The operations of the asylum required an increasing number of medical and administrative personnel, along with people to cook, clean, guard, escort, serve, raise vegetables, tend livestock, garden and landscape, build, repair, plaster, paint, smith, and more. At the top of the system was the chief physician, in theory an experienced “alienist” specializing in caring for the mentally ill (although some of the first of these men had to acquire this expertise on the job). During the tenure of John Neilson (1819- 1829), the head of the medical service did not reside at the asylum, but was a visiting attending physician, with one or two residents reporting to him. This arrangement changed in 1829 under his successor, James MacDonald, and thereafter the Attending Physician resided on the grounds, at first in apartments inside the main building and then after 1852 in the fine residence created for him on the west side of the campus.
Working alongside the attending and initially reporting directly to the board of governors were a superintendent and matron, charged with the administrative and physical management of the facility, including the difficult task of hiring, training, supervising, and, when necessary, firing the many nurses, attendants and other employees needed to keep an institution like this running, ensuring that these individuals could perform the challenging and often thankless task of working with mentally disturbed patients with a proper balance of firmness, responsibility, kindness, and objectivity. This parallel medical and administrative structure quickly proved a point of tension. It became increasingly clear that the demands of “moral treatment” required the physicians to be concerned with many of the practical aspects of patients’ daily lives that formally belonged to the more practical and administrative realm of the superintendent, and physicians’ desires for increased authority in these areas led to rivalry and confrontations, and sometimes conflicts between the attending physician and the board of governors. There was more than one instance of financial malfeasance by a superintendent, and the fact that the superintendent and matron were often a married couple seems to have encouraged this. The result was an evolution of this office. In 1833, the title of “superintendent” was changed to “warden,” and he was placed more fully under the authority of the attending physician. In the last two decades of the Bloomingdale’s existence, as the service grew increasingly professional and medical in character, the warden and matron ceased to figure among the officers of the asylum and the physician assumed the title of “medical superintendent.”
Nine men held the post of chief physician during the Bloomingdale's 73 years on the Heights. Three of them stand out in terms of their energy, expertise, and contribution to the growth of the institution and of the psychiatric profession in general, and a fourth, by the upheaval and personal tragedy that marked his administration.
James MacDonald (1829-30, 1832-37) intially worked as a resident physician under John Neilson, and his talent and energy in that job recommended him to the governors as a successor. He was unhappy with some aspects of the asylum's operations however, and as an incentive to his remaining, the governors consented to an 18- month leave of absence so that he could visit the leading asylums of Europe and gather information about ways of enhancing the Bloomingdale's own program. His reports and letters from that trip (which also make clear that this was something of a Grand Tour for him) brought back important new ideas back to the governors and had a broader impact on the emerging world of psychiatric medicine as well. At the asylum he pushed to expand the implementaton of moral treatment. He insisted on the creation of a solid library, and the acquisition of the latest newspapers and magazines to provide engagement for the patients' minds. He also became a passionate advocate for occupational therapy, something the governors would resist, and continue to do through the remainder of the asylum's tenure on the Heights. Was this resistance, at heart, a reflection between the notions of workshop and palace, of concerns about the disruptive potential of any kind of social equalizing? The "most wealthy patients" Taylor spoke of capturing were probably not likely to find manual labor a helpful remedy. MacDonald also pressed to reduce the role of the superintendent, since he increasingly saw it as an obstacle to the physician's most effective arrangement of the patients' environment. Ultimately, conflicts over this and occupational therapy led to his departure from the Bloomingdale in 1837. In the years following his departure, he came to be seen as the leading regional expert on the treatment of the insane, and his recommendations were sought by the group working to develop a state asylum on Blackwell's Island. He also set up his own facility for treating the mentally ill, which came to be known as the Sanford Asylum, located first in the Murray Hill and later in Flushing. His premature death from pneumonia 1849 was met with an outpouring of sorrow and praise in the periodical press.
Pliny Earle (1844-1849) brought a new level of energy and dedication to the work of the asylum and had a major impact despite the briefness of his tenure. In some respects, he represents the epitome of the tradition of "moral treatment." Trained at the University of Pennsylvania in the treatment of mental illness and further educated by a tour of the major mental institutions of Europe and experience as director of the Friends Asylum in Philadelphia, he brought unprecedented experience to the job. Principled, independent minded, even eccentric, he brought to the profession a zeal probably born of his devout Quaker upbringing. Single all his life, he seems to have devoted himself entirely to his calling.
As attending physician, he introduced new rules for staff and patients, introduced detailed new statistical programs for tracking patients' affliction and their treatment. He enhanced the Asylum's library and introduced a program of education, himself delivering many of the lectures himself and inviting outside speakers as well as a means of returning his charges to normality. He made use of the data gleaned in his work to write and publish extensively on mental illness, including many of his conclusions in his annual reports, and argued that with proper treatment, significant numbers of those suffering from mental illness could be cured. He also drew up a first history and monograph on the Asylum and its work. The periodical literature of the period contains a number of approving accounts of his work.
It would appear that principled support of vocational therapy eventually led him into conflict with the governors, just as it had in the case of MacDonald, and he resigned in 1849, going into private practice for a time, and then serving on a voluntary basis during the Civil War at the Government Hospital for the Insane in Washington, D.C. (headed by his successor at the Bloomingdale, Charles Nichols). In 1864 he became the director of the Northampton State Lunatic Hospital. He continued to be a leading figure in the field, pursuing more research of the kind he had done at Bloomingdale and serving from 1884 and 1885 as president of the Association of Medical Superintendents of American Institutions for the Insane (forerunner of the American Psychiatric Association), which he had earlier helped to found in 1844.
