Department of Planning and Landscape Architecture

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Clemson University

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Email: Hewitt@clemson.edu

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Email: Hewitt@clemson.edu

The paper examines the parallel development of nineteenth-century medical and environmental design theories that correlated local environmental conditions with a settlement’s physiological and psychological health, suggesting that while medical theory during the period exhibited great breadth and variety, particularly significant to the development of nineteenth-century urban America was the influence of miasma theory, and a group of emerging psychiatric theories concerned with the apparent increase in urban insanity. To that point, the paper examines the ascendance and broad acceptance of miasma theory by American physicians, and the subsequent popular diffusion of the theory’s caveat associating environmental characteristics with health and disease. Concerning the emerging psychiatric theories, the paper focuses on the influence of moral therapy and theories correlating insanity with urbanization. Parallels in environmental design theory are examined through the writings of Frederick Law Olmsted. Olmsted’s interest in healthful environments are traced from his formative years, to his design of Central Park, to his affiliation with the United States Sanitary Commission, and through his proposals for dozens of urban schemes throughout the urbanizing cities of the northeast and the United States. The paper is organized in such a manner as to trace the influence of miasma theory in general, to establish Olmsted’s awareness of miasma theory, and to describe its application in urban context. Similarly the paper traces the influence of the psychiatric theories in general, establishing their influence on Olmsted and describing their application in urban context.

Risse, in "Epidemics and Medicine: The Influence of Disease on Medical Thought and Practice", suggests that "disease is as frequently open to cultural as well as biological variability, defined to a great extent by social judgments based on sets of values," and that as definitions change," it is often in relation to those social, cultural and biological components." (Risse, 1993) His observations might nowhere be better illustrated than in the landscape and urban "tissue" of late nineteenth-century American cities, particularly in those of the rapidly urbanizing Northeast. Many urban historians have written about the role of physicians, public health advocates, and reformers in shaping these cities, with the subsequent development of an impressive body of work treating the general topic. Yet while this body of work shows great breadth in recognition of the influence of medicine on urbanizing America, there is considerable variation in emphasis among the individual works concerning the significance of that influence. (McKelvey, 1963;Jackson, 1972; Chudakov, 1981)

A survey of representative urban histories treating the influence of medical thought on nineteenth-century cities suggests several "natural breaks" within the larger body of work. Histories addressing form and structure reveal broad interest and a considered development of several significant architectural and environmental types associated with medicine - including hospitals, tenements, insane asylums, cemeteries and parks. (Thompson, 1985; Burnett, 1986; Plunz, 1990; Grob, 1973; Jackson, 1989; Schuyler, 1986; Cranz, 1982) Within the literature, there is also a pronounced interest in the relationship between medicine, social processes, and housing at village, town and city scales — particularly regarding the effects of value formation, diffusion, and class influence on housing development. (Handlin, 1979; Bindford, 1985; Gaskell, 1981) Scant in number, histories concerning period sanitation and street engineering have necessarily treated the subject with greater emphasis than the morphological histories in general. They differ from the formal histories in their more direct development of issues concerning the rise of public institutions, professional organizations, urban systems and city planning (Keating 1984; McShane, 1978; Peterson, 1979)

A noteworthy group of work addressing period American urban social structure correlates medicine with issues of poverty, ethnicity, race, or immigration. Of those, the histories documenting issues of urban poverty offer the strongest correlation between medical thought and social structure. (Ward, 1989; Bodner, 1990; Pleck, 1979) Histories of nineteenth-century religious movements and urban religious organizations, in turn, can offer evidence of the influence of popular medical thought and non-traditional healing practices on period urban social structure. (Magnuson, 1977; Fuller, 1989) And while often very narrow in scope or anecdotal, there are worthwhile urban economic and political histories referencing the influence of medical thought on the development of model company towns, and the reform movement. (Garner, 1984; Foglesong, 1986; Melosi, 1980; Lubove, 1963)

