A public outcry against the lamentable state of patient care in public and private mental asylums during the 1870s and 1880s led to the formation of a reform movement that eventually changed not only hospitals but the nature of psychiatric practice as well. Psychiatry had been progressively moving away from an environmental theory of mental disease that associated it with a degenerate moral environment toward a new German approach that centered on the pathology of the brain and nervous system. This change brought alienists (as asylum-based psychiatrists were called) within the compass of scientific medicine.

Changing the Asylum.

The quality of patient care, however, lagged behind advances in medical theory. The movement to reform asylums was led in part by neurologists, whose discipline rivaled psychiatry. Neurologists charged that asylum superintendents were outside the mainstream of American medicine, unable to engage in scientific research and...