Charles H. Nichols (1849-52, 1877-89) was a Quaker like Earle, but a man of much more pragmatic and down-to-earth temperament than his predecessor. Historian William Russell notes "Just as Dr. Earle was said to be of an 'arithmetical turn of mind,' it may perhaps be equally correct to say that Dr. Nichols was of a mechanical or architectural turn of mind." (Russell, 244) This difference in character perhaps explains why he chose not to continue Earle's school and lecture series. He was eager, however, as his predecessors had been, to develop a program of occupational therapy, and was just as unsuccessful in convincing the governors to give their approval. He also devoted much attention to the physical plant and administrative measures, making important improvements in the sanitary conditions of the institution, pressing for better classification of patients, and warning, somewhat ominously, as it woud turn out, about the need for better training of nursing and other staff working with patients and the need for a larger staff in this area, noting that Bloomingdale was falling behind its peers in these areas. Reportedly, he came into conflict with the governors on some of these issues, and so happily accepted the invitation of President Milliard Fillmore in 1852 to come to Washington, D. C. to set up and lead a government hospital for the insane (St. Elizabeth's), an undertaking in which he collaborated with the social reformer Dorothea Dix. His administrative skills enabled him to assume leadership in a number of other social and governmental institutions in Washington as well. He rose to a position of prominence in the psychiatric field, serving as president of Association of Medical Superintendents of American Institutions for the Insane, and drawing national attention as an expert witness for the insanity defense of Charles Guiteau, assassin of President James A. Garfield. He was to return to the Bloomingdale in 1877, but that part of the story is best treated after discussing the man he came to replace.
David Tilden Brown (1852-77) was the longest-serving head of the medical service at Bloomingdale, but his career ended in tragedy. By all accounts, he was a competent, respected, and well-liked physician, frequently quoted in the press of the period and often asked to appear in court as an expert on insanity. Nonetheless, he did not have the kind of impact on the the field that his ambitious predecessors McDonald, Earle, and Nichols had: no leadership in major national organizations, little published research, far less extensive annual reports than those produced by Earle or Nichols. There are in fact signs that his commitment to this career may have been less single-minded: after an initial period of service as a physician in asylums in the late 1840s, he had fallen "ill," and escaped in 1849 into a brief stint as an explorer, leading expeditions across Nicaragua to find routes that could be used by prospectors heading to California for the great gold rush before he returned to the career of an "alienist" in the 1850s. More than one contemporary observer remembered him as "sensitive," suggesting a vulnerability and aversion to stress and confrontation. His actions as head of the asylum in the face of confrontation seem to suggest the same: frequent absences, sometimes due to "illness," sending assistants to testify in court on his behalf, denying access to patients reportedly held against their will on grounds of "confidentiality" or "fragility," and, on a number of occasions, hastily releasing patients required for presentation in habeas corpus cases, or transferring them to other institutions. For a variety of reasons, some beyond his control, he was hit with a wave of public scrutiny and a vicious press campaign charging abuses in the admission and treatment of patients, and while the formal investigations that resulted ultimately vindicated the asylum, they did note some lapses and failures of administration. The weight of the stress and perhaps the sense of personal failure appears to have been too much for him, and he suffered a nervous breakdown, resigning for reasons of illness in 1877 and traveling to Europe for treatment for melancholia at Edinburgh. He subsequently retired to a farm in Batavia, Illinois, where he lived peacefully for a number of years, until an enterprising reporter for The New York World discovered him in the summer 1889 and published an article recounting the events of the 1870s, describing the doctor's bout with mental illness, and revealing his current location. This public exposure of his failed career seems to have broken him completely, as he hanged himself a few days later.
Charles Nichols (again), appears to have been called in by the directors to address the crisis around Brown's resignation in 1877, since his hiring was announced almost simultaneously with the announcement of Brown's departure. In the years that followed, he worked to bring new order to the Bloomingdale. Among other things, there was an increasing "medicalization" of the treatment program, resulting in the disappearance of nonmedical officers such as the steward and matron and an increase in the number of physicians. Nichols also continued to work on his goal of providing better "classification" of the patrons on the basis of both medical and social criteria. A clear reflection of this would seem to be the two major building projects of this period, Green Memorial Hall and Macy Villa, both explicitly designed to accommodate wealthier patients.
Under his administration, the "habeas corpus" crisis of the 70s seems to have died down considerably. Although there were still stories in the press (particularly in the press outside New York) about alleged wrongful imprisonments, their impact on the Bloomingdale appears to have been far less disruptive, and there were fewer reports of the kind of physical abuse that had produced such a sensation in the preceding decade.
Nichols found himself forced to defend the asylum against a new set of charges about its supposed unfair enjoyment of tax exemptions, its focus on a largely well-to-do clientele, and its suppression of real estate values on the Heights. He was an eloquent witness on its behalf in the New York Senate hearings on those questions in 1888. While defending the Bloomingdale against those who sought to drive it from the Heights, he was also working quietly in the background to plan for a new campus in White Plains, and while he did not live to see the new facility, its layout and architecture reflect much of his thinking.