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CORRELATION OP SCIENCES IN THE INVESTI-
GATION OP NERVOUS AND MENTAL DISEASES.

FROM ARCHIVES OF NEUROLOGY AND
PSYCHOPATHOLOGY, VOLUME I. 1898.

STATB HOSPITALS PRESS,
UTICA, NEW YORK, 1809.

CORRELATION

OF SCIENCES

IN THE INVESTIQATION OP NERV-
OUS AND MENTAL DISEASES...

FROM TBI PATHOLOGICAL mSTTTnTB
OF THB MSW TOBK 8TATB HOSPITALS.

• • •
• • •

• •

• • - ••

■ •

• • •
• • •

IRA VAN OIESON.

State Hospitals Press, Utica, N. Y.

1899.

Monos^raph Publications from the
State Hospitals Press, Utica, N. Y.

Correlation of Sciences in the Investi-
gation of Nervous and Mental
Diseases,

Ira van Gieson.

Price ^ Si^oo
Studies on Granglion Cells,

Jambs Ewing.

Price, Sf-So
Neuron Energy and its Psychomotor
Manifestatunis,

Ira*

• ••• : .•iPr/a.it^jO'

Notes on Criminal Anthropology and

Bio-Sodologyt

Henry Lylb Winter.

Price, So^o

A Series of Experiments with the
Weigert Mettiods--With Special
Reference for Use in Lower Brain
Morphology,

C. JuDsoN Herrick.

Price, So^

Preliminary Experimental Studies in
a Case of Amnesia with a Dis-
cussion of their Psychopathological
Significance,

WnxiAM A. White.

Price, So. JO
Adomegalia,

Harlow Brooks.

Price, Sf.oo

3^)^

CONTENTS.

PART I.

PAGBS.

Chapter I— The History of Psychiatry i>aa

Chapter II— The Psychopathic Hospital 22-30

Chapter III — The Asylum and Science 30-53

Chapter IV — Psychiatric Investigation. . ^ 53-72

PART II.

Chapter V— Nonnal Psychology and Psychopathology.. 73- 88

Chapter VI— Normal Histology of the Nervous System, 8^x04

Chapter VII— Comparative Neurology 105-112

Chapter VIII— Department of Cellular Biology 1x2-132

Chapter IX— Pathological Anatomy, Bacteriology and

Physiological Chemistry X32-X57

Chapter X— Pathological Physiology X57-i74

Chapter XI— The Investigation of Blood in Insanity. . . X74-X76

Chapter XII— Anthropology X77-^5

Chapter XIII— The Unclassified Residuum. 205-207

Chapter XI V— The Future of Psychiatry 207-2x0

PART III.

Chapter XV— Facts and Theories in Medical Science. . . . 2x1-222

Chapter XVI— The Patho-Anatomist and the Clinician... 222-224

Chapter XVII— The Pathological Institute and Ps3rchiatry, 224-233

Chapter XVIII— Medicine and Psychiatry 233-238

610.

THE CORRELATION OF SCIENCES IN THE
INVESTIGATION OF NERVOUS AND MEN-
TAL DISEASES.*

IRA VAN GIESON. M. D..
Director of the Pathological Institute of the New York State Hospitals.

*• No one can have a firm g^rasp of any science if,
by confining himself to it, he shuts out the light of
analogy, and deprives himself of that peculiar aid
which is derived from a commanding survey of the
co-ordination and interdependence of things and of
the relation they bear to each other. He may, no
doubt, work at the details of his subject; he may be
useful in adding to its facts ; he will never be able ^
to enlarge its philosophy. For, the philosophy of
every department depends on its connection with
other departments, and must therefore be sought
at their points of contact. It must be looked for in
the place where they touch and coalesce ; it lies not
in the centre of each science, but on the confines and
margin." — Buckle's Essay on Mill.

PART I.
PSYCHIATRY, ITS GROWTH AND METHODS.

Chapter I.

THE HISTORY OF PSYCHIATRY.

The history of the insane has been written again and
again, and is familiar to all who deal with this unfortu-
nate and dependent class; still a glance at this growth
and progress of psychiatric work g^ves such graphic and
incontestible evidence of the absolute dependence of the
progress of the treatment of the insane upon science,

* This paper is in substance a report presenting the purpose of the Pathologi-
cal Institute of the New York State Hospitals to the State Commission in
Lunacy for transmission to the legislature. Prom its nature it had to be writ-
ten in an untechnical form. As this paper not only endeavors to forecast the
work of the State Hospitals and the Institute but also covers the scope of their
official publications, it may not be inappropriate to publish this text in the
Archives, with such modifications as have been found indispensable.

a CORRELATION OF SCIENCES.

that I may ask for indulgence in once more tracing the
outlines of this chronicle.

In the early Egyptian, Babylonian, Assyrian and Bib-
lical periods, the whole subject of insanity was entirely
wrapt up in the grossest superstition and relegated to
the influence of good or evil spirits. The ancient
Egyptian understood well enough what every other civil-
ized nation has found out by observation, namely, the
enormously destructive effects of alcohol upon the human
brain. An ancient papyrus exhorting a drunkard to
forsake the tavern, states " that if beer gets into a man,
it overcomes the mind."

Biblical illustrations of insanity are too familiar to need
mention. The insanity of Saul, Nebuchadnezzar, and
the feigned insanity of King David are household knowl-
edge. The healing of the lunatic in the New Testament
describes the classical symptoms of epilepsy, and the de-
portment of the swine after being pervaded by the devils
or unclean spirits, cast out of the Gergesene madman,
gives a graphic illustration of the objective character and
individuality of demoniacal possession in insanity.

A glance at the status of insanity among the Greeks is
very interesting. The Hellenic world regarded insanity
as a visitation of the Gods. This was natural and in har-
mony with the elaborate character of their mythology.
Homer tells how the anger of the Gods reduced Belleropbon
to melancholia and Sophocles describes the furious and
destructive mania of Ajax terminating in melancholia,
Euripides gives such a fine description of the cardinal
symptoms of an attack of homicidal fur>' with epilepsy
that it might well pass as the description of a well in-
formed modem psychiatrist.

The first protest against the superstition and ignorance

CORRELATION OF SCIENCES. 3

in which this subject was enveloped is found in the writ-
ings of Hippocrates. Hippocrates was wonderfully in
advance of his times. Here was a physician and a man of
scientific knowledge, practising in the fifth century before
Christ, yet his bold, self-reliant opposition to superstition
and ignorance always kindles new admiration. He wastes
no words in battering down the makeshift of ascribing
misunderstood things to the Divinity, the invariable refuge
of the ignorant.

In speaking of epilepsy the ** Sacred Disease,** he says:
** The sacred disease appears to me no wise more Divine
nor more sacred than other diseases; but has a natural
cause from which it originates like other affections. Men
regard its nature and cause as Divine from ignorance and
wonder, because it is not at all like other diseases.*' He
also brings out the inconsistency of singling out epilepsy
as the sacred disease since so many kindred affections of
the brain of equally mysterious origin ought equally well
be called Divine or sacred diseases. He remarks again :
**They who first referred this disease to the gods appear
to me to have been just such persons as the conjurors,
purificators, mountebanks and charlatans now are. * * *
Such persons, then, using the Divinity as a pretext, and
screen for their own inability to afford any assistance, have
given out that the disease is sacred, adding suitable rea-
sons for the opinion, and they have instituted a mode of
treatment which is safe for themselves, namely, by apply-
ing purifications and incantations and enforcing abstinence
from baths and many articles of food, which are unwhole
some to men in disease. * ♦ * This disease is formed from
those things which enter into and go out of the body and it
is not more difficult to understand and cure than the
others, neither is it more Divine than other diseases.

4 CORRELATION OF SCIi':NCKS.

* * * **Men ought to know that from nothing else
but the brain (the soul and with it physic manifestations
was located in the stomach by one eminent physician of
the middle ages) come joy, despondency and lamentation

* * * and by the same organ we become mad and
delirious.*'* These are fine, blunt, common sense words
from a scientific man, and it is a pity that they remained
unheeded for two thousand years.

Hippocrates* hint as to the causal agency of epilepsy in
the italicised sentence is particularly interesting, for even
to-day we have only begun to search out whether epileptic
attacks may not be due to the action on the brain of some
poison which escapes from the intestines into the blood in
course of disordered digestion. Hippocrates clearly points
out too that disease of the brain is accountable for
insanity. Besides this he even classified insanity with
such good sense into manias, melancholias and dementia,
that in 90 per cent of the cases at the present day the self-
same classification is used.

Furthermore he believed that diseases of the brain were
caused by **bad humors.*' And if the term **bad
humors ** be translated as poisons or toxic agents it is the
scientific language which we have just begun to employ
in explaining the cause of many forms of insanity.

This remarkable man went even further. He proposed
treatment and cure of the insane, by ridding and purging
the body of these brain disturbing humors.

The next champion of enlightenment with regard to
the insane, appears in Asclepiades, about 100 B. C. He
protested against poisoning patients with opium and
hyoscyamus, but tried to ** induce sleep by gentle friction. "
He would not tolerate venesection, nor dark cells, but
brought his patients out into the light and gave them an

CORRELATION OF SCIENCES. 5

efficient diet which although somewhat abstemious was
systematic and regular.

The renowned Celsus living somewhat later is rather
disappointing in his treatment of the insane, for what good
there was in his moral treatment, was overbalanced by
the abuse of the insane, making them ** capitulate," by
starving, binding in chains and in beating them. His
influence in subsequent periods was also pernicious, for as
Tuke remarks: '*It is melancholy to reflect that many
centuries afterwardm^all that was bad in his system was
faithfully copied and even intensified, while what was
good (the music, the sports, and the excitement of cheer-
ful hopes) was overlooked ; as was also the employment of
friction — in other words, massage and regular exercise
after food. "

Of all names illustrious in the rescue of the insane from
Hippocrates down to the times of men of Pinel's stamp,
that of Caelius Aurelianus stands alone and unrivalled.
The isolated brilliancy of this man is due to scientific
knowledge and the attributes of courage of convictions,
common sense and humanity. Moreover, all this in the
man was happily joined with a faculty of practical applica-
tion in the salvation of the insane. I can do no better
than to quote from Dr. Tuke as to what this man accom-
plished :

** He had no patience with those who reduced a violent
patient to obedience by flagellation which he speaks of as
applied to the face and head, and so causing swellings and
sores. He recognized the mental pain from which the
unfortunate would suffer on returning to consciousness.
He placed the maniac in a room, moderately light and
warm and excluded everjrthing of an exciting character.
His bed was to be firm, properly fixed to the floor, and

6 CORRELATION OF SCIENCES,

situated so that the patient would not be disturbed by see-
ing persons enter the room. Straw, soft and well beaten,
but not broken, was to be used for the bed, and if the
patient tried to injure himself, he was to be padded on the
neck and chest with soft wool."

" Minute and praiseworthy were the rules laid down by
the enlightened physician, as to the duties of attendants and
it would not disgrace, says Dr. Tuke, the corresponding
regulations in the hand-book prepared by the Scotch branch
of the Medico- Psychological Association. Thus they were
to beware of appearing to confirm the patient's delusions
and so deepen his malady. They were to take care not to
exasperate him by needless opposition and they were to
endeavor to correct his delusions at one time by indulging
condescension and at another by insinuations. Fomenta-
tions by means of warm sponges were to be applied over
the eyelids in order to relax them, and at the same time
to exert a beneficial influence on the membranes of the
brain, "

" Restlessness and sleeplessness were to be relieved by
carrying the patient about on a litter. During convales-
cence theatrical entertainments were to be given. • • •
Riding, walking and the exertion of the voice were recom-
mended. For the poorer patients, farming was to be
encouraged if they were agriculturists, while if sailors
they were to be allowed to go on the water. He
denounced the abstinence which Celsus had extolled and
asserted that a low diet was more calculated to cause than
to cure madness. Further he protested in the strongest
manner against putting patients in chains and trusted to
ire and control exercised by attendants. He speaks
against the practice pursued by some of making patients
intoxicated, inasmuch as insanity was often caused by

CORRELATION OF SCIENCES. 7

drink. He was opposed to venesection (but not to cup-
ping) and to reducing the strength of the patient by the
administration of hellebore and aloes, on the contrary, he
favored soothing and invigorating the patient by emollient
or astringent application."