Much like the urban histories, the medical histories show great breadth in recognition of the influence of medicine on urbanizing nineteenth-century America. And as with the urban histories, there is also considerable variation in emphasis among the individual works concerning the significance of that influence, with ample secondary and anecdotal treatment of the subject matter by many of the authors. (Rosenburg, 1989; Sargent, 1982; Caplan, 1989) Like the urban histories they also tend to correlate medicine with cities most strongly in morphological studies, concentrating more often on hospitals, clinics, asylums, and tenements.(Freymann, 1974; Rosenberg, 1987; Gauldie, 1974; Evans, 1982) Histories of public health, not surprisingly, exhibit perhaps the greatest association between health and cities, particularly concerning the rise of public institutions, professional organizations, urban systems and city planning. (Duffy, 1992; Tesh, 1995; Hamlin, 1992)

Yet while the degree of interest in the influence of medical thought on nineteenth-century urbanizing America is unquestionably strong, limited attention has been given to the interpretation, incorporation, and application of specific medical bodies of knowledge to intentional design of those cities. Moreover, the preponderance of the literature is ‘somatic’ in orientation (concerning mostly physiological manifestations associated with the epidemic and contagious diseases) with little or no reference to the influence of psychiatric medical thought. What’s more, there appears to be no work, which examines the interpretation, incorporation, and application of both ‘somatic’ and psychiatric theories in the design of nineteenth-century urban America. What is clearly evident from primary and secondary sources, however, is the parallel development of period medical and environmental design theories, which correlate local environmental conditions with a settlement’s physiological health and psychological health.

The paper outlines that development, suggesting that while medical theory during the period exhibited great breadth and variety, particularly significant to the development of nineteenth-century urban America was the influence of miasma theory, and a group of emerging psychiatric theories concerned with the apparent increase in urban insanity. To that point, the paper examines the ascendance and broad acceptance of miasma theory by American physicians, and the subsequent popular diffusion of the theory’s caveat associating environmental characteristics with health and disease. Concerning the emerging psychiatric theories, the paper focuses on the influence of moral therapy and theories correlating insanity with urbanization. Parallels in environmental design theory are examined through the writings of Frederick Law Olmsted. Olmsted’s interest in healthful environments are traced from his formative years, to his design of Central Park, to his affiliation with the United States Sanitary Commission, and through his proposals for dozens of urban schemes throughout the urbanizing cities of the northeast and the United States. The paper is organized in such a manner as to trace the influence of miasma theory in general, to establish Olmsted’s awareness of miasma theory, and to describe its application in urban context. Similarly the paper traces the influence of the psychiatric theories in general, establishing their influence on Olmsted and describing their application in urban context.

There is general agreement among medical historians that nineteenth-century American physicians maintained widely divergent opinions concerning the origins and causation of disease. Sczygiel and I argue in 19th Century Medical Landscapes: John H. Rauch, Frederick Law Olmsted and the Search for Salubrity, (Hewitt, 2000) that despite this wide variation, miasma theories gained popular prominence in late nineteenth-century America. In support of that argument, we suggested that the gain in popular prominence was the result of several factors, including: the theoretical ascendance of miasma theory in Britain, the sea change in American medical thought at mid-century; the use of medical topographies to ascertain the health of a particular locality based on its environmental characteristics, and the popularization of miasma theories by United States Sanitary Commission - Christopher Hamlin’s and Ann LaBerge’s work gives credence to this proposition.

Hamlin describes the transformation in theoretical stance within the British medical community from a holistic, socially based understanding of disease toward an environmentally based understanding derived largely from miasma theories. According to Hamlin, central to the acceptance of the new theoretical stance by the British medical community, was physician Southwood Smith’s reconstitution of disease etiology, relating widely accepted theories of physiological excitation and biological predisposition more closely with miasma theories than had been previously accepted. (Hamlin, 1990)

LaBerge suggests, however, that perhaps as important as Smith’s theoretical substantiation, were British public health advocate Edwin Chadwick’s theoretical transformations of French public health statistics. In Mission and Method, she chronicles those transformations, suggesting that while Chadwick substantiated Villerme’s statistical work in Paris, he proposed that poverty, rather than acting as a causative factor in disease etiology as suggested by Villerme, was instead a manifestation of urban disease and sickness. His position, in concert with Smith’s miasma rationale, effectively shifted the epistemology of disease etiology away from biological and social processes, placing greater emphasis on the environment as the source of disease, at least within the British sphere of theoretical influence. (LaBerge, 1992)

