved to the Utica (NY) State Hospital as a junior physician and became Hospital Superintendent in 1854, remaining in this post until his death.
Gray was a strong believer that mental illness was due to physical causes that could be found in the brain, as opposed to the long-standing belief that mental illness was due to 'moral' causes. In 1870, Gray added a pathologist to his staff in Utica, the first American asylum to do so.
In 1881, President James A. Garfield was assassinated by Charles Guiteau. Brought to trial, the major question was whether Guiteau was sane or insane (which would avoid the death penalty). The prosecution and defense each assembled prominent psychiatrists and neurologists to testify on their points. Gray was a major and strong witness for the prosecution that Guiteau was sane. Guiteau was hanged, but many later psychiatrists believed he was insane.
Gray himself was shot by a mentally ill person soon after the Guiteau trial and later succumbed to his wounds.
Pliny Earle, M.D. (1809-1892)
Pliny Earle provided a major influence in challenging the “curability” rates of mid-19th-century mental hospitals. At the time, the small public and private mental hospitals (most had 300 beds or fewer) were posting hospital cures of their patients as high as 90%. Admission to the hospital virtually guaranteed cure of the illness.
Earle began to question the statistics which were published regularly in The AJI. He pointed out the lack of uniform standards of diagnosis and classification and the negligent manner of counting readmissions. In 1877, he published an important work on the topic, The Curability of Insanity (Utica, N.Y.).
Earle, a Massachusetts native, graduated from the University of Pennsylvania Medical School in 1837 and studied in Europe for a year. He served on the staff of the Friends Hospital in Philadelphia and in 1844 became Superintendent of The Bloomingdale Hospital in New York until 1849. In 1864, he became Superintendent of the Northampton (Mass.) State Hospital, where he remained for 22 years and where his interest in hospital cure rates was roused.
Earle enjoyed visiting hospitals abroad. In 1839, he published a report, Visits to Thirteen Asylums for the Insane in Europe, mainly covering Great Britain and France. In 1851, he visited an asylum in Havana, Cuba, and in 1854, he published another report entitled, Institutions for the Insane in Prussia, Austria, and Germany.
He was President of the Superintendents’ Association from 1884 to 1885 and also active in the AMA and The New York Academy of Medicine.
Pliny Earle. An examination of the practice of bloodletting in mental disorders. (New York, 1854). http://resource.nlm.nih.gov/66430020R
Edward Jarvis, M.D. (1803-1884)
Edward Jarvis may be called the first American psychiatric epidemiologist. He became a leading authority on vital statistics in the U.S. during the period 1850 to 1870.
Jarvis, born in Massachusetts and educated at Harvard (M.D., 1830), had unsuccessful medical practices in Massachusetts and Kentucky. He returned to the Boston area in 1843 and began seeing, treating, and housing mentally ill patients in his home. In 1840, at the request of educator Horace Mann, he published a book on health for use in schools, Practical Physiology for the Use of Schools and Families (Philadelphia, 1848) which was later translated into a number of languages, including Japanese.
Jarvis had studied the Federal Census for 1840 and found errors relating to the counting of mentally ill persons. He became a member of the existing American Statistical Society and president for many years, and on behalf of the Society, he wrote a petition to Congress to revise procedures for gathering census data, entitled "Statistics of insanity in the U.S." (Boston Medical & Surgical Journal, v. 27, September 21, 1842). He later served as a consultant to the Census Bureau for the 1850, 1860, and 1870 census activities.
He was much concerned about the role in mental health of race and ethnicity as related to social class and the influence of immigration as American culture. He published over 50 papers on statistics, hygiene, and insanity including the article, “Insanity among the colored population of the free states” (American Journal of the Medical Sciences, v. 7, 1844, p. 71-83). In 1860, Jarvis was an official delegate for the Statistical Society to an International Statistical meeting in England and visited asylums there. Psychiatric historian Gerald Grob wrote, "Jarvis contributed to a newer synthesis that merged medicine, morality and social science." (G. Grob, Edward Jarvis and the Medical World, Knoxville: Univ. of Tennessee Press, 1978, p. 221).
George Beard, M.D. (1837-1883)
George Beard is credited with coining the word "neurasthenia," a term that came into great prominence in the late 19th and early 20th centuries.
Beard received his medical degree in 1866 at The College of Physicians and Surgeons in New York and then joined Dr. A. D. Rockwell, a New York neurologist who was using electricity in medical and surgical therapy and with whom Beard later published favorably received book on the subject. Beard became interested in psychology, and in 1876 he read a paper at a meeting of the American Neurological Association entitled, "On the influence of the mind on the cure and causation of disease" (Journal of Nervous & Mental Diseases, 1876, vol. 3, pp. 429-434). Beard credited emotions as influencing symptoms which could be dispelled by positive thinking, to which he applied the term "mental therapeutics." His paper met with derision from his colleagues, and The Superintendents’ Association lost no opportunity to disparage Beard’s writings. Beard’s book, A Practical Treatise on Nervous Exhaustion (Neurasthenia) (New York, 1880) received a scathing review in The AJI (April 1880, v. 36, pp. 522-526).
Historian Charles Rosenberg wrote, "Beard was neither a profound nor critical thinker. His popularization of the idea of neurasthenia won him an international reputation in the late 19th century… he was a forerunner of French and modern psychological medicine." ("The place of George M. Beard in 19th-century psychiatry," Bulletin of the History of Medicine, 1962, v. 36 (3), pp. 245-259).
Bernard Sachs, M.D. (1858-1944)
Bernard Sachs, called "The Dean of Neurology" at the turn of the century, was the first to describe the clinical picture of "amaurotic family idiocy" (Tay-Sachs disease). He was twice elected to the presidency of the American Neurological Association, at ages 36 and 74. One of his primary goals was to ally psychiatry and neurology.
Sachs was born in New York, attended Harvard and went to the medical school in Strasburg (then part of the German Empire) receiving his medical degree in 1882. He then spent two years studying with Theodor Meynert in Vienna, J. M. Charcot in Paris, and Hughling Jackson in London. On his return to New York, he opened a practice to treat mental and venereal diseases, and he established the first neurological service at a private hospital (Mt. Sinai). He published almost 200 papers and the first American textbook on child psychiatry, A Treatise on the Nervous Diseases of Children (New York, 1895), and later, Nervous and Mental Disorders from Birth to Adolescence (with Louis Hausman; New York, 1926).
Sachs was opposed to psychoanalysis as a treatment method. He had sat with Freud in Meynert’s laboratory and then corresponded with him many years. Sachs said psychoanalysis was illogical, unsubstantiated in science, and possibly dangerous when used with children. His book, The Normal Child (New York, 2nd edition, 1926) contained a long chapter on the "evils of psychoanalysis."
Sachs was a strong advocate of bringing neurology and psychiatry together into a single "neuro-science," which he stressed in an invited address at the annual meeting of The Medico-Psychological Association in 1897, "Advances in neurology and their relation to psychiatry" (Proceedings of the American Medico-Psychological Association, 53rd Annual Meeting, Baltimore, May 11-14, 1897).
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