The work of this man does not need much comment.
It speaks for itself. He is the Pinel of ancient times —
a firm indomitable humane apostle of science, striking
off the manacles of the insane, neglecting the twaddle
of superstition and instituting measures for treatment and
cure. In short, he took the insane out of the dungeons,
bedlams and infernos, and placed them in hospitals,
where they belong like other human beings afflicted with
diseases of other organs than the brain. All this we in
the light of modem times have only brought into gen-
eral use within the last twenty or fifty years. The man
was some seventeen hundred years in advance of his times.

Thus we find that even in ancient times science rescued
the insane from the hades of superstition and reached its
climax in caring for and treating them in the enlightened
hospital of Aurelianus, the forerunner of the great'modem
hospitals of the present day in our own State. This took
some four hundred years from the times of Hippocrates
to Aurelianus (first century A. D.) The remarkable thing
in this epoch of progress in psychiatry, is the fact that it
was accomplished by three or four great leading men not
even operating consecutively much less collectively, and in
the face of a mythology which firmly pervaded almost all
walks of life. When a man like Hippocrates starts a
movement of such magnitude some one must stand at
hand to take up his mantle and push the work with
unflagging zeal. A great man cannot accomplish grand
innovations without having great successors.

8 CORRELATION OF SCIENCES,

From the decay of ancient civilization to our own times
the histoiy of the insane has but repeated itself. In the
middle ages common sense and science were dethroned by
ignorance. Rationalism went to pieces and even the frag-
ments fell down and vanished in the abyss of superstition.
In such a benighted environment science could not thrive
and all that had been done for the insane was completely
lost. The insane fell into the clutches of superstition
and mysticism and literally and figuratively sank into the
hands of the devil, whence they were plucked forth by
science centuries later through the Pinels, Tukes,
Chiarugis, Daquins and ultimately placed in enlightened
hospitals through State care agency and the labors of
Esquirol, Foville, Guislain, Tuke, ConoUy, Jacobi, Ferrus,
Rush, Virgilio and Pisani.

The fate of the insane in the middle ages was simply
hideous. They wandered about "possessed of Devils,"
without home or habitation, with everyone's hand against
them and no choice between the Scylla of public cursings
and the Charybdis of the care of their relatives. For we
well know that private care of the insane, as it is liable
to be in all times, is a species of private hell.

Things even came to a worse pass than this, the insane
were not even accorded the saving grace of being con-
sidered human beings. They were not at times even
taken to be men possessed by devils and fiends, but were
held to be a different species, a set of animals or positive
incarnations of devils taking on human guise. -The
atrocities which such a belief would entail upon the insane
are hard to describe.

It is needless to dwell upon these things were it not to

showthatwe cannot possibly expect progress in the care of

. the insane without fostering the scientific study of insanity.

CORRELATION OF SCIENCES. 9

Truly nothing was spared the insane from the brutality
of the jailers armed with sticks and dogs, and the spittings
and mockings of the multitude ** for whom the sight of the
misery of the insane became an object of amusement and
recreation, " up to the administration of noisome decoctions,
rivaling the witches broth in Macbeth. One of these was
Venice treacle, which started in with the flesh and broth
of vipers, and then passing through sixty-two other in-
gredients, including all manner of disreputable weeds and
filthy roots, strove for final absolution by tapering oflf
with Canary wine and honey.

One redeeming feature of gentleness of humanity is the
care of the insane of this age by the monks. While the
monks could never free their minds from the belief that
the insane were possessed by devils and fiends, compassion
dwelt in their hearts, and their ** Exorcise te*' and ** Vade
retro SatanuSy* after New Testament teachings, were
more kindly exorcisms of the devil than flails, stones,
bludgeons and stakes. Churches and Holy wells accord-
ingly often furnished a refuge for the insane.

Let us drop the curtain upon the times when the quasi
religious man hardened his ignorance into contempt and
vindictiveness at the sight of a Kepler explaining the path-
ways of the planets, of a Galileo elucidating the laws of
mechanics, or of a Pinel smiting off the gyves of the insane.
His enmity has long since smouldered into ashes, and out
of them have arisen the beneficent hospitals of our own
times; for meanwhile science had been slowly resurrecting

* Most undoubtedly the insane contributed the maiority of victims to this eyil
torture. The vaporings and incredible feats which the paretic proclaims
and the systematized delusions in certain other forms of insanity must have
furnished abundant ease of conscience for the bigots of such times to torment
lunatics as witches or devils. The doings of religious maniacs and melan-
cholies must also have furnished sufficient blasphemy to merit torture and
death. We can hardly believe, however, that it made much difference with the
insane, whether they were called witches or *Munaticks."

lO CORRELATION OF SCIENCES.

from the tomb of the dark ages, and had chosen men
of Philip Pinel's stamp as her apostles to deliver the
insane out of bondage. Xo one with even a most languid
interest in the terrible history of the insane or in their
present welfare, can fail to be interested in the character
and doings of Pinel.

The story of Pinel has often been told, but I trust that
the moral I have in mind, in repeating a sketch the history
of the insane, will not stand out any the less boldly by
rendering the account again.

Pinel's work, unlike that of Hippocrates and Aurelianus.
was enduring because he had the good fortune to have a
successor like Esquirol. The secret of Pinel's power lay
in the fact that he was an apostle of science. He had that
which few, if any, about him possessed — an elementary
but scientific knowledge of insanity. Beside this, he had
the energy and courage to defend his beliefs against the
pseu do- scientific and social prejudice of his time. He saw
that the insane did not belong to a different species, but
that they were human beings afflicted with a disease of
the brain ; that they had to be considered as patients, and
receive medical care and treatment in hospitals like other
human beings atBicted with maladies elsewhere in the
body, Pinel's good fortune was his inspiration by science.

Toward the close of 1793, Pinel, who was physician at
the Bicetre (the great French prison for the insane), could
stand the sight of things there no longer. He went to one
of the leaders of the French Revolution for authority to
take the irons off the insane. "His demand was bold, for
he ran the risk of attracting the distrust and suspicion of
men always disposed to find everywhere plots against
themselves." In fact, the suspicion immediately betrayed
itself in Couthon's reply:

CORRELATION OF SCIENCES. II

** Citizen I shall go to-morrow to Bicetre to inspect it;
but woe to thee if thou hidest the enemies of the people
among thy lunatics. "

The man kept his promise, and arrived next morning
at Bicetre to examine the insane himself in detail. He
soon tired of the monotony of the pandemonium of screams
and yells, and the clanking of chains echoing from the
damp and filthy cells, and, turning to Pinel, said, *'Look
here, citizen, are thou insane thyself, that thou wilt un-
chain such animals?** ** Citizen," replied Pinel, *'I am
convinced that these lunatics are so unmanageable only
because they are robbed of air and liberty, and I dare
hope much from the opposite means of treatment.**
•*Well, do with them what thou likest, but I am afraid
thou will be the victim of thy presumption. "

Pinel commenced work that same day. Had he not in
advance taken all precautionary measures which such a
step required, such as proper provision for the freed
slaves, he would have failed. In less than a week he had
freed more than fifty lunatics from their manacles. * * Some
were exceedingly dangerous, and among them patients who
had been in chains for ten^ twenty and even thirty years.*

Pinel stayed two years at the Bicetre, encountering
plenty of the pigheaded opposition of ignorance, but he
had the satisfaction of seeing his efforts crowned with
success. The excitement created by bad treatment gave
way to quietness and improvement in the patients, and
tractability replaced tumult and disorder. Everywhere he
went, light, air and decent food came. Promenades and
workshops arose to divert into wholesome trends the

^ Dr. Pargeter in 1792 says that the festerings of these manacles and cords
at times actually destroyed the flesh of the extremities. In one case where
the jailer had tied the patient's legs with cords, when removed, these had so
lacerated the integuments, tendons and ligaments, that gangrene took place.

1 2 CORRELA TION OF SCIENCES.

disordered energy of the insane. Jailers were forced to
discard their sticks and dogs and had to become
attendants. In short, Pinel forecast the modem hospital
for the insane.

Pinel then went to work at the Salpatrifere, another
large prison for the insane at Paris. Again he met with
blind, malignant opposition, but achieved success in the
end.

Seldom, if ever, do strokes like Pinel's make their force
felt as soon as it would be expected. Vox populi is often
not vox Dei^ but vox ignorant ice. For the people are
ignorant, and ignorance fights desperately against knowl-
edge and science.

Without detracting from Pinel's glory it would be unfair
to overlook the work in Germany, England and Italy.
In Germany, in several places, Pinel's work had already
been accomplished. As early as 1773, no lunatic was
allowed admittance to the asylum at Berlin without a
medical certificate. In 1785, at Frankfort-on-the-Main, a
hospital of the enlightened type existed, and also at Lubeck
(1788), and at Brunswick (1793). Berlin started one in
1784.

The reason for this advance in the care of the insane by
Germany is not hard to find. The Germans foster scien-
tific research ; they have found out that it pays. Science
is substantially encouraged by the government, and econ-
omy, strength, prestige and humanity are the returns.
Amid such a splendid galaxy of names as Gall, Spurzheim,
Haller, Burdach, Reil, Oken, Jacobi and Nasse it could
not be otherwise. Observe, too, how, at the beginning of
the century, Germany was taking means to sow broadcast
a general knowledge of insanity, that it might not be im-
mured or become narrowed within the asylum walls. We

CORRELATION OF SCIENCES. 1 3

find that domiciles for the insane were built near the
universities, where scientific investigation of the insane
might be broadened out and an understanding of insanity
brought to the general practitioner by teaching the medical
student.

Dr. P. M. Wise, the president of our State Commission
in Lunacy, has, in his recent address before the New York
State Medical Society, struck the keynote of this same
appeal to have a wider appreciation and teaching of in-
sanity in our own country, especially when, in these days,
we are stepping across the threshold of a new epoch in
scientific investigation of insanity which bids fair to make
a revolution in the progress of psychiatry.

Note, too, Germany's foremost attitude in arousing and
keeping alive interest in mental science in her journals
even at the beginning of this century. The magazine for
Psychotherapeutics was started in 1805 and rehabilitated in
1808, with less pedagogy and metaphysic and more natural
philosophy. A little later Nasse started a second journal
which owed much to Jacobi, the Nestor of the German
alienists who exercised a personal influence on the devel-
opment of mental science in Germany.* In 1819 another
journal devoted to the inte?ests of the insane, appeared.
In 1838 still another, and in 1844 AUegemenie Zeitschrift
fiir Psychiatric, which still continues.

Here are five journals devoted to the interests of insan-
ity within the first half century. No other nation has a
record like this. The influence of these journals on the
progress of insanity has indeed been great.

* Homage is again to be rendered to Samuel Tuke, for his example inflnenced
Jacobi who translated into German in x8aa Tuke's " Description of the (York)
Ketreat containing an account of its Origin and Progress, the Modes of Treat-
ment and a Statement of Cases.*' (1813).

1 2 CORRELA nON OF SCIENCES.

disordered energy of the insane. Jailers were forced to
discard their sticks and dogs and had to become
attendants. In short, Pinel forecast the modern hospital
for the insane.

Pinel then went to work at the Salpatrifere, another
large prison for the insane at Paris. Again he met with
blind, malignant opposition, but achieved success in the
end.

Seldom, if ever, do strokes like Pinel's make their force
felt as soon as it would be expected. Vox populi is often
not vox Deiy but vox ignorantice. For the people are
ignorant, and ignorance fights desperately against knowl-
edge and science.

Without detracting from PineVs glory it would be unfair
to overlook the work in Germany, England and Italy.
In Germany, in several places, Pinel's work had already
been accomplished. As early as 1773, no lunatic was
allowed admittance to the asylum at Berlin without a
medical certificate. In 1785, at Frankfort-on-the-Main, a
hospital of the enlightened type existed, and also at Lubeck
(1788), and at Brunswick (1793). Berlin started one in
1784.