While both Hamlin and LaBerge affirm that the ascendance of Southwood’s and Chadwick’s theories accelerated the predominance of miasma theories and its attendant emphasis on environmental empiricism, perhaps more significant for America was the theoretical groundwork those theories provided for an accelerating shift in accepted American medical ideology. Warner, in The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America 1820-1885, argues that that critical shift facilitated the acceptance of European environmentally based medical theories among American physicians. Citing the "principle of specificity" as the underlying rationale for a transformation in American medical epistemology beginning in the second quarter of the nineteenth-century, he contends that for American physicians "specificity" offered the strengthened theoretical connections between physiological condition and specific locality absent in the preceding more systematic ideologies, and moreover, that "specificity" prompted greater efforts documenting both meteorological and environmental conditions of disease in a given area. (Warner, 1986) Yet while specificity facilitated the acceptance of European environmentally based medical theories and prompted heightened the awareness of meteorological and environmental conditions among physicians, interest in the documentation of meteorological and environmental conditions of disease were confined neither to physicians, nor to the adherents of "specificity". (Cassedy, 1986; Tomes, 1997)

Particularly significant to the growing awareness of the connection between environment and disease was the popularity of "medical geographies" - written by settlers (both lay and physician) to both describe newly encountered environments and to document their attendant affects on health. The use of these "medical geographies" to correlate new environments with disease followed the pattern of prevailing medical methodologies associated with the " classical medical topography." Those medical topographies sought to identify specific environmental characteristics associated with disease including, but not limited to: the speed of moving water, the degree of water agitation, the depth of water bodies, mixing of fresh and salt waters, presence of wetland conditions, room configuration, housing density, the presence of trees for oxygenation and mechanical cleansing of air, density and types of vegetation, soil types, etc. (Jones, 1967; Warner, 1992; Rosenberg, 1960)

Daniel Drake’s A systematic treatise, … is representative of the many period studies referencing these conditions. Typical of such studies, Drake described soil composition as "one of the conditions necessary for autumnal fever," noting that it supplied " the matter out of which a poisonous gas is formed," and that " all other circumstances being equal, autumnal fever prevails most where the amount of organic matter is greatest and least where it is the least." He suggested that solar heat was a significant factor in his etiology of yellow fever, and that it "impregnate[d] the air with vapor, giving it a high dew point," evaporating " the superfluous water of ponds, swamps, marshes and lagging streams…promoting the extracation of gases and the assumed undiscovered gas malaria." (Drake, 1854)

Noted historian, John Duffy’s assessment of the popularization of "sanitation" in nineteenth-century America verifies the influence of the kinds of specific environmental characteristics mentioned in the topographies, geographies, popular books and medical reports of the United States Sanitary Commission. One such report entitled "Military Hygiene and Therapeutics" suggests that in locating camps it was important to avoid marshlands, or "malarious" areas. In another report titled "Miasmatic Fevers," the authors addressed the manifestations and environmental conditions associated with specific fevers, including: the location and design of regimental hospitals; patient requirement for fresh air; the placement of wall-openings for cross-ventilation; the avoidance of less salubrious below-ground quarters; the concern with absorbed noxious vapors; and outdoor areas of foul air. (Post, 1865) Yet while Duffy’s suggestion that teaching disease prevention and advocating avoidance of miasmatic conditions affected the lives of millions of Americans attests to the popularization of miasma theory and its attendant specific environmental characteristics, perhaps as significant as the Sanitary Commission’s popularization of miasma, was its ‘convocation’ of prestigious practitioners, advocates for public health, and environmental designers of the period. (Duffy, 1992)

Olmsted’s awareness of the effects of physiologically unhealthy environments, however, did not begin with the Sanitary Commission, but can be traced from his formative years, and to his work in Central Park. Andrew Jackson Downing’s views on healthful landscapes no doubt informed Omsted’s conception of the healthful qualities of landscape, as they did much of mid-century America. His early readings of John Claudius Loudon would also have introduced him to the intricacies of miasma theory and urban design, including referenced sources on malaria. (Simo, 1988) Olmsted’s understanding of the design applications in urban settings was broadened, as well, as a result of his collaboration with sanitary engineer George Edwin Waring Jr. (Waring,1867)

