Salmon in France and Beyond: A Rising Star
When America entered World War I, Salmon enlisted and was appointed to the role of chief consultant in psychiatry for the American Expeditionary Force (AEF), America’s detachment to the Western Front in France. He was stationed behind the front lines in Lorraine with the goal of setting up and administering psychiatric care to soldiers suffering from the shocks of war. He was posted near Neufchâteau, not far from Toul, where one of his ancestors, Nicholas Salmon, had lived in the mid-18th century (1).
Salmon’s psychiatric hospitals garnered respect from other Allied commanders, even as he struggled with Pearce Bailey, the head of psychiatric services for the AEF, to secure resources for their operation. Salmon’s hospitals constituted a major step for the military medicine of his time. Equipped with hundreds of beds, care in Salmon’s facilities reflected his orientation to clinical environments. He stressed the importance of cleanliness and orderliness, asserting that this could go a long way in preventing the deepening of war-related sicknesses (2). He found that many soldiers returned to the front after receiving space to rest, stabilize, and recuperate.
Towards the end of the war, when the Allies broke through the German lines, Salmon began to move with the army. After the Armistice was declared, he took a short tour through Germany with other Allied psychiatrists. Stopping in Luxembourg, occupied by the Germans during the War, he remarked on the similarity of Christmas decorations with those at home, saying in a letter to his wife that “the toy stores are filled with just the same toys you see at Christmas in Gimbels and Wanamakers. But, dearie, the Christmas tree hangings! Everything was here - tinsel, little Santa Clauses, big and little red glass balls, chains of them and even a little angel standing on a tinsel cloud like we have!” (3)
Much of Salmon’s internal world during this time is recorded in his correspondence with Helen. Many of these letters are very tender, offering insights into their relationship:
“To be home with you and the kiddies will be enough for me for some time, sweetheart. I have been looking over some of your letters written in December and it seems so very long ago. Maybe it's different with the younger men but I long so for you, dearie, that there is just one big with - to have this over and come home to you. Nothing in the future - after that - is very important just now.” (August 18, 1918) (4)
When Salmon finally left France in 1919, he wanted to make sure that veterans were treated well by military and civilian authorities. Having lived in close quarters with soldiers for two years, he felt that veterans were owed a debt by society. The process of good treatment began, for Salmon, the moment returning ships entered New York harbor (Ellis Island was, during this time, used as a military hospital for returning soldiers). In a letter to his colleague Dr. W.L. Russell, Salmon asks:
“Would it not be possible for a neuro-psychiatrist to go down the bay with the boarding officers and see what kind of cases there were and what arrangements were needed for their care? We used to do that with immigrants after things got well started and certainly returning American soldiers are entitled to as much consideration as immigrants.” (5)
Interestingly, Salmon here calls on his previous experiences on Ellis Island, substituting the tense, confrontational immigrant processing examinations for well-intentioned, preventative examinations directing veterans to proper care facilities as fast as possible.
After the war, Salmon devoted himself to two causes: veterans and psychiatric education. He gained international renown due to Allied respect for his psychiatric hospital system, and he used this momentum to advocate for psychiatry. He described the newly-identified phenomenon of “shell-shock” as essentially a problem of “psychological medicine” (6) and used media outlets like The New York Evening Sun and The World to educate the public about PTSD and the plight of veterans (7).