The reason for this advance in the care of the insane by
Germany is not hard to find. The Germans foster scien-
tific research; they have found out that it pays. Science
is substantially encouraged by the government, and econ-
omy, strength, prestige and humanity are the returns.
Amid such a splendid galaxy of names as Gall, Spurzheim,
Haller, Burdach, Reil, Oken, Jacobi and Nasse it could
not be otherwise. Observe, too, how, at the beginning of
the century, Germany was taking means to sow broadcast
a general knowledge of insanity, that it might not be im-
mured or become narrowed within the asylum walls. We

CORRELATION OF SCIENCES. 1 3

* Homafi^e is again to be rendered to Samuel Tuke, for his example influenced
Jacobi who translated into German in x8aa Tuke's '* Description of the (York)
Ketreat containingr an account of its Orisrin and Progress, the Modes of Treat-
ment and a Statement of Cases." (1813).

13 CORRELAnON OF SCIENCES.

disordered energy of the insane. Jailers were forced tt>
discard their sticks and dogs and had to become

attendants. In short, Pinel forecast the modern hospital
for the insane.

Pinel then went to work at the Salpatrifere, another
large prison for the insane at Paris, Again he met with
blind, malignant opposition, but achieved success in the
end.

Seldom, if ever, do strokes like Pinel's make their force
felt as soon as it would be expected. I'ox populi is often
not vox Dei, but vox ignoraiitite. For the people are
ignorant, and ignorance fights desperately against knowl-
edge and science.

Without detracting from Pinel's glory it would be unfair
to overlook the work in Germany, England and Italy,
In Germany, in several places, Pinel's work had already
been accomplished. As early as 1773, no lunatic was
allowed admittance to the asylum at Berlin without a
medical certificate. In 17S5, at Frankfort -on-the-Main, a
hospital of the enlightened type existed, and also at Lubeck
(1788), and at Brunswick {1793}. BerUn started one in
1784.

The reason for this advance in the care of the insane by
Germany is not hard to find. The Germans foster scien-
tific research; they have found out that it pays. Science
is substantially encouraged by the government, and econ-
omy, strength, prestige and humanity are the returns.
Amid such a splendid galaxy of names as Gall, Spurzheim,
Haller, Burdach, Reil, Oken, Jacobt and Nasse it could
.'^Ot be otherwise. Observe, too, how, at the beginning of

I century, Germany was taking means to sow broadcast

meral knowledge of insanity, that It might not be im-

i or become narrowed within the asylum walls. We

CORRELATION OF SCIENCES. 1 3

Note, too, Germany's foremost attitude in arousing and
keeping alive interest in mental science in her journals
even at the beginning of this century. The magazine for
Psychotherapeutics was started in 1805 and rehabilitated in
1808, with less pedagogy and metaphysic and more natural
philosophy. A little later Nasse started a second journal
which owed much to Jacobi, the Nestor of the German
alienists who exercised a personal influence on the devel-
opment of mental science in Germany.* In 1819 another
journal devoted to the inte?ests of the insane, appeared.
In 1838 still another, and in 1844 Allegemenie Zeitschrift
fiir Psychiatric, which still continues.

* HomAgt is again to be rendered to Samuel Take, for his example inflnenced
Jacobi who translated into German in i8aa Tuke's *' Description of the (York)
Ketreat containing: an account of its Orig^in and Progress, the Modes of Treat-
ment and a Statement of Cases." (1813).

14 CORRELATION OF SCIENCES.

Germany's* example, then, is a fine monument for my
plea of a state support of scientific investigation of the
insane.

Italy was but little in the vanguard of Germany at the
close of the last century. Chiarugi and Daquin had com-
menced reforming the asylum at Florence on Pinel's plans
before the latter had begun his work.

In England, the work was taken up and continued by
the Tukes at Bethleni and York retreat.

In the United States, the insane were at first subjected
to the same abuses as elsewhere. But in spite of its early
hardships and poverty, this country centering its efforts
at Philadelphia managed not to be behind in the progress
of humanitarian treatment of the insane.

As early as 1751, Dr, Thomas Bond put forth his efforts,
seconded by Benjamin Franklin, for the establishment of
an hospital for the relief of the sick poor and " for the re-
ception and cure of lunatics," This hospital, too, recog-
nized that insanity was a disease and that its victims were
to be cared for and treated by physicians. It was in this
hospital that Dr. Benjamin Rush gathered for twenty-nine
years his experience that led him to suspect that much in-
sanity arose from poisoning of the brain by the acute
bodily diseases, an important point of view that has now
come to the surface. It also should be remembered that
the United States very early recognized the maxim of

lUodard. This was

le Gerraooy traa In advance with a few institutlnns It is of coarse not to
I IcDt^th and breadth of tha land was np to the same
caw in every other country atraggling for the weal of

D bad enlightened Bethleni and York
Id the same at the Florentine Aayltim.
in France, aa we have seen. Pinel corrected Blcetreand SalpetrlSre. Throngti-
out these couDtrieB the example was takeo up very slowly. By her teaching*,
her journal*, her hospitals, and tbe requirement of medical certificateB,
Germany had the leftd.

CORRELATION OF SCIENCES. 1 5

Horace Mann that the dependent insane are wards of the
State, a conception which led to their final redemption
from abuse.

Twenty-four years passed by before Pinel's work ad-
vanced a single step. For Esquirol, his disciple, making
an inquiry into the condition of the insane and their estab-
lishment in 18 19, had occasion to write such bitter words
as these :

** These unfortunate people are treated worse than
criminals, and are reduced to a condition worse than that
of animals. I have seen them nailed, covered with rags
and having only straw to protect themselves against the
cold moisture and the hard stones they lie upon; deprived
of air, of water to quench their thirst and of all the
necessaries of life ; given up to mere gaolers and left to
their brutal surveillance. I have seen them in their nar-
row and filthy cells without light and air, fastened with
chains in these dens in which one would not keep wild
beasts. * * * This I have seen in France, and the
insane are ever3rwhere in Europe treated in the same
way."

The second epoch in the progress of the insane is the
period of passive indifference on the part of society. In
several countries, in one or two institutions, the insane
were released from the bondage of chains and on their
way toward decent and humane treatment. But from the
release of manacles to care and treatment in the hospital
was a long stride, and unhappily a period of forty years
from the beginning of the century awaited the insane in a
second epoch of the indifference of society.* Very slowly
indeed did Pinel's redemption make itself felt.

*In 1804 the law classed the insane with animals ; thus the code Napoleon
(Belgium, 1804) punished those who allowed *' the insane and mad animals to run
about free."

1 6 CORRELATION OF SCIENCES.

The insane were simply freed from their chains and noth-
ing more. To any further progress society was indifferent.
The insane were simply put out of the way, no longer
actively tortured in the majority of instances, but merely
gotten rid of. This was a period of sequestration, a nega-
tive mercy to the insane on the part of society, compared
with previous times. After society had stowed the insane
out of the way, where they could do no harm nor be
heard from, this was the end of them. No one took the
trouble to know whether justice and individual liberties
were travestied, nor was there any pretense of medical
supervision and treatment.

Accordingly the insane were stowed away in the iniqui-
ties of the almshouses, workhouses, and other rookeries,
or confined with prisoners in jails. This was the epoch of
social indifference, which occurred between Pinel's and
Esquirol's times and the State care, culminating in the
modem hospitals. This was the day of Bedlams, Pande-
moniums and Madhouses, and over their doors might as
well have been written the motto: **Who enters here
leaves hope behind." This was not much of an improve-
ment over the Infernos which Pinel found.

This kind of thing continued longer than we should ex-
pect. In Belgium, for instance, Guislain found it evil
enough to suit the most pessimistic views of human
nature. The physicians in the asylums held subordinate
positions, under lay superintendents who were specu-
lators, working the lucrative side of the thing. It must
have been a fine thing to filch political mone}'- out of
such poor devils as lunatics, and have their cost per
capita reduced to seventy centimes a day. Most of the
patients were under the care of their relatives, who were
generally ready to believe anything of them, and treated

CORRELATION OF SCIENCES. 1 7

them accordingly. Others fell into the clutches of mer-
cenary Judases who bid against each other for the lowest
prices. The patients were shut up in cellars, or small cells,
Mrith hardly enough to eat or drink, with chains and iron
rings on their hands and feet, without the faintest pretense
of medical authorization. Some, when brought out of
these ratholes, arrived at the asylums in a dying condition.
These iniquities were still going on in a civilized country
in the years of the Christian era 1841 to 1850!

This condition of things should warn the custodians of the
insane not to fall back into ancient practices of barbarism,
by intrusting the insane, who are really diseased and have
to be treated methodically and scientifically, like all other
patients in hospitals, into the hands of the laity who are
ignorant of medical science. Such a condition of things
would tend toward a reversion to the old system of making
the insane prisoners or slaves to people who would grind
out of them whatever profit they could.

When the insane have recovered from their mental dis-
order, but not sufficiently to be able to stand the wear and
tear on nervous energy in resuming the struggle for exist-
ence, it is most important to provide an intermediate stage
of after care between their release from the hospital and
their return to the activities of life. The plan of allowing
the laity to have care of the insane except in the judicious
provisimi for after care is opposed to the whole course
of science which has taught us that insanity is a disease
and must be treated by physicians of special scientific
training.

The history of the succeeding epoch in the progress of
the insane, is too familiar to need mention. Ferrus has
much of the credit in initiating this most important step
of State care of the insane in France during the latter

1 8 CORRELATION OF SCIENCES.

portion of the first half of this century. Other countries
independently took up the same work.

Within the last twenty or thirty years, with State care
as the haven, and science as the beacon light, the insane
have been guided into the refuge of enlightened care and
treatment. They have been taken from the almshouse,
the madhouse and pandemonium, from amongst criminals,
and placed in enlightened hospitals. Dante's motto has
faded from the doorway, and the hope of treatment and
recovery is held out to them.

In our own State, we have good reason to be proud that
our institutions are not in any way behind those of any
other place in the world. The name of asylum redolent
with so many hateful memories of the past has been
erased and the word ** hospital" symbolizing humanity
and hope substituted.

The last word of the history of the insane in our own
country cannot be written without paying tribute to the
members of the first Commission in Lunacy of the State
of New York, especially to its President, Dr. Carlos F.
MacDonald, to the present Commission, as well as the
superintendents of the State hospitals. The present
progress in the treatment and welfare of the insane in our
State is their achievement.

The history of the insane may be divided into four
periods :

I. The Period of Revenge.
II. The Period of Indifference.

III. The Period of Humanitarian and Empirical Treat-

ment.

IV. The Period of Scientific Study, Rational Treat-

ment and Preventive Medicine.
The first period presents the spectacle of society under

CORRELATION OF SCIENCES. 1 9

the ban of ignorance, revenging itself upon the insane.
This lasted some seventeen hundred years or more up to
the times of Pinel.

The second shows the passive, indifferent attitude of
society. This was the period of mere sequestration of the
insane, witnessed in the first half of this century.

The third presents the more inspiring sight of the active
interest of society in behalf of the welfare of the insane
through legislation and the founding of hospitals for ben-
eficent care and medical treatment. The third and present
epoch we may designate as the period of empirical medi-
cal treatment. In this epoch the material welfare of the
insane, such as their housing, comforts, amusements,
moral and physical care, have reached a high degree of
excellence.

The future oxidi fourth epoch in the history of insanity
will be the period of rational medical treatment and cure,
and possibly by more radical measures in public medicine
for the prevention of the increase of insanity. This will be
based upon a more thorough understanding of the cause
and course of the disease in any given case. This fourth
epoch, the threshold of which we are crossing at the pres-
ent time, is coincident with the establishment of centres
of scientific investigation, in conjunction with systems of
caring for the insane, in public and private hospitals.
Science has hardly begun the broad and detailed investiga-
tion of the causes, origin and course of insanity. All this
progress up to the present time has come about by the
general march of science in medicine before even any
detailed attempt was made to unravel the specific prob-
lems of insanity itself. How much more then, may we
expect for the future when science will begin to use its
present capacity and fitness to reach the very heart of

20 CORRELATION OF SCIENCES.

the problem, the scientific story of the whole life history
of insanity.

This new and fourth epoch in the history of the insane,
launched forth by the stimulus of modem scientific in-
vestigation, will gradually point out the way and take into
account the benefits of the pretention of insanity.