Olmsted’s appointment to a committee of experts by the New York Legislature in 1870 to study the prevalence of malaria and the feasibility of development on Staten Island, speaks to the status he had achieved as an accomplished environmental designer and health advocate of the period. The resultant report, dated 1871, relies heavily on the expertise of physicians, sanitary engineers and geologists and his personal planning and design theories, but the role of medical theory in his design solutions remains clearly evident. Housing was to be adequately distanced to permit the flow of air to diffuse any contaminants, and trees were to help purify the air, as the poisoned air was largely neutralized in passing through foliage. He also suggested that trees could serve the important function of absorbing excessive moisture from the soil and preventing the rapid heating and subsequent release of the gases, and that belts of trees were known to be a malarial barrier. (Olmsted, 1871)

But Olmsted’s understandings of the relationship between physiological health and density, ventilation, landscape condition and certain characteristics of water and open space not only served as rationale for suburban expansion, but also as the basis for a larger urban scheme. Based on assumptions that industrializing cities would continue to grow and that their growth and economic diversification were essential components of progress towards a higher level of civilization, he proposed that planning for growth was indispensable if conditions of misery, disease and other "evils" associated with urban areas were to be avoided. (Bender, 1975) He suggested incremental growth while incorporating specific landscape typologies in accord with the prevailing medical etiologies as specific objectives meant to counter the evils. In particular three landscape typologies stand out in his writings: low density urban and suburban neighborhoods, large pleasure parks and smaller local parks, and tree-lined parkways with connecting promenades.

In an 1877 report to the Board of the Department of Public Works of New York City concerning the layout of two new wards, Olmsted recommended more open space, and less dense urban patterns because "in the middle of all these dark, narrow cubes there must be a large amount of ill-ventilated space, which can only be imperfectly lighted through distant skylights, or by an unwholesome combustion of gas." In general support of lower densities he stated,

"…we are able to reach the conviction, beyond all reasonable doubt, that at least, the larger share of the immunity from the visits of the plague and other forms of pestilence, and from sweeping fires, and the larger part of the improved general health and increased length of life which civilized towns have lately enjoyed is due to the abandonment of the old-fashioned compact way of building towns, and the gradual adoption of the custom of laying them out with much larger spaces open to the sun-light …." (Olmsted, 1877)

His suggestions concerning the establishment of urban parks rest, in part, on beliefs that

"…the most serious drawback to the prosperity of town communities has always been dependent on conditions…which have led to stagnation of air and excessive deprivation of sun-light. (Olmsted, 1868)"

"Air is disinfected by sunlight and foliage. Foliage also acts mechanically to purify the air by screening it. Opportunity and inducement to escape at frequent intervals from the confined and vitiated air of the commercial quarter, and to supply the lungs with air screened and purified by trees [was necessary for the protection of health]" (Olmsted, 1868)

In defense of his proposals for tree-lined boulevards he noted that,

"If such streets were made still broader in parts, with spacious malls, the advantage [in scenery and in air quality] would be increased. If each of them were given the proper capacity, and laid out with laterals and connections in suitable directions to serve as a convenient trunk of communication between two large districts of the town or the business center and the suburbs, a very great number of people might thus be placed every day under influences counteracting those with which we desire to contend." (Olmsted, 1870)

And while the argument that European theoretical developments influenced American medical thought concerning miasma, that the use of medical topographies and the Sanitary Commission were instrumental in popularizing theories of miasma, and that Frederick Law Olmsted in turn, interpreted and used those theories to "inform" his proposals for the development of parks, boulevards, neighborhoods, and suburbs, employing designed elements as disease barriers, air purifiers, and therapeutic access, seems clear from the above evidence, Olmsted’s awareness and interpretations of medical thought were not limited to ‘somatic’ medical theories and miasma-based environmental types, but extended to period psychiatric theories and reigning conceptual models of the mind.