In one of his more high-profile engagements, Salmon spoke to assembled veterans at Carnegie Hall on November 4, 1921. In his speech, Salmon lambasted the government's efforts to care for veterans, arguing that the hospitals set up by an $18 million appropriation from Congress were made of “paper”, and were inadequate for veterans’ needs (8). He said that Congressional appropriations were held up by legislators convinced there was “a great horde of self-seeking, ex-service men” lying about their conditions to receive government handouts (9). He explained how this simply was not the case, claiming only 1 out of 200 ex-servicemen were seeking treatment, and mostly for non-military diseases, such as “insanity” and tuberculosis. Salmon continued:
“If we could only get those other three in two hundred and take them out of their homes - where the tuberculous man is losing his best hours and the man with mental disorder allowing the shadows to fall - and put them now in hospitals instead of waiting until we can no longer help them and then show our sympathy, what might we not accomplish?” (10)
This address provides a chance to reflect on Salmon’s understanding of government. Just as with immigration, Salmon urged the government to support a program of preventative or palliative psychiatry. Yet again, he was confronted with a narrative of “unworthy” patients taking hold of the taxpayer’s wallet to deceitfully secure care from the state. Unlike his immigration discourse, Salmon deconstructs the notion of “unworthy” patients, emphasizing the debt owed by the government and society to veterans. While the motivations for immigration were “purely industrial” in 1914 (11), America needs to “again get behind its fighting men” in 1921 (12). In both cases, the government’s capacity for care is unrealized, but the determination of who should receive this care is still to be contested.
In 1921, Salmon was appointed by William Darrach, Dean of the Columbia University College of Physicians and Surgeons, as Professor of Psychiatry (13). Salmon left the NCMH in that year and devoted himself to his position at Columbia. He developed an extensive program of psychiatric coursework, divided between “psychoses”, “mental deficiency and constitutional states”, “psycho-neuroses”, and “prophylaxis (mental hygiene)” (14). Although mental hygiene was now integrated into the psychiatric curriculum, it only received one hour of lecture in the fourth year of medical school. He was also popular with the students, many of whom attended psychiatry lectures only if given by Salmon (15). Additionally, Salmon brought other members of his circle into Columbia, such as Roosevelt Island Psychiatric Institute Director George H. Kirby (16). At times, the psychiatry and neurology departments were integrated into one department, and at other times separated from one another. Salmon bickered with neurologists and other psychiatrists who opposed his vision of psychiatric education.
Salmon’s greatest contribution at Columbia was another fund-raising endeavor, this time the construction of the Columbia Medical Center at 168th and Broadway. Salmon called on funders to develop a new, state-of-the-art hospital complete with a psychiatric wing. He lobbied New York City, which had recognized the need for new hospitals as early as 1916, when it asked doctors to reevaluate the utility of the Randall’s Island Hospital (17). The hospital still exists today as a partnership between Columbia and New York Presbyterian.
Salmon and his family continued to live in Staten Island during the War. When Salmon became a professor at Columbia, the family decamped to the suburb of Larchmont in Westchester County. During the summer, they would go to Dorset, Vermont, a hamlet surrounded by the natural beauty of the Green Mountains. During his free time, Salmon indulged his love of sailing, taking trips on his sailboat, the Malabar, around the Long Island Sound.
It was on one of these yacht trips that Salmon met an early and untimely death in 1927. Traveling up the Sound from New York, Salmon fell off his boat and drowned. It is unclear why or how this accident occurred. Salmon was suffering from previous health conditions at the time; Harvey Cushing had suggested that Salmon had a problem with his Gasserian ganglion (18), and the autopsy confirmed that he had been suffering from a brain tumor. While the impression among Salmon’s friends was that he had been overcome by vertigo (19), and that his death was an accident, rumors swirled that Salmon had committed suicide due to the severity of these health conditions. Those who knew him in his last years, including William Darrach, dismissed the possibility of suicide (20), and the exact cause of the accident remains unknown to this day.
Salmon left behind his wife and 6 children: Thomas Kingerlee, Edwin Ashley, Richard, Russell Goldsmith, Helen Elizabeth, and Barbara (21). Helen would outlive Salmon by 26 years, passing away in 1953. Helen and Thomas’ children would go on to have careers in art, urban planning, and medicine. Edwin served as a Sanitation Commissioner for New York City under Robert Moses and later as the Dean of Bellevue Hospital (22). The Salmon family continues to honor Thomas W. Salmon’s legacy and is active in efforts to keep his memory alive.