Unfortunately, the time is not yet at hand when these
measures for the prevention of insanity can be at all ex-
tensively or successively applied. Public opinion is not
yet reared up to the scientific truths as to the sources of
insanity, nor of their menace to civilization and society.

In educational directions, a scientific basis for the
phenomena of human nature should be taught earlier in
the schools. The innate instability of the higher and
self-controlling spheres of the brain and the proneness of
these spheres to undergo retraction from other parts of the
brain, under the influence of toxic and other pathogenic
stimuli, and the concomitant phenomena of beginning
insanity or degeneracy, should have an elementary and
simple presentation in the school text-books on physiology.
The same presentation should be made of the physical basis
of heredity and the noxious effects of insufficient food
supply and poisons upon the germ plasm and nerve cells.
Above all, the action of alcohol upon the nerve cell should
be impressed upon the minds of growing children as soon
as they are able to assimilate such knowledge. The
evil sources, such, for instance, as the dissemination of
syphilis that lead to the worst and most intractible
forms of nervous and mental diseases are here among us ;
we cannot overlook them ; they are factors of life and the
State must sooner or later face the problem of taking
strong measures to counteract and mitigate them.

As already forecast by empirical experience, science,

CORRELATION OF SCIENCES. 21

even at this early stage in the new epoch of the scientific
investigation of the insane, shows that in the case of an
individual, without hereditary defects of the brain, the
conditions for recovery are favorable. The probability
that retraction of the arms of the nerve cell may dislocate
them from their fellows, and cause corresponding dissoci-
ation of consciousness, synonymous with many phases of
insanity, shows that no irreparable damage has occurred
in the brain. Its mechanism is intact, but is merely, as it
were, thrown out of gear. Each tiny cellular microcosm
in the brain is intact, it has undergone no destruction, but
a slender rift has occurred somewhere between the con-
nection of the cells, and fields in the higher domains of
consciousness are split oflE. There is no longer harmony,
but discordance in the inter-relation of the spheres of higher
consciousness.

The nerve cell itself may even undergo quite a
train of organic changes without passing over into the
bourne of destruction, hence the chances of recovery in a
perfectly normal individual, undamaged by hereditary
burdens upon his nervous system, are most hopeful. It
remains for us to correct the process of retraction, which
is a sign of deficient energy of the nerve cell, and the
brain may be made whole again. Such a form of treat-
ment worked out on strictly scientific grounds has actually
been applied with successful results by one of our Associ-
ates at the Pathological Institute in a case of so-called
double consciousness and has been based upon the
principles of pure science, and premised step by step
from a scientific investigation of the case lasting many
months.

Science, however, cannot be expected to perform mira-
cles in the cure of the insane. If insanity be taken in its

22 CORRELATION OF SCIENCES.

early stages when the brain is free from hereditary de-
fects, much may be accomplished and the view is hopeful.
But if the beginnings of insanity have passed away, and
are replaced by its later stages, whether in the individual
or extended through a series of generations, the time has
gone by when science might direct intervention. If a
nerve cell is once destroyed, the damage is irreparable.
A nerve cell is ordained with its functions but once during
life, and is never replaced by a new one. If one, or two
generations have damaged their nervous system and the
germ plasm at the same time, and have entailed a heavily
mortgaged cerebral estate upon their successors, the time
for restituting the mechanism to provide for the lost
energy of the nervous system has passed. Hence the
constant plea of the scientist to those who have jurisdiction
over the insane to seize the process in its beginnings,
where it is less of a burden to the State, and more amen-
able to recovery, than in the final stages, hence the anxiety
of the scientific student of insanity to look for the time
when public opinion may at least put forth some few
efforts in the direction of preventive medicine in insanity.

Chapter II.

THE PSYCHOPATHIC HOSPITAL.

The great importance, both practical and scientific, of
apprehending the early stages of insanity, is obvious.
The question is as to the means for this end. It is nothing
short of a misfortune and an impediment to psychiatric
progress in the large cities of this country and particularly
in its metropolis, that no hospitals exist for the incipient
and initial stages of insanity. The establishment of such
a hospital is exceedingly important. It would encourage

CORRELATION OF SCIENCES. 23

a better popular understanding of insanity and educate
the rank and file of the populace to bring the insane
earlier to the attention of the psychopathologist and psy-
chiatrist. For the memories associated with the word
asylum still linger in the popular mind. In spite of the
enlightenment of the modem hospitals for the insane
there is still an aversion in the lay mind toward bringing
a patient to an institution for '* the insane " until the case
becomes serious, even dangerous. The asylum is thought
of in the nature of a last resort and used under more
or less compulsory circumstances. In these hospitals
for initiary stages of mental diseases, placed in the
midst of the great cities, many cases would be presented
voluntarily and the custom of sending patients before
becoming violent or mentally irresponsible would take
root and grow. We should do all in our power to
concentrate attention upon a wider apprehension of the
beginning and acute cases of insanity. This can in the
main be accomplished by educating and persuading the
popular mind to the belief that in the treatment of the
earliest phases of insanity lies the greatest hope of
recovery, and that this hope dwindles more and more as
the symptoms become more durable and persistent. The
establishment of such a hospital would be a first and most
valuable step toward the fulfillment of this educational
influence of the importance of sending insanity in earlier
stages than is presented to the ordinary hospitals for the
insane. It follows likewise that the operation of such a
hospital is an important factor in bearing on the prevention
of insanity.

Dr. Peterson's name for this greatly needed institution
— The Psychopathic Hospital — embodies its functions
admirably. The name psychopathic hospital would

CORRELATION OF SCIENCES.

r or later convey to the minds of the people a feeling
,t from that of the asylum. For in the commitment
to the asylum, people believe that their relatives or friends
are liable to be placed side by side, or at least in the same
atmosphere, with the inveterate and doomed cases of in-
sanity. This feeling certainly enlists sympathy. From
this general repugnance to the asylum, and from the fact
that the patients are put in a hospital for " the insane,"
thus branding them with the stigma of "insanity," natur-
ally makes the family put off the evil hour of the diagnosis
of insanity. The patient is retained at home, all hope is
lost or the case becomes unmanageable. The psycho-
pathic hospital in the metropolis would, in the course of
time, largely do away with the prejudice that now holds
back the early and favorable cases from proper treatment
and study.

The meaning of insanity in the popular mind is most
often crushing and conveys an element of hopelessness.
If then these associations of the name are in a certain
measure obstacles to psychiatric progress, we must take
into account the popular feeling, especially as there are
good scientific grounds for it and indulge it in a different
and more hopeful conception of the early stages of
mental disease. Let us substitute for the sweeping
term "insanity" some equivalent, such as "psycho-
pathy," which will convey to the lay understanding
that the patients for this hospital are not yet insane in
the popular sense, but are subject to a process, which if
taken in hand, will prevent development into insanity.
The sphere of the hospital is to seize the active percursor
of insanity as well as the early stages of mental disease.
The psychopathic hospital is for the reception of many
patients which would not be ordinarily regarded as ready

CORRELATION OF SCIENCES. 25

for commitment to the asylum. Yet from this very
standpoint how valuable is its sphere in prevention and
cure of insanity ? The psychopathic hospital is for the recep-
tion and wider identification of earlier^ functional and more
curable phases of mental diseases. According to the idea
based upon the principle of neuron energy as a law govern-
ing the progpression of the phases of mental diseases* the
insane fall into two great classes as regards hospital treat-
ment and care. Broadly considered the first class would
comprise those early phases of mental diseases correspond-
ing to the functional mental maladies or psychopathies\
should pass into the psychopathic hospital. The second
class constituting the organic strata of mental disease or
the neuropathiesj and belong to the hospitals for the insane.
This second class is composed of two groups. The first
includes the cases whose symptoms correspond to degen-
erative and regenerative energy cycles of the neuron,
while the second includes those cases manifesting symp-
toms of progressive degeneration and attended with
destructive changes in the neuron. These two groups
should be individualized in the hospitals for the insane.

The cases of the first class are amenable to recovery.
Of the second class, the condition of the first group is less
hopeful though recovery is not impossible; while the
condition of the second gproup is hopeless.

The psychopathic hospital is practicable in the large
cities. This distribution of insanity relative to treatment
and care based upon the theory of neuron energy cannot be
carried out in practice with fixed and absolute boundaries

•Vide '* Neuron Energry and its Psychomotor Manifestations." Archives,
Vol. 1, No. t.

t The psychopathies exhibit phenomena concomitant with dissociation and
agsn'^ST&tion of the neurons. Loc. cit.

X Loc. cit.

CORRELATION OF SCIENCE!

of the divisions. While the province of the psychopathic
hospital includes the functional strata of mental and also
certain nervous diseases, it should also provide for the cases
entering the threshold* of the upper strata of neuropathic
mental diseases. Certainly one great factor of practical
importance independent of the advantages of such dis-
tribution for scientific study, is that the division brings
the matter of expectancy of cure to the surface.

When one reflects upon the importance of studying and
treating the earlier phases of insanity and its tendency
toward preventive medicine in mental diseases, it seems
really strange that the evolution of the psychopathic
hospital in the large cities of this country has not been
anticipated. The practical benefits of the psychopathic
hospital are too obvious. The fact that the plan would
bestow cure upon many patients who, left to themselves or
their friends, would otherwise be committed to the asylum
later in a much less curable, even in a hopeless condition,
answers the argument of gain over cost and the practical
utility of the hospital.

Abroad, particularly in Germany, almost every city and
university town operates a plan of this kind in the in-
stitutions known as psychiatric clinics. In New York
City it must be said to our disparagement that the only
substitute — and perceiving the great purpose of such pro-
vision for psychopathies it is more a makeshift than
substitute — is a pavilion at one of the public hospitals.
Facilities for study at this place are few; here the cases
are merely distributed to the various large asylums in
the vicinity. As this pavilion is merely a centre of dis-
r tribution it has neither theoretical nor practical thera-

mtio value. Whether or no such an institution should be

CORRELATION OF SCIENCES. 27

undertaken wholly or partly by the State is a question out
of my province, but the expansion of this pavilion into a
psychopathic hospital is an imperative necessity.

From the practical issues let us turn to the value of
such a hospital for scientific research in psychiatry. This
may be summed up in saying that the very heart of the
greatest problems in mental disease lies in the investiga-
tion of the cases entering the psychopathic hospital. The
impetus to progress in psychiatric research from the
scientific investigation of the cases in such a hospital
cannot be overrated. Many who are providing the oppor-
tunity for the gprowth of scientific centres in connection
with hospitals for the insane or whole systems of these
hospitals are prone to think that the cases for investiga-
tion lie exclusively in the sphere of the asylum. This is
a mistake. Qtmntitativcly the material for investigation
in the asylum is indeed great ^ but qualitatively regarded the
opportunities are few. In the hospitals for the insane the
majority of the cases are in too late a phase of the morbid
mental process to be suitable for investigation. A single
properly selected case in the psychopathic hospital where
the morbid process and concomitant psychomotor
phenomena are in an initial stage of development is
worth more by far for investigation than hundreds of the
average run of asylum cases. The investigation of such
cases may furnish the key to great laws and principles
governing the whole course of mental and nervous
diseases.

The first thing in inaugurating scientific centres of
psychiatric research is to find their sphere of investigation.
This lies largely in the study of a class of cases which
could be induced to enter the psychopathic hospital.

For the sake of illustration I venture to allude to the

28 CORRELATION OF SCIENCES.

scientific centre of the New York State lunacy system.
This institution, while in intimate touch with the hospitals
for the insane, is not incorporated with one of them for
the express purpose of affording extensive scope of investi-
gation. It is situated in the metropolis to seek material
for the study in one of its most important departments —
that of psychology and psychopathology. But without any
systematic hospital provision for the psychopathies where
to individualize and collect them, our opportunities for in-
vestigation in this most important province are limited and
dictated by chance and accident. The study of these cases
is not taken up by the university psychological laboratories
for here investigation turns in the rut of routine scholas-
ticism and is so immersed in the study of the psychomotor
phenomena of the normal individual, the college student,
that the great value of making progpress in the knowledge
of the normal phenomena by correlative research of the
abnormal is unfortunately altogether neglected. The
general practitioner sees many of these psychopathies.
To him they are most often a sort of noli mc tangcrc to be
passed on to the specialist. From the psychiatrist they
receive scant attention and ultimately fall into the hands
of the neurologist who so little comprehends their nature
and cause, but is ashamed to confess it.