Emphasizing medical culture and institutional tradition as key factors in period European psychiatric influence, Edward Shorter argues persuasively, that the absence of tradition in America afforded by the "pre-mad house" phase in European psychiatry in conjunction with the belated development of American medical institutions, contributed to the relatively few "distinctly American" psychiatric traditions prior to 1930. (Shorter, 1980) Evidence of the extensive development of European "asylums" beginning in the fifteenth century and the development of the relatively few American medical institutions prior to 1800, supports his observation. (3 pre-nineteenth-century American institutions existed: the Pennsylvania Hospital -1752, New York Hospital — 1791, and the psychiatric hospital in Williamsburg —1773)

Corroborating Shorter’s underlying premise of European theoretical dominance, Dain’s examination of both European and American asylum culture suggests, that in contrast to their European counterparts, the majority of institutional superintendents in nineteenth-century American asylums were neither concerned with systematizing their convictions and experiences in publication or with conducting scientific studies. His research reveals a general disinclination of leading American institutional physicians to publish in journals, and his survey of their writings confirms the relatively small amount of original theoretical development. (Dain, 1964) Yet while Shorter’s and Dean’s work is, in and of itself, an admittedly narrow reading of the current scholarship addressing period American psychiatric theory, their work is particularly relevant to the urbanization of nineteenth-century America in its documentation of European theoretical influence on American psychiatric institutions, and the significant effect of those institutions on period American attitudes linking the environment with mental health.

Those influences linking the environment with mental health are well documented in the literature addressing period American corporate asylums and period psychiatric theories associated with "moral treatment." Representative of the scholarship documenting these institutions and theories, Andrew Scull’s Social Order / Mental Order, Anglo-American Psychiatry in Historical Perspective, treats the development of American East Coast lunatic asylums as a departure from accepted American responses to insanity with distinct impacts on the popular movement to reform treatment of lunatics in America. His research traces the most direct lines of that institutional influence to the Friends’ Asylum at Frankford and the Bloomingdale Asylum in New York, but perhaps more importantly, he affirms the early American corporate asylums’ theoretical alignment with William Tuke’s "moral" theories in patient treatment, developed at Tuke’s asylum - "The Retreat," in York, England. (Scull, 1989)

Tuke’s concept of moral treatment was largely synonymous with the creation of specific environments that would promote recovery through the use of environmental settings promoting productive activity, rural beauty and edifying pastimes. (Rothman, 1980) In America, Thomas Story Kirkebride (widely recognized as the originator of period "reformed" asylum design) affirmed Tuke’s settings-based theories in his own work, suggesting that in ideal asylum settings,"[t]he surrounding scenery should be of a varied and attractive kind, and the neighborhood should possess numerous objects of an agreeable and interesting character. The building itself should be placed so that "views from every window, especially the parlors and rooms occupied during the day, had pleasant prospects, and opened onto pleasure grounds." (Kirkebride, 1854) Considered essential to those settings for both Tuke and Kirkebride, was an atmosphere, which afforded the "…simple removal from familiar scenes and associations, with changes in habits of life, [which] is often, of itself, sufficient to modify favorably the diseased manifestations." (Tomes, 1984)

That "atmosphere" gained national recognition through the widely publicized success of their corporate asylums and through the subsequent large-scale expansion of the asylum system in America. The expansion of the asylum system can be attributed in large part to an awakening popular sentiment in support of mid-nineteenth-century social reform in general, and to the efforts of individuals such as Dorothy Dix, but a survey of secondary sources suggests it was the institutional focus of mental health reform, which provided the vehicle for the public’s awareness of psychiatric theories in general and for a their understanding of the relationship between environment and mental health specifically (Cherry, 1989; Tomes, 1995; Taylor 1974) More importantly for the morphogenisis of American cities, it was the psychiatric theories associated with those institutions, which provided the means by which Olmsted, Kirkebride, and others could "translate" popular concern for mental health into physical form appropriate for the country’s rapidly urbanizing cities, in the same manner that Olmsted, Loudon, and Downing translated miasma theory and popular concern for physiological health into proposals for salubrious urban and suburban environments.

Many Olmsted scholars reference his convictions concerning the creation of psychologically "restorative" environments, as well. Olmsted’s sympathies with the various period reform movements are also well documented, as is his familiarity with period romantic, transcendental, and religious literature alluding to the psychological and spiritual effects of nature. His work for various hospitals, for several state insane asylums, and his work on some of the early corporate asylums associated with the rise of "moral treatment" are also documented. (Beverage, 1997) Yet the most telling evidence of his awareness and interpretation of period psychiatric theory, lies with his own numerous writings and proposals, and particularly in those referencing the kinds of environmental settings associated with "moral treatment", and in those contemplating period conceptual models of the mind.

