time the position of Attending Physician was abolished and the Resident Physician was made the Chief Medical Officer of the Asylum.  It was not until 1837 that an amendment to the by-laws regulating the powers of the physician and the Warden was adopted which gave to the physician the power of appointing and discharging at pleasure all the attendants on the patients, while to the Warden was reserved the power of appointing and dismissing all other employees.  Fourteen years had thus elapsed since the opening of the Asylum before the physician was given control of even the nursing service.  The first Annual Report of the Resident Physician of the Asylum to be published appeared in 1842.  In this, Dr. William Wilson makes a general statement in regard to the beneficial effects of the moral as well as the medical treatment pursued in the institution, and refers particularly to occupations, exercise in the open air, amusement, religious services, and he asks that a workshop be erected for the men.  It is evident that by this time the authority of the physician in the management of the institution had been extended and it is perhaps significant that in his report of the following year Dr. Wilson refers to a plan for distribution of food which had been evolved in co-operation with the Warden.  Under the direction of Dr. Pliny Earle, who was appointed physician to the Asylum in 1844, treatment directed to the mind was further elaborated and systematized, and the place of the physician in the management of the hospital was more firmly established.

This brief survey indicates how, in the development of the work of the institution, it required years of practical experience to show to the Governors that, in order to secure for the patients the treatment which the Asylum had been established to furnish, it was necessary to extend the powers and duties of the physician so that he could control and direct the internal management and discipline, and all the resources for social as well as individual treatment.  This extension was continued until finally the present form of organization was adopted in which the chief physician is also the chief executive officer of the institution.  This was, however, not fully accomplished until 1877.  It is now universally recognized that the physician must be the supreme head of the organization, and all American institutions and most, if not all, of those in other countries are now similarly organized.

In the early development of Bloomingdale Asylum, this extension of the influence and authority of the physician is the outstanding medical fact.  It did away with division of responsibility and removed from discussion the question of moral as distinct from medical treatment.  Thereafter a harmonious and effective application of all the resources of the institution to the problems of the patients became more easily and certainly possible.  Since then, the resources for treatment directed to the mind have been developed as steadily and fully