Both the psychiatrist and neurologist have practically
confessed inability to cope with these cases by merely
identifying the phenomena in clinical groupings under
purely descriptive names. As for the meaning of the
psychopathic phenomena and the underlying morbid
process they have caught but little more than a
glimpse.

The ideal home of centres of psychiatric research is in
the psychopathic hospital and clinic in the large cities

CORRELATION OF SCIENCES. 29

where opportunities are also best afforded for the remain-
der of the diversified investigation of the institution.
The psychopathic hospital would also exert a valuable
influence upon the aim of such a centre of psychiatric
research of bridging over the unfortunate gap in the
scientific study between mental and nervous diseases.

The psychopathic hospital should include on the staff the
general practitioner as well as the specialist, the psycho-
pathologist, neurologist and psychiatrist ; it should be the
valuable meeting ground of both of these provinces or
rather both departments of the same province. Under
the influence of such a hospital an effort might also arise
to seek out these cases instead of leaving the initiative of
admission and committal of psychopathies and insanities
to such an incompetent judge as the laity.

Stumbling blocks to the art and exiles from the science
of medicine the psychopathies have been sadly neglected.
Yet these same cases contain the greatest measure of
knowledge for psychiatry, psychology, psychopathology,
neurology and the science of medicine in general. The
importance of collecting these cases in a psychopathic
hospital and clinic for a wider, more accessible field of
research is indeed great. Instruction in the combined
psychopathic hospital, clinic and centre of psychiatric
research would also be an important factor in medical
education.

The beneficent influence of the psychopathic hospital is
finely summed up in the closing lines of Dr. Peterson's
address:* ** A psychopathic hospital would accomplish a
great practical good. It would be a boon to the many in-
sane now gathered daily into a pavilion at one of our

* In&vLgvLTsA address to the New York Neurological Society, May, 1898. Jour-
nal of Mental and Nervous Disease, June, 1898.

30 CORRELATION OF SCIENCES. ^^|

hospitals merely for distribution to various asylums. In
such a hospital many cases could be treated and cured,
thus avoiding transfer and commitment to asylums.
Medical students and special students of psychiatry would
profit from the convenience of access to the psychiatric
clinics and the young graduate would enter upon practice
with some definite knowledge of insanity and its treat-
ment. But the greatest value of the proposed special
hospital would undoubtedly be the opporttmities afforded
for those aggregate studies by many specialists which are
destined one day to discover the origin and cure of many
of the psychoses and incidentally to unravel some of the
mysteries of mind."

Chapter III.

THE ASYLUM AND SCIENCE.

Turning now to the organization of research work in
psychiatry, we must emphatically point out the fact that
scientific work along the old routine lines of one-sided in-
vestigation of insanity, would be nothing but a snare and
delusion; it would be a loss of time and labor; it would
be an utter failure, barren of actual scientific results.

The one-sided scientific investigation of insanity by the
microscope alone is not liable to yield results which
a comprehensive study is naturally bound to bring
about. It is equally safe to say that a restricted provision
for scientific work on insanity, along the beaten track,
followed for the last ten or twenty years, would, in a very
short time, become effete.

The general impression seems to be not only among the
laity but in the medical profession at large, and even in
thatibranch of it which deals with the insane, that all that
is necessary for scientific investigation in unravelling

1
I

CORRELATION OF SCIENCES. 3 1

the life history of mental diseases, is to bring into the
asylum microscopes, certain complicated machinery for
cutting thin slices of brains, an assemblage of aniline dyes
to stain these slices, and a goodly assortment of various
sized bottles and jars for the preservation of the brains.
This is a sadly mistaken notion of the way of investigating
insanity. It has been done over and over again in the
past twenty years at the hospitals for the insane, and the
results toward advancing psychiatry were not only highly
disappointing, but the plan has actually wrought harm.

Fettered by the incompetency of clinical methods of
investigating the living patient, psychiatry turned for
scientific light to the study of the dead through the micro-
scope. Thus, while in the living patient were hidden
great scientific truths and vast material for scientific
discoveries which might have inaugurated new trains of
thought and revolutionized whole departments of inquiry,
the psychiatrist was unable to reap the benefits by
reason of the inadequacy of his methods of investigation.

These methods are based on a wrong plan and an in-
sufficient conception of the great comprehensiveness of
the phenomena in insanity. The methods are of the
clinical kind, adapted for observation at the bedside in
ordinary general diseases of the body, but so utterly unfit
for the study of mental symptoms that one can hardly
expect to catch so much as a glimpse of the real nature
of these phenomena. One may say that where inquiry by
these kinds of methods leaves ofiE a large part of true
scientific research in psychiatry begins.

Thus psychiatric research is turned aside from one of
its most important domains and nearly the whole burden
of the work is cast upon the microscope. In this way,
save to the few bolder minds, the inspiration of the whole

CORRELATION OF SCIENCES.

scieotific side of psychiatry is dwarfed and bound up in the
work of the microscope and its accessories. It seems
strange that so noble, so comprehensive a science as
psychiatry should be circumscribed to a single unaided
branch of scientific research as pathological anatomy by the
methods of the microscope. But it is still stranger that this
unaided branch of investigation should have been in itself
circumscribed to the last degree. If the microscope is
used broadly and with scientific reflection; if it is co-
ordinated with many other branches of science, the
research is most important in psychiatry. But in psy-
chiatric investigation it seems as if mental vision instead
of expanding as the lenses grew higher, diminished its
scope of field hand in hand with that of the lens. Micro-
scopical study in psychiatry has been made synonymous
with specialized pathological anatomy of the nervous sys-
tem. In fact, so specialized and restricted is this study,
that what is gained in accuracy and minutiie of facts is
more than outweighed by a loss of comprehension and
appreciation of their value.

This study is of a topographical nature. While it ren-
ders a conscientious account of the distribution of gross
terminal changes in the brain in the last and destructive
stages of mental disease, the detection of the early phases
and of the processes underlying the whole life history of
certain classes of insanity are entirely beyond its scope.
Thus the pathological processes in the great mass of men-
tal disease are ignored. Such a study again disregards
co-ordination with pathological processes in the lower parts
of the nervous system concomitant with nervous diseases.
Pathological anatomy of nervous diseases presenting a
simpler set of conditions for research should be intimately
linked with and constitute the stepping stones to appre-

CORRELATION OF SCIENCES. 33

hension of patho-anatomical processes in mental diseases
enveloped as they are by far more difficult conditions of
study. Worst of all, however, is the fact that this inves-
tigation utterly neglects any philosophical correlation of
morbid processes in the nervous system with those occur-
ring elsewhere in the body. This seemingly constitutes
the "speciality" of ''specialized pathological anatomy of
the nervous system " — to hold aloof from the light of
analogy with the operation of the great fundamental laws
which govern pathological processes in the whole body
uniformly. This specialized study, not only in psychiatry,
but also in neurology, has come to such a pass, that
the nervous system seems to be regarded as something
apart from the rest of the body, as if subject to peculiar
pathological processes of its own.

This is indeed a puny effort to fathom the depths of so
profound a science as psychiatry. Through this special-
ization its field of inquiry was isolated and the range of
the intellectual sphere of the science correspondingly nar-
rowed. This extreme specialization fastened itself upon
psychiatry and blighted its genius. It rebuked that
boldness of conception which diversity of study alone
can bestow. Science has two sides ; the mechanical side
of merely gathering facts and the intellectual side of
evaluating the facts and discovering the laws that under-
lie them. The discovery of laws, principles and general-
izations is the true and highest function of science and
constitutes the spirit of scientific progress; whereas if
attention be wholly concentrated upon the mechanical
side, science comes to a standstill. Many, however,
confound the mechanical with the intellectual sphere
of science. They are prone to think that the mere
mechanical work of gathering facts is synonymous with

34 CORRELATION OF SCIENCES.

the intellectual work of co-ordinating the values of the
facts. This constitutes the great danger of specialization
in science. This restricted plan of research fastened
its view upon a single point and neglected the vast
horizon of psychiatry. The little gain in new facts is
really a great loss in the range of scientific thought.

In this way it has happened that psychiatry is behind all
other branches of medicine both as to valuable facts and
scientific theories; it even lacks speculations and hjrpoth-
eses, the fertilizing germs of scientific progress. In this
position many aspersions have been cast upon psychiatry.
It has become a target for querulous demands for more
rapid development than the organic laws of its growth
would permit. It has almost become a fashion to attack
psychiatry and complain that it has lagged behind all
other medical studies. This criticism comes from the
votaries of other departments of medicine, and among
them prominently the neurologist, who immersed in his
own peculiar limited and to him all important science
forgets that the progress of psychiatric research is de-
pendant upon advances in his own department. In fact
the neurologist, '* normal " psychologist and the *' special-
ized " pathologist of the nervous system are the very
ones to be blamed for the narrowness of the horizon
in their own sciences and the supercilious air with which
they regard the investigators of abnormal mental life.
Well may the psychiatrist turn to these people and say:
" And why beholdest thou the mote that is in thy brother's
eye, but considerest not the beam that is in thine own
eye ?"

It seems to me that the sort of criticism coming from the
neurologist, normal psychologist, specialized pathologist,
etc., is shallow and even foolish. For what is the use of

CORRELATION OF SCIENCES. 35

elaborating that which is perfectly obvious? Surely the
obvious thing in the progress of psychiatry is that being
the greatest, the most difficult and comprehensive of all
medico-psychological sciences it must necessarily be the
last to begin its progress. The psychiatrist has quite
properly ignored this sort of criticism. At times, his just
resentment has been aggpravated, for he knows the great-
ness and difficulties of his science. Baffled in wresting out
its truths without being discouraged, defeat quickening his
resources, he has created the science and done all that could
be done towards its advances. Yet in the midst of this he
must needs suffer attacks from those who labor in a mere
tributary science, stepping stones to psychiatry. He has
had to hear criticism from the very ones who have held
psychiatry in check by not developing or correlating their
departments of research sufficiently to be of service in the
difficult and comprehensive domain of psychiatric research.
The psychiatrist has been in the position of Haiiy, the
great father of modem crystallography, whose means of
observation were so rude that subsequent generations of
crystallographers marvelled that he could have founded
the science with such imperfect methods.

Perceiving the greatness of psychiatry in the past,
realizing that the present is about to unfold its grandeur,
and beholding psychiatry in the future as the queen of
the neuro-pathological and psychological sciences, it is far
from my thoughts to share in this conventional kind of
criticism. If, therefore, in this text, I have protested
against the inadequacy of the present plan of psychiatric
research, it must be clear that this has been done in order
that I might, according to my measure, substitute a larger,
broader plan of the correlation of sciences in psychiatry
which must surely encourage thought, scientific power

36 CORRELATION OF SCIENCES.

of the imagination and engender progress. Even now
the genius of psychiatry like the fabled gcnic^ unloosed
from the vial, is gathering into form, the haze is beginning
to take on the stature of a giant among the medical
sciences, and they who have carped at its growth, will be
quick to render homage to its future gprandeur.

While to many it may seem unnecessary to go into
details respecting the inadequacy of isolated microscopic
work in insanity — for the inefficiency of this present
restricted method of microscopic research in psychiatry
must be well recognized — nevertheless three reasons urge
the discussion of the subject.

In the first place this restricted method is inadequate

because it can only contribute to the mechanical side

of science, it will do little more than heap up facts.

The restricted use of the microscope in psychiatry can only

give microscopic results.

In the second place, and here I think that others who
are endeavoring to build up centres of psychiatric research
will see the force of the argument, this restricted plan
must be rooted up and its influence cast away before we
can have the freedom and means to substitute the broader
plan of the correlation of science in psychiatry.

In the third place, this restricted method benumbs the
whole intellectual sphere of the science of psychiatry;
it discourages originality and genius, the discovery of
laws, principles, and deductive forecasting of effects.