Olmsted’s references to "morally therapeutic" settings are most evident in his efforts to introduce new environments into city fabric, intended to "withdraw the mind to an infinite distance" from all "objects associated with streets and walls of the city"; or to present a "class of objects agreeable as possible and at the same time entirely different from the objects connected to tasked faculties", or to treat "nervous tension, over-anxiety, hasteful disposition, impatience, irritability, and other symptoms". His effort to improve city life through exposure to pleasing rural scenery, and his proposals for the development of urban transportation systems, boulevards, parks and suburban communities, also offers clearly more than the "simple removal from familiar scenes and associations" to those of "rural beauty, edifying pastimes, and creation of pleasant prospects" advocated by the adherents of moral treatment. Evident in both his proposals and within the rationale of moral treatment theory is the separation and antithetical visual differentiation of therapeutic environments from pathogenic environments — a notion derived from period "Lockean" conceptual models of the mind.

Central to Locke’s premise and perhaps most significant to Olmsted’s ability to "translate" psychiatric theory into physical form, was Locke’s notion that the imagination was a faculty directly acted upon by visual stimulation. According to "Lockean" theory, that connection between visual stimulation and mental process made possible a direct response between environment change and change in mental processes. (Tuvesen, 1960; Barrios, 1996) As such, it was theoretically possible that both the pleasurable and spiritual responses to such scenes as rural landscape could be used to counteract the "evils" of city life. For urban America and for Olmsted, that theoretical possibility meant that the introduction of visually differentiated designed environments offered the possibility of healthy environmental alternatives to the period’s rapidly growing "morbid" urban environments.

In his "Review of recent Changes, and Changes which have been Projected in the Plan of the Central Park," Olmsted referenced these theoretical possibilities, suggesting a need for parks which offered "the constant suggestion to the imagination of an unlimited range of rural conditions," so that city inhabitants could "withdraw the mind to an infinite distance from all objects associated with streets and walls of the city." (Beverage, 1997) He elaborated his medical rationale for urban parks in his published report, Mount Royal, Montreal. In it he suggests,

""[i]t is a great mistake to suppose that the value of charming natural scenery lies wholly in the inducement which the enjoyment of it presents to change of mental occupation, exercise and air-taking. Beside and above this, it acts in a more directly remedial way to enable men to better resist the harmful influences of ordinary town life, and recover what they lose from it. It is thus, in medical phrase, a prophylactic and therapeutic agent of vital value; there is not one in the apothecaries’ shop as important to the health and strength or to the earning and tax-paying capacities of a large city. And to the mass of people it is practically available only through such means as are provided through parks." (Olmsted 1881)

Olmsted’s knowledge of widely accepted medical beliefs recognizing both the interrelationship between hierarchical mental processes and physiological processes, and the correlation between stressed and unstressed portions (faculties) of the mind, is evident in his statement,

"These terms (sanative and restoring) are not metaphorical. They testify precisely that the charm of natural scenery is an influence of the highest curative value; highest, if for no other reason, because it acts directly upon the highest functions of the system, and through them upon all below, tending, more than any single form of medication we can use, to establish sound minds in sound bodies — the foundation of all wealth. But to this process of recuperation a condition is necessary, known…as the unbending of the faculties which have been tasked, and this unbending of the faculties we find is impossible, except by the occupation of the imagination with objects and reflections of quite different character from those which are associated with their bent condition. To secure this such a diversion of the imagination, the best possible stimulus is found to be the presentation of a class of objects to the perceptive organs, which shall be a agreeable as possible to the taste, and at the same time entirely different from the objects connected to those occupations by which the faculties have been tasked. And this is what is found by townspeople in a park." (Olmsted 1881)

And just as his larger urban schemes satisfied the city’s need for good air and access to physiologically restorative parks and city districts, his urban transportation schemes were also meant to be psychologically therapeutic, placing people "every day under influences counteracting those with which we desire to contend," and offering them relief from the "certain oppression of town life, symptoms of which are nervous tension, over-anxiety, hasteful disposition, impatience, irritability, which are reversed by the contemplation of pleasing rural scenery." (Olmsted 1886)

