d or employed on the farm or in walking exercises in the open or in
classes to be designated by the Resident Physician "with," however, "the
approbation of the Superintendent," who you will recall was not a
physician. These patients were, the report recommends, to be
particularly under the charge of the Resident Physician when thus
employed or amused "out of the Asylum." At this time, the Attending and
Resident Physicians were placed on a small salary, and the Resident
Physician was instructed to "devote a greater portion of his time and
attention to the moral part of the establishment and to communicate to
the Committee such improvements as his experience shall suggest to be
useful and necessary in carrying into more complete effect the system of
moral treatment and to report from time to time to the Committee the
effect of the measure adopted." This seems to have been the beginning of
a realization that the moral management of the patients was inseparable
from medical treatment and must necessarily be the task of the
physician. Seven years after this, in 1831, the Committee found it
advisable to spread upon the minutes an "interpretation and
regulations," relating to the Superintendent and Matron of the Asylum
and to the Asylum physicians, to the effect that the Committee
understood that the regulations "placed the moral treatment on the
physician alone, under the direction of the Asylum Committee, and that
the responsibility remains with him alone, that this treatment commenced
with the reception of the patient, the ward where he shall be placed,
his exercises, amusement, admission of friends, the time of discharge
from the house.... And that all orders to nurses and keepers which the
physicians may think necessary to carry these orders into effect _shall
be communicated through the Superintendent_" (or Warden). In 1832, the
Resident Physician, Dr. James Macdonald, who had just returned from
Europe after having spent a year in visiting the institutions for mental
disorders there, made a report in which he rather significantly referred
to the impracticability of making a sharp distinction between the
medical and moral treatment of the patients, it being difficult to say
where the one ended and the other began, or to put one into successful
operation without bringing in the other. At this time the position of
Attending Physician was abolished and the Resident Physician was made
the Chief Medical Officer of the Asylum. It