Some years since in discussing the future progress of
psychiatry and neurology, a distinguished psychiatrist
and neurologist said to me; *'We seem to have gone
as far as we can. Every subject whether in neurology
or psychiatry seems exhausted. There is nothing new to
work at, or nothing to add to the old things. The micro-

CORRELATION OF SCIENCES. 37

scope fails to give any new light." If this restriction of
the investigation of both mental and nervous disease to
the so-called clinical methods, and to the specialized
pathological anatomy of the nervous system had produced
such a gloomy impression upon a man of note, what must
have been its effect upon the young observer entering
either of these provinces in the fullness of enthusiasm for
research. Certainly the effect would be to chill scientific
imagination and flatten originality and genius. The stress
of the restricted conception of work would drive him into
the beaten track without his stopping to reflect upon
broader plans of work. He would dig out a few more
facts at the extremity of this narrow avenue of inves-
tigation and probably get the belief that this was
accomplishing the true aim of science.

Since that time two great and powerful methods of
microscopic investigation have come into use in neurology
and psychiatry. From this it might be argued that the
restricted plan of this specialized microscopic work in
neurology and psychiatry was right ; that it merely lacked
improvement in methods. It is perfectly true that these
two methods (Golgi's and Nissl's) afford a startlingly
wider range of facts in the nervous system than we had
hitherto dreamed of. But of what use are facts unless we
appreciate their value? There must be something more
than the microscope and the ability to work it. There
must be mind to put a value on the facts. And for the
mental evaluation of the fact there must be diversity of
scope and the light of analogy that comes from a gprasp of
more than one limited department of research. If the
microscope became so perfect that we could see molecules
in the nerve cells, its unaided work would never give us
the complete insight to the phenomena of thought, either

38 CORRELATION OF SCIENCES.

normal or abnormal. I think the whole conception of the
exclusive restriction of psychiatric or neurological research
to the clinical methods and the specialized pathological
anatomy of the nervous system by the microscope is wrong
and inadequate.

For considerable time the thought has been growing on
me as to the great importance of fields between several
of the departments of neuropathological and psychia-
tric research. It seems to me that the investigation
from these ^^intermediate fields of science ^^ is what is
most needed at present to coimteract the drawbacks of
specialization. Briefly stated, what is principally needed
to gprasp the great comprehensiveness of psychiatric Ire-
search is the bridging over of psychiatry, psychology,
neurology and pathological anatomy. If this union shall
be accomplished in the newer science of psychopathology
there will soon follow a renaissance in all of these branches
of research. If then I have noted certain shortcomings
of the asylum methods of psychiatric research, it is to
measure the better the great benefit and inspiration to
psychiatry that must surely follow the research conceived
by a federation of sciences.

If a restricted mechanical plan of microscopic work
were the right way to investigate the nature of insanity,
it would be comparatively easy to write the stereotyped
report of the microscopes, machinery and glassware
bought, interspersed with prophecies as to what was going
to be done with these things in clearing up the mystery
of mental diseases. A list of autopsies by the hundred
might have also been added presenting the conventional
statistical arrangement as to age, race, sex, mania,
melancholia, paresis and dementia, and the tabulation of
the spots of softening, atrophy of convolutions, thickening

CORRELATION OF SCIENCES. 39

of membranes, blood vessels, etc., or other ^oss signs
of wreckage of the brain.

The mechanical method of applying the microscope
would make things go smoothly in establishing laboratories
for psychiatric research since it minimizes the burden of
thought and scientific reflection.

The time has not arrived, nor will it ever come, when
the scientist can be replaced by the mechanician and
scientific thought by machinery.

Were this the way of investigating scientific problems
of insanity, we would have simply had to carry the micro-
scope into the asylum. There would have been no need of
making such frequent explanations to the visitors of the
Institute, in answers to their surprise of not finding such an
institution centered in one of the hospitals for the insane,
and confined to the direct study of the objects of its
research, the brains of the insane.

The impression that scientific investigation of mental
diseases is shooting wide of the mark and not attaining
its object unless confined to the study of the insane
themselves and their brains, seems deeply rooted in
the minds of not only the laity, but also of the self-con-
tented, routine-working, unreflective pathologists and
psychiatrists. It makes at first, one blush, then uneasy,
and finally simply bored when one has to reiterate to many
a would-be scientific specialist, the same obvious element-
ary reply to the puerile question: ''What has this to do
with insanity?" when one man is observed at a desk,
patiently studying the workings of the nervous system of
the cockroach; and another is seen experimenting upon a
perfectly sane individual and producing artificially some
interesting departure from the normal operations of the
mind, or a third investigator is inducing artificially a

f40 CORRELATION OF SCIENCES.

poison into the nervous system by an experiment on one
of the lower animals; or a fourth investigator is watching
the effects upon the nervous system of some ordinary dis-
ease of every-day occurrence, like typhoid fever, dropsy,
or pneumonia. The time has not come, nor will it ever
arrive, when any one can expect to understand normal or
abnormal operations of the mind, by simply gazing
through the microscope at the brains of the insane.

Fortunately this narrow conception of restricting the
vast domains of psychiatric research to mechanical micro-
scopic work has not been allowed to govern the planning
of the scientific centre for the insane in the State of New
York. The guardians of the State System of Lunacy
have foreseen the advances that may be made by properly
conducted scientific investigations of the insane, and have
sanctioned the plan of departing from the beaten track.

There is but one way ever to expect success in the
scientific study of the insane, and that is to conduct
such investigations from a comprehensive and many-
sided standpoint. This is perhaps more necessary for
insanity than for any other subject that science deals
with. What we want is an intelligent, methodical study
of facts, phenomena, inductively collected observations
and experiments, aided by the cautious but indispensable
use of theory and hypothesis.

Scientific investigation of mental diseases must be un-
shackled from the narrow circumscribed conceptions which
have so long governed it. Psychiatry must be freed from
the confines of the asylum walls. The research must be
broadened out and brought to bear on a great many prob-
lems which cannot be found within the asylum. The
investigation must be brought forth into the outside
world, and be applied to the great and varied number of

CORRELATION OF SCIENCES. 41

phenomena which lead up to an understanding of the
sources and nature of insanity.

The difficulty with the investigation of insanity in the
asylum, is this: Insanity does not develop within the
hospitals, because the patients are brought there after
the symptoms have developed and often gone far on
the highway of mental derangement. As a rule the
patient is not brought to the asylum unless his mental
malady has become so well established that he has become
mentally irresponsible. Now on the face of the matter, it
is hardly sensible to expect that we can get an insight into
the deepest problem of science — the mechanism of mind, its
variation, its operation, its growth and decay, its normal
and abnormal manifestations — unless we have the oppor-
tunity of studying such operations in their very birth.

The direct and exclusive study of the manifestations of
the insane in connection with some one single method
as studying the microscopy of the brain in the asylum
is the poorest way of attempting to attain any real
scientific results. Such study is always prone to become
narrow, and forget 'the enormous comprehensiveness
of the great and diversified standpoint of the various
factors in the source of mental diseases. The point
may be illustrated by a single example. Suppose a
man bom of three or four generations of alcoholic
ancestors, with a hereditary deficiency of the capacity for
elaborating nervous energy. He attempts to go through
the wear and tear of life, with a minus sign set down
against the energy of his nervous system by the abuses
and profligacies of his ancestors,* and tries to make good
that deficient energy, by artificial means. He drinks
alcohol or uses other stimulants to supply this lack of

*Vide '* Neuron Energy and its Psychomotor Manifestations."

42 CORRELATION OF SCIENCES.

energy. (This is the meaning of the '* craving for
stimulants" in many men). He increases the mort-
gage on his nervous system, a mortgage started by his
ancestors; and the penalty is ultimate bankruptcy of the
capacity of the working power of his brain. He hovers on
the borderland of insanity for a time, and is finally brought
to the hospital. After spending months and years in the
hospital for the insane, in a futile attempt to restitute a
misspent energy of his nervous system, or eking out what
unbalanced energy remains there yet, he finally dies, and
often enough, by some intercurrent disease. It is perhaps
unnecessary to go into details to show how futile it is to
trace the life history of the patient's cerebral events with
their parallel psychic manifestations, when we are given
only the last paragraphs of the final chapter to work out
the narrative. The task is simply impossible. One may
as well go blindfolded through the first nineteen miles of
a twenty-mile pathway, full of detours and devious turns,
and then attempt to recount its topography and windings
by going through the last mile without the blind. Yet
just such work is being attempted all the time, and little
good does it accomplish, in adding to the store of real
knowledge of the why and wherefore of insanity.

It is perfectly true, in the case just cited, that with the
microscope a number of changes may be found in the
brain structure. As a matter of fact, they have been set
down with much precision, according to the development
of the methods of microscopic investigation at the time of
record. The literature of insanity contains plenty of
descriptions of alterations in the brain, in old inveterate
cases of insanity, where mental disease has converted the
edifice of the mind into a mass of ruins. When now
the question comes up, as to what these changes mean,

CORRELATION OF SCIENCES. 43

and the vital query as to the significance of these changes
indicative of wreckage of the brain, then the same litera-
ture and the same observers remain silent. When it
comes to the essence of the whole problem, the meaning
of the changes that are seen under the microscope, the
more important task of rising above the facts to their
interpretation, of reflecting on the causes and course of
these changes, remains almost wholly unaccomplished; in
short the whole history of the psychopathological pro-
cesses is sadly wanting, the very thing we wish to know.
The conception and method of restricted microscopic work
in psychiatry are fundamentally wrong. The most that
such observations can point out is that the brain has gone
to ruin, and this anyone with sound sense might well enough
infer without taking time and trouble to pore into the micro-
scope. The tremors and unsteadiness of the muscles, the
unfaithful conveyance of messages from the outside world,
into such a man's disordered brain, the insurgent gamut
of his passions, the brutal and unbridled fury of his
loosened sub-consciousness, and 'finally, the imbecile bab-
blings indicative of the severance of the connections
in the lowermost parts of the brain, all proclaim the ruin
of the brain even to the most casual observer without
using the high power lenses.

I dwelt upon this case, because in the minds of many
this is the kind of material and the aspect of the problem
that is to be given to the scientist to unravel some of the
mysteries of insanity. In other words the selections are
to be made in the asylum as to the mode and manner of
carrying on scientific work. The discrimination and
choice of the problems and the study by the microscope
were hitherto directed by asylum men. This, at first
glance, seems quite natural. The asylum physicians are

44 CORRELATION OF SCIENCES.

to tell the scientist what to do, and how he shall work, how
to use his materials and problems. This would seem a
delightfully simple solution of the whole question — ^for
by far the most arduous work in science is not in the
material but in its mental sphere. The mental side of
science is the master which governs the mechanical work
in the external world. The ability to attain conceptions
gliding science in gathering and co-ordinating causes
and effects; the operations of inductive and deductive
reasoning; the ability to suspect, forecast and predict the
operation of causes; the judgment in selecting the fit
problems from the unfit; the guidance of investigation
and observation; the fashioning of theory and speculation
in the scientific use of the imagination; all these con-
stitute the highest and true aim of science and also its
most arduous sphere of work.

Unfortunately such a plan as this — ^the general guidance
or control of laboratory investigation of psychiatry by the
asylum — still prevails as a general rule. Asylum physi-
cians are to pick out cases here and there, preserve the
brains, send them to the scientific centre and have the
material ** worked up for publication and contributions to
science." Plans of this sort may be '* practical" but for
the ** theoretical" purposes of science they are not liable
to engender and encourage progress.

If the scientist is to be under the direction and control
of the asylum physicians, and is compelled to shape his
investigation of the problems befitting their conception,
and is to be restricted to investigation of such autopsy
material as they may see fit to choose, his energy is liable
to be crippled. It is easy to ask for results or plan out
work for another, especially when we are more or less
unacquainted with the enormous details and complications

CORRELATION OF SCIENCES. 45

of the physical methods for investigation, and leave in the
background the mental methods of science that such work
requires.