Within his larger scheme, boulevards, like his park carriage roads, were designed to require the least effort in driving, if people were to benefit to any extent from the ‘unconscious influence’ of the scenery through which they passed. And while the possibility of this ‘unconscious influence’ also applied to his suburban road systems, his suburban community designs exhibited his attempt to introduce other psychologically beneficial attributes, as well. Considering his proposals for Riverside, Illinois and Berkeley California, he noted that,

"The chief advantages which a suburb can possess over a town on the one hand, and over a wilderness on the other, will consist in those which favor open-air recreation beyond the limits which economy and convenience prescribe for private grounds and gardens. The main artificial requirements of the suburb then, are good roads and walks, pleasant openings and outlooks, with suggestions of refined domestic life, secluded, but not far removed from the life of the community." (Olmsted 1868)

The desired effect was "to have such a scene constantly before one. If within control, it should be held only where it can be enjoyed under circumstances favorable to sympathetic contemplation," noting, moreover, that the "general quality of the distant view should be natural and tranquil." Concerning the domicile itself, he advised that,

"Attractive open-air apartments, so formed that they can be often occupied for hours at a time, with convenience and ease in every respect, without the interruptions of ordinary occupations or difficulty of conversation are indeed indispensable in the present state of society to the preservation of health and cheerfulness in families otherwise living in luxury. The inmates of houses which are well-built and furnished in other respects, but in such apartments are lacking, are almost certain, before many years, to be much troubled with langour, dullness of perceptions, nervous debility or distinct nervous diseases… to indulge in unhealthy excitements, to depraved imaginations and appetites, and frequently to habits of dissipation." (Olmsted 1865)

Yet beyond his dire predictions of potential psychological consequences attendant with the lack of a garden rooms attached to suburban habitation, his intent was to provide circumstances, which were,

" affordable to a pleasurable wakefulness of the mind without stimulating exertion; and the close relation of family life, the associations of children, of mothers, of lovers, or those who may be lovers, stimulate and keep alive the more tender sympathies, and give play to faculties such as may be dormant in business or on the promenade." (Olmsted, 1870)

Writings such as these, recommending such things as the "withdrawal" from the confinement of town living, natural settings as a therapeutic response to the pathogenic influences of city life, the use of designed environments meant to stimulate and restore mental processes, are clearly as innovative in their use and interpretation of period psychiatric theory as are the proposals for the development of parks, boulevards, neighborhoods, and suburbs, employing designed elements based on miasma theory. Moreover, Olmsted’s proposals contemplating site-scale and city-scale modifications for the psychologically therapeutic benefit of the individual and the group are as comprehensive as are his miasma-based proposals. And while it seems abundantly clear that he was significantly influenced by both miasma and moral treatment theories, Olmsted’s contemplation of other urban issues associated with mental illness is also evident in his writings and proposals.

Gerald N. Grob, in Mental Illness and American Society, 1875 — 1940, suggests that beyond physiological pathologies, period mental illness was believed to be caused by conditions such as: the increasing demands of modern civilization, the immigration of degenerated individuals, an inherited predisposition to insanity, use of alcohol and drugs, sexual excess, poor nutrition, poor housing, somatic diseases, and a variety of moral / psychological causes. (Grob, 1983) Typical of period psychiatric thought concerning these conditions, neurologist George Beard’s classic work American Nervousness, argued that America created a more intense social milieu, especially for those with the finest sensibilities, because of the new nation’s relatively less stable institutions, while some period physicians believed stress was increasing because of the peculiarly American sense of personal accountability for one’s life.

Representative of many period "degenerative" theories linking hereditary insanity with evolution of the human brain and progress of human societies, Benedict Augustine Morel, 1809-1872, proposed psychological features, such as melancholic disposition or chemical agents like alcohol could lead to brain changes which were hereditary, and that these traits were cumulative leading to the extinction of succeeding generations. While incorporating evolutionary precepts within in their dialectic, theories such as Morel’s also often rationalized class and race differences as neutral workings of those theories rather than the outcome of unfair social practices, reflecting the period tendency to divide culture according to its highbrow and lowbrow appeal. (Caplan, 1969; Drinka, 1984) Olmsted postulated the therapeutic resolution of these conditions through the use of designed environments in much the same manner as he postulated the resolution of miasmatic and psychopathic conditions.

