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 system of administration in which the chief physician is also the chief executive officer of the institution was a result of an evolution which took many years to reach its full consummation.

Pinel, many years before Bloomingdale Asylum was opened, had shown by the most careful observation and practice that the management and discipline of the hospital was a most powerful agent in the treatment of the patients.  The manner in which he was led to this conclusion is a remarkable example of the scientific method.  When he became physician to the Bicetre he found that the methods of classification and treatment recommended in the books seemed to be inadequate, and, desiring further information, he says:  “I resolved to examine myself the facts which were presented to my attention; and, forgetting the empty honor of my titular distinction as a physician, I viewed the scene that opened to me with the eye of common sense and unprejudiced observation....  From systems of nosology, I had little assistance to expect; since the arbitrary distributions of Sauvages and Cullen were better calculated to impress the conviction of their insufficiency than to simplify my labor.  I, therefore, resolved to adopt that method of investigation