One of the positive obstacles in bringing a scientific in-
stitution for investigation of the insane in working order
is to be trammeled by worthless cases and useless
material. Another difficulty is to have the fact realized
that nine cases out of ten, and that ninety brains out of a
hundred chosen at the asylum and sent to the central in-
stitute contain insuperable difficulties for investigation,
and their study most frequently contributes nothing to
the advance of psychiatry. Furthermore, when such
brains are sent to the scientist, the constantly chang-
ing intricacies of the problems of preservation are liable
to be ignored, for these are to be learned by ex-
perience only, instead of following a stereotyped set of
rules. The brains are generally spoiled by being im-
properly preserved; they are quite liable to have been
treated by methods of preservation which render them unfit
for the application of the latest and most modern methods
of investigation. The time has passed when one or two
routine methods were used indiscriminately for all cases
of patho- anatomical investigation of the niervous system.
Science is now in possession of a great number of methods
in this branch of research and only years of experience can
determine the adaptation of the particular method for the
case.

A difficulty very liable to be encountered in establishing
laboratories or institutions for scientific investigation of
the insane lies in the fact that internes and other mem-
bers of the staff are rather generally expected to be able
to plunge into the intricacies of scientific research with-
out any preliminary training. Naturally the results are

46 CORRELATION OF SCIENCES.

disappointing. For it is not sufficient to have a given
theme of research planned out by the scientist, the work
must also be entrusted to a man of scientific training. If
scientific research is to be extended among the staffs of
the hospitals at least one or two men in the hospitals
should be chosen with regard to their previous scientific
/rrt/wrw^ and not merely on the basis of their capacity to
do the clinical or official routine asylum work. For such
work, excellent as it may be in itself, does not enable a man
to cany on scientific research.

It is unfortunate for the progress of scientific in-
vestigation of insanity that psychiatric research work
seems to be held so simple a matter that any one
with a little training may launch forth into the success-
ful accomplishment of investigating the pathology and
psycho pathology of the nervous system. If men in the
hospitals are to do scientific work they should have a
good, solid foundation laid for- this work by prehminary
education in their undergraduate and medical {and post
graduate medical) curriculums. A biological and psyclu>-
logical training in the undergraduate courses giving a
broad scope of reasoning over the facts in pathological
anatomy, psycho and cytopathology is not only highly
valuable but indispensable. The science of medicine
should be more generally coupled with biology and
psychology.

Medicine is an art, and by far the greater majority of
physicians are practitioners of this art, and we must free
ourselves from the popular belief of confounding the
physician, the practitioner with the scientific investigator.
One may be a scientist without being a physician, and one
may be a physician without being a scientist.

If medical superintendents of the hospitals for the

CORRELATION OF SCIENCES. 47

insane desire the members of their staffs to join the
work of the scientific centre, they should choose among
the men one or more who have had special training in
some particular line of research as, for instance, in general
pathological anatomy, combined with a knowledge of
normal histology of the nervous system, or in some other
branch of research, such as cellular biology, physiological
chemistry, psychology, psychopathology, etc. Only
after these conditions are fulfilled is the extension of
scientific work to the hospital staffs feasible.

With some general as well as special scientific training
among the members of the staff scientific work can be
extended into the hospitals most profitably. To ask
the director of the laboratory and his colleagues to supply
this foundation, to cast aside their own problems and give
up their valuable time, the result of years of training, in
teaching what should have been learned during the college
curriculum, is not only to retard the development and
progress of the laboratory, but to bring its activities to a
standstill.

Within the past decade two methods (those of Nissl
and Golgi) have been developed in the microscopic in-
vestigation of the nervous system which have been hailed
with delight by the psychiatrist, as these powerful
methods open up exceedingly valuable avenues of in-
vestigation in the pathological anatomy of mental
diseases. It is singular, however, that the impression
should gain ground among many psychiatrists that all that
is now necessary for the members of hospital staffs to
take advantage of this lately arrived and long delayed
opportunity for advances in the difficult domain of patho-
anatomical research of mental disease is to master the
mere technical details of these methods.

TION OF SCIENCES,

To master such a method as Nissl's is a comparatively
bsigniiicant task, but to interpret the results gained by
the use of the method is quite another matter. This
involves a wide knowledge of cellular biology, general
pathological anatomy, and, above all, of the general
^yttamics and organisation of the nervous system.

Furthermore, it is mere mechanical work to array facts I
concerning changes in an individual cell or group of nerve I
cells in some instance of a mental malady brought to
view by Nissl's or any other method. To attain the real *
aim of science, however, we should reflect upon the mean-
ing of these facts, and above all endeavor to connect them '
with the changes in function of the particular cell or s
of cells involved and to ascertain what part the diseased
cells play in the general organization and functional infer-
relation of various parts of the nervous system. ,

Facts are the building stones of science. Many devotees J
of science never rise above the mediocre position of carting
the stones from the quarry and dumping them in conglom-
erate heaps; they use their methods in a routine fashion
and gather blindly and without reflection facts which
are often trivial and worthless. The true scientist is like
the architect; he must first realize the purposf and J>/an of
the building; he mtist know the value of the material and
se/ect it with great care. The true scientists not only
gather valuable facts but also worry about their inter-
pretation and the laws which govern them.

Familiarity with the mere mechanical side of techni- '
cal methods does not enable one to appreciate facts, nor I
does it give him a knowledge of the appropriate application '
of the methods.

In brief, to expect hospital men to accomplish scientific
research in mental pathology with little or nothing more at J

CORRELATION OF SCIENCES. 49

their command than familiarity with one or more methods
of technical investigation by the microscope gained by a
few days or weeks of study in the laboratory is as sensible
as to expect a student to understand and intelligently
use a foreign language by drilling into his mind a few
rules of S3mtax. Without general and fundamental
knowledge of the subjects to which scientific methods
of investigation are applied, the mastery of these methods
places the scientific novice in much the same position as
the patients afflicted with mindblindness who see perfectly
well with their eyes, but are unable to recognize the things
seen.

The director of the scientific institution and his col-
leagues should not be called upon to overcome scientific
mindblindness. This seriouly interferes with the primary
object of the whole scientific work — namely, the investi-
gation into the laws of insanity. To achieve such work,
the scientific standard of hospital men must be raised.
It would be advisable that examinations of candidates
for positions of internes and juniors should provide
for the entrance or choice of men with the requisite pre-
liminary scientific training to make feasible the extension
of scientific work into the hospitals.

If a scientist is to investigate the problems of insanity,
he must be left absolutely free and untrammeled in the
selection of such work which wide experience has taught
him to expect good results. He must not however isolate
himself, but should be in constant touch with his colleague,
the hospital physician, advise and collaborate with him.

Our statement of the truth as to the relation of science
to the asylum should not be taken as embodying the
faintest echo toward anything derogatory to those who
devote their whole lives in treating and ameliorating

• • • • ••• • • ••* **

CORRELATION OF SCIE

through clinical studies, the welfare of the most difficult
and trying subject in all medicine, the unfortunate and
dependent insane. We ought, however, to acknowledge
candidly that few, if any, can learn to accomplish the
intricate duties of the treatment and welfare of the insane,
grasp the clinical science of psychiatry, master in addition
the details of other fields of scientific investigation of in-
sanity, and keep abreast with the advances in all of the
stupendous side issues which such investigation must
necessarily involve. It lies beyond any one man's capacity
to master two or more provinces of science in these days
of specialization. Life is too short.

There are a hundred different ways of investigating
insanity. How is any one who is not familiar with these
methods and working with them every day, to exercise the
discrimination as to which shall be used to carry out a
particular kind of inquiry? The work of microscopic
examination of the human nervous system at the present
day, a single branch of inquiry in the scientific investi-
gation of the insane, is a herculean task. In fact no one
man working months even in a single case, can accomplish
it. Such work has to be divided up among several in-
vestigators whose training in his own particular specialty
embraces no short period, in order to avoid the pitfalls of
error, which constanly beset the pathway of investigation.

There is no royal road to science, nor is there any single
way of examining the brain. Several methods, each with
all of its intricacies and variations, in most cases have to
be used simultaneously. When the brain is once taken
out of the body and put in one preserving fluid or
another, to make it fit for the preparation of thin, almost
diaphanous tiny slices, which are stained with various
dyes, for microscopic study, we may induce plenty of

CORRELATION OF SCIENCES. 51

artificial changes in this procedure, changes that have no
existence in the brain during life. All these things have
to be taken into account and nothing but actual experi-
ence, learning from our failures and mistakes, can
guard against the pitfalls of error.

Moreover, when an insane patient dies of some inter-
current disease, such as pneumonia, fever or some other
secondary malady, having no primary relation to his
insanity, the poison of the intercurrent disease leaves its
traces upon the nerve cells, and greatly interferes with
the determination of the pathological processes correlative
with the symptoms of insanity. Such cases are at present
of little, if any value, for scientific investigation. A set
of lesions have been superimposed upon the pre-existing
ones in the brain correlative with the symptoms of in-
sanity, and it is hard to discriminate between the two sets
of changes. All this is not liable to be taken into account
by those who in their eagerness and enthusiasm for more
scientific light upon the mysteries of insanity are naturally
prone to select cases like these for investigation.

Even if the brain were properly preserved; cut into
sections ; perfectly stained in a dozen different ways, and
weeks of study embodied in writing in the descriptive
composition style: that the nucleus of the cell is
** swollen," its body is ** shrunken," ** cloudy," ** pig-
mented" or *' unduly granular;" that its granules are
**too fine " or **too coarse," or that its tail (neur-axon) is
''thickened " or full of ** holes." What of it? What good
does all this do, if during the life of the patient there
were no observations or experimentation upon the psycho-
motor manifestations beyond such ambiguous descriptions
as ** semi-delirious," *'semi-stu porous" or ** partially de-
mented." This is like reading a book by studying
minutely through a microscope the shape, size and color

52 CORRELATION OF SCIENCES.

of the letters without the attempt to penetrate into their
combined meaning. The mere heaping up of facts with-
out understanding them as little constitutes the function
of true science as the conscientious counting of stars
deserves the name of astronomy. Piles of ungeneralia^ed
and unclassified facts in science are often so much
rubbish. Pathological anatomy is in need of interpreta-
tions of its masses of facts by the aid of biology, cellular
biology and psychopathology. In fact, observations by
the microscope form a relatively small and secondary part
of psychiatric research. Its great sphere is the psycho-
motor manifestations themselves which little more than
shadows across the microscopic field.

Cases at the hospital for the insane must be critically
selected for study and experiment; their psychomotor
manifestations closely studied by observation and experi-
mental methods borrowed from the domain of psychology
and psychopathology. Furthermore a progressive series
must be found in which the definite phases of the psycho-
motor manifestations correspond to certain stages in the
whole course of pathological process.

It is clear, then, that there are many drawbacks to the
direct study of insanity in the loose and restricted way in
which it is carried on at present. It is the largest problem
in science^ and it cannot be imprisoned within the asylum
if we ever expect to find its solution; and the present
time bids fair to justify such an expectation, provided the
study of the problem be properly and broadly undertaken.

I am aware that it may sound sententious to speak
in this way of the futility of the restricted method
of attempting to study insanity directly within the
asylum walls, but I cannot help pointing it out since it is
the wrong way of solving the problem. Ninety-nine brains
out of a hundred, the symptoms of which we are asked

CORRELATION OF SCIENCES. 53

to explain by the microscope, are at present absolutely
worthless for study. It is a mere waste of time.

Why is psychiatry in the rut in which we find it to day?
Because, frankly speaking, as intimated in the subse-
quent text devoted to psychology and psychopathology in
the next section, psychiatry has no appropriate scientific
methods to work with in studying its field of inquiry —
the abnormal phenomena of consciousness. The only
methods which psychiatry has are clinical methods.
These are appropriate only for investigating the phenom-
ena of the lower parts of the nervous system and symptoms
of the body and are wholly incompetent to investigate
the abnormal manifestations of the higher parts of the
nervous system correlative with abnormal states of
mental life. The investigation of the bodily symptoms
in insanity are of the highest value, because through the
body we may attempt to correct disorders in the nutritive
supply of the brain and restitute pathological expendi-
tures of energy of the nerve cell, but in attempting to
investigate 7nental symptoms psychiatry must use the
methods of pathological psychology or psychopathology.

Chapter IV.

PSYCHIATRIC INVESTIGATION.