The division of culture according to its highbrow and lowbrow characteristics (with its implicit reference to "degenerative" theory) is evident in Olmsted’s longer passages on the less educated and refined working peoples appreciation of rural scenery, in his "Notes on the Plan of Franklin Park and Related Matters," but his use of designed elements to counteract the degenerative consequences of that social division are perhaps best expressed in his comments that,

"No one who has closely observed the conduct of people who visit the Park, can doubt that it exercises a distinctly harmonizing and refining influence on the most unfortunate and most lawless classes of the city, - an influence favorable to courtesy, self-control, and temperance." (Olmsted 1886)

In answer to Morel and others’ concern with social degeneration, his beliefs are most articulately described in his theory of "neighborly receptive recreation," found in his, "Public Parks and the Enlargement of Towns." In that address he states his design’s intention to:

"… induce people to engage in what I have termed neighborly receptive recreations, under conditions which shall be highly counteractive to the prevailing bias to degeneration and demoralization in large towns. To make clearer what I mean, I need an illustration which I find in a familiar domestic gathering, where the prattle of children mingles with the conversation of the more sedate, the bodily requirements satisfied with good cheer, fresh air, agreeable, light, moderate temperature, snug shelter, and furniture and decorations adapted to please the eye, without calling for profound admiration on the one hand, or tending to fatigue or disgust on the other." (Olmsted, 1886)

Yet Olmsted’s concerns were also related to the widely accepted notion that civilization itself was a cause of mental illness. In his most direct comment on the subject he stated:

"At the same time there is no doubt that the more intense the intellectual activity, which prevails equally in the library, the work shop, and the counting room, makes tranquilizing recreation more essential to continued health and strength than until lately it has been. Civilized men while they are gaining ground against certain acute forms of disease more and more subject to other and more insidious enemies to their health and happiness and against these the remedy and prevention can not be found in medicine or athletic recreations but only in sunlight and such forms of gentle exercise as are calculated to equalize the circulation and relieve the brain."

By simply adopting this course as a habit, men who have been breaking down frequently recover tone rapidly and are able to retain and active and controlling influence in an important business, from which they would have otherwise been forced to retire. I direct school-girls, under certain circumstances, to be taken wholly, or in part, from their studies, and sent to spend several hours a day rambling on foot in the Park." (Olmsted, 1886)

Thus, just as European theoretical developments had influenced American medical thought concerning miasma; as the use of medical topographies and the Sanitary Commission had been instrumental to popularizing theories of miasma; and as Olmsted had interpreted those theories and popular attitudes to "inform" his proposals for the development of parks, boulevards, neighborhoods, and suburbs, so too had period European psychiatric theories and popularized attitudes associated with "moral treatment", mental degeneration, and urban insanity similarly influenced Olmsted and his urban design proposals suggesting the need for "withdrawal" from the confinement of town living, natural settings as a therapeutic response to the pathogenic influences of city life, the use of designed environments to stimulate and restore mental processes, and "neighborly receptive recreation" In the largest sense, this process that culminated in Olmsted’s designs and proposals and ultimately in new urban form evidenced the correlation between medical theories and the growth of nineteenth-century American cities based on the diffusion of period medical thought and theory among and between period physicians in Europe and America, on the popularization of those theories through national publications and the activities of period medical and public institutions, and on the translation of medical knowledge associated with those theories across early professional boundaries. In perhaps its most overt sense, that "translation" introduced new formal nineteenth-century urban elements and design theory, addressing: disease barriers, air purifiers, therapeutic access ways, visual barriers suggesting unlimited ranges of restorative conditions, therapeutic suburban garden rooms, low density urban and suburban neighborhoods, large therapeutic parks and smaller local recreational parks connected by tree-lined parkways and promenades, as well as, natural environments conducive to neighborly and refined social behavior and antithetical to the mental strains of civilization - often still evident in American urban fabric today. Formal elements such as these are generally not the topic of urban analysis, evaluation, or even historic interpretation. And while the documentation of elements such as these seem promising as topics for further research, Olmsted’s use of landscape characteristics and formal types associated with medically recognized environmental qualities and mental processes, suggest that the kind of medical information that can change the formal qualities of cities, and particularly the kinds of information that can be shared or "translated" across disciplinary boundaries, is particularly worthy of further research.

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