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 medic