In the last chapter we have pointed out a very natural
reason for the backwardness of psychiatry after other
branches of medicine have made considerable and even
brilliant advances. Psychiatry has had to wait until
several tributary sciences, especially the science of con-
sciousness — psychology — attained a considerable degree
of development. At present these tributary branches
have reached a growth and capacity to enter the service
of psychiatry and its future is indeed grand. The story

C0XKIXAT10K OF SCIEXCES.

of the progress of psychiaUy is sampty the story of the
progress of any other scieoce. Every scteDce. do matter
how far it may be advanced, has had its infancy. So it is
with psychiatry, and it woald be exceedingly presumptu-
ous to take the science to task, so to speak, because it
is in an early period of growth. We must remember
that this is one of the youngest departments of all medical
sciences. It is only twenty or thirty, or at the outside,
fifty years since psychiatry was recognixed. The under-
standing of insanity was exceedingly late in emerging
from the ignorance, prejudices and scholasticism of the
middle ages.

It must be borne in mind too that the empirical develop-
ment of the art of psychiatry was inevitable to herald the
birth of the science. The material welfare of the insane,
their recognition as wards of the State, the building of
hospitals, medical care and treatment, had to be worked
out empirically in their natural course, and all these
experiences had to be gained as a starting point for scien-
tific progress in insanity. The function of art is utility,
that of science, ascertaining truth; the one seeks to con-
trol phenomena, the other gains foreknowledge of them.
As knowledge and civilization advance, one of their great-
est achievements is to replace the empirical faculty of
control represented in the sphere of art by a scientific
basis. Id any branch of knowledge capable of practical
tpplicatioQ, art develops first and grows up to the limits
of empiricism. Then science appears, replaces the em-
pirical basis of art and continually expands and strength-
Ms its power of control and utility by placing the

tive power of science at the service of art. Looking
into the future, it seems to me that this is

nittg to psychiatry. The art of psychiatry has
i the limits of its (more or less) empirical develop-

I
I

CORRELATION OF SCIENCES. 55

ment; the true science of psychiatry is now beginning
to appear, and from now on will bestow on the art the
fertility of a scientific basis.

Psychiatry has reached the limits of the methods used
for the last twenty and thirty years. It has done all that
it could in that direction. Future fields of investigation
are perfectly barren, unless this science gathers new facts.
This it cannot do unless removed from its rut makes
use of methods which at present it does not possess,
and is correlated with other affiliated paths of investi-
gation in medicine, biology and psychology.

There is a right way and a wrong way of attempting to
investigate insanity. The wrong way is to restrict the
whole study of insanity to the brains of insane patients,
long after all clues have disappeared from scrutiny. The
wrong way again is to study the brain as though it were
apart from the rest of the body and subject to peculiar
laws of its own in the origin and course of disease pro-
cesses. Investigators in psychiatry are liable to take but
little heed of the advances and investigations in morbid
processes which take place in other parts of the body,
such as the kidney, the lung, or even the humblest
•constitutents of the organism, such as the simple
tissues. The process underlying disease and its several
phases which we call degeneration, inflammation,
hyperplasia, etc., and wrongfully intimate as distinct
entities, are of the same fundamental nature in these
simpler organs and tissues as in the complex nerv-
ous system. Presented under simpler conditions for
investigation in the simpler tissues and organs, the light
of analogy is most important for the valuation of the
homologous pathological processes underlying mental and
nervous diseases. But many have fallen into the great

56 CORRELATION OF SCIENCES.

danger of specialization in studying the pathological
processes of the nervous system. For specialization
coerces the attention to a single part and is prone to breed
neglect of the relation of the part to other parts and to
the whole. No one can expect to understand pathologi-
cal processes in the nervous system by studying them in
that system alone. To understand morbid processes in
the nerve cell one must study them side by side with a
knowledge of the cell in general, and correlate the study of
the pathological anatomy of the nervous system with the
general pathological and physiological laws valid for the
organism as a whole. What is needed is lests ** special-
ized " and more ** generalized ** study of the pathology
of the nervous system.

If I were asked to give any one prominent reason why
we have so little scientific knowledge of the life-history of
insanity, I would say it is because of insufficiency of
methods of investigation and its restriction, for instance,
to the mere mechanical microscopical work on the brains
of the insane. The enormous advances and revolutionary
methods in the anatomy and physiology of the nervous
system, in psychology and psychopathology, in cellular
biology, and in the study of pathological processes in the
body at large seem to have remained outside the pale of
the asylum walls.

The psychiatrist seems to think in studying the scien-
tific aspect of insanity, in investigating the patho-
anatomical changes in the brain that he is dealing with
something apart from the rest of the body, apart from
every science except psychiatry and need not be concerned
with general knowledge and methods which mark the
enormous advances of the present day in normal and
abnormal psychology or psychopathology, cellular biology,

CORRELATION OF SCIENCES. 57

physiological chemistry, comparative neurology, general
pathological anatomy, cytopathology, etc.

It might seem as though it had been intimated here
that microscopic investigation of the brains of the insane
in the asylums was of no use. This is not the point. The
protest is against exclusively restricting the investigation
of insanity to such a province. The investigation of the
brains of the insane in certain critically selected cases at
the asylum, under the guidance from beginning to end
of a life study, of the methods of this field of investiga-
tion and of a correlated study with disease processes
occurring throughout the body in general is of the utmost
value. The only protest has been against this constitu-
ting the whole and exclusive field of scientific investi-
gation of the insane.

No such restricted investigation can hope to do much
more than to set down a few desultory facts in the ulti-
mate chapters of the life-history of insanity, and even
then with no explanation as to what these facts mean or
how they have come about. As it is now, we are quite
familiar with the gross alterations that go hand in hand
with wreckage of the brain in old inveterate and terminal
cases of insanity, but we know comparatively little of
what these changes mean, and still less as to their relation
to the production of the patient's symptoms during life.

While the undue subordination of the many-sided
domain of psychiatric research to microscopical work on
the brain is unphilosophical and restricted, this work in
itself is extremely complicated and the value of a com-
manding view of its intricacies has not had as general an
appreciation at the asylum as might be desired. In this
branch of work there are dozens of radically different
plans of investigation, and each one of these with its

58 CORRELATION OF SCIENCES.

several technical methods and their variations and com-
plicated details, has a specific and definite object to attain
that no other method can give. It takes years of large
experience with these methods of investigation to deter-
mine which one will subserve the best use; for one must
plan ahead, from the very moment the brain is removed
from the body, and apprehend, in a general way, the char-
acter of the disease process which is at work to choose the
particular method of exposing its traces upon the nervous
system. Very frequently provisions have to be made for
the simultaneous use of several methods of investigation
of the nervous system of any one particular individual
taken at the stage of the disease which bids fair to yield
interpretable results. Hence the great embarrassment
which the scientist is constantly encountering in material
sent to him for investigation is the fact that it is either
placed in some fluid which is utterly unfit for the particu-
lar line of investigation or it presents some inappropriate
phase of the pathological process.

In an institute for the scientific investigation of insan-
ity, it is a bad plan to burden the scientist with autopsy
material selected and preserved by any one who lacks the
experience and training in the methods of microscopic
study which alone gives discrimination as to which one of
a great many methods is fit to use, and it is wrong to put
the scientist to the impossible task of elucidating anything
from such material. Yet, as a general rule, the rather
elementary idea seems to have taken root that the opera-
tions of such a department are to be carried on by placing
L the scientists in its charge in the untenable position
r of investigating brains that are either unfit from the
I selection of the stage of the disease or imjiossible of
Kinvestigation by reason of unsuitable preservation.

of
t is J

CORRELATION OF SCIENCES. 59

unreasonable to suppose that any one can gain knowledge
of the material best adapted for profitable pathological
study or the intricate technical methods of this investi-
gation without making it a subject of detailed and
specialized study.

With the exception of interpreting the results of study
of abnormal changes in the brain with the microscope,
the preservation of the brain and other organs of the
body is the most important datum in the whole investiga-
tion. For if the first steps in the investigation, the
details of preservation for microscopic study, be wrong or
inefl&cient, the accomplishment of the subsequent steps of
the research is out of the question. The scientist must
have complete control of the scientific work, and yet work
hand in hand with his scientific colleague, the clinician.

The sections cut from the brain for microscopic study
are but one-ten-thousandth of an inch thick, but the
surface covers over one hundred square inches. It would,
therefore, require the study of millions of these sections,
which are generally but one-half the diameter of a penny,
to make the microscopic examination of the brain in any
given cases of insanity at all complete. The human
nervous system has such a large volume and is so extens-
ively distributed over the whole body that much judg-
ment must be exercised in choosing the particular regions
upon which to concentrate the bulk of the microscopical
study. It lies beyond the capacity of a single observer
to make a complete examination of the brain. It requires
a force of several men to divide up the work within limits
that can be accomplished. No wonder, then, that the
work at the Institute, even in this single department of
microscopic study of the brain, has to be subdivided and
the results correlated weeks or even months after the

6o CORRELATION OF SCIENCES.

investigation is started. In fact, in addition to the
herculean task of examining the abnormal brain one
must constantly have at hand sections from the same
regions in the normal brain to measure and compare the
changes in the abnormal brain.

Few realize that it takes years for an investigator of
even the largest opportunities to collect material from the
bodies of patients suffering with any particular form of
disease, to correspond to all the phases in the pathological
process of that disease. People seldom die in the great
majority of diseases, until the process underlying the
disease is well established, far advanced or has reached
terminal, often destructive stages, so that we have no
clue for tracing out the origin and course of the morbid
process.

In a particular disease, for instance, we had to wait a
number of years before any clue could be obtained to the
origin of certain peculiar destructive canals running up
and down the spinal cord. Several years after finding the
terminal result, the beginning of the disease was seen, in
which state patients exceedingly seldom die. But the
beginning and initial stage of the disease was so different
from the terminal and destructive alterations that the
relation between the two was not recognized. Finally,
within the past year, a patient happened to die in the
middle stages of the disease, and now piecing all the
stages together, we are able to record the pathological
process underlying a hitherto unrecognized disease of the
spinal cord. So it is with disease processes in insanity.
If the brain is examined at some particular stage in the
course of the disease, this does not by any manner of means
tell us the whole stor>^ of the morbid process, it is a mere
episode in the life history of the disease, a portion of a

CORRELATION OF SCIENCES. 6 1

single chapter, which perhaps forecasts the next, but tells
us very little about the preceding chapters. We have to
trace the history of the early phases as we have opportuni-
ties of finding them, beginning at the first, but certainly
not at the last, and working backward, a decidedly wrong
order in such an enormously complicated problem as
relates to the pathology of mental and nervous diseases.

The well nigh insurmountable obstacle of the direct
study of insanity within the asylum is that the most diffi-
cult aspects of the problem are encountered. In most
of these asylum cases the gap between the effect and
cause is too great for induction to span the bridge. Nor,
as a rule, can we put the materials from the asylum under
our immediate control and experiment for varying the
conditions indispensable to the inductive method. In
studying the earliest phases of insanity these difficulties
are greatly reduced. These earlier phases are nearer to
the causal end of the morbid process manifesting itself in
a series of successive phenomena amenable to control and
experiment. By a series of experiments in which by suc-
cessively varying the surrounding circumstances and then
carefully noting the facts, undesired perturbations may be
eliminated and principles and laws may be discovered.
This accomplished we may use the laws deductively and
descend to the facts, bringing more and more of them
into harmony and within the fold of the law. After this
stage in the investigation — the discovery of a guiding
principle — ^the later phases of insanity, constituting the
majority of cases in the asylum, may be more clearly
understood. Finally, science being in possession of the
secrets of the early stages and the predisposing factors of
insanity will exercise its highest power of forecasting and
controlling phenomena. This being at the disposal of

fil

CORRELATION OF SCIE

psychiatry as an art, may yield practical therapeutic and
prophylactic methods far exceeding our most sanguine
expectations.

It is in the study of the early phases and predisposing
and proximate causal factors of insanity that one begins
to realize the comprehensiveness of the science of psychi-
atry and the enormous extent of its ramifications, It is
here that the play of the correlation of many sciences
comes into action.

We must proceed from the simple to the complex. The
simpler aspects of the problems in insanity — simple only
in constituting the scientific order of progression in the
advance of psychiatry, but otherwise exceedingly difficult
and comprehensive — can only be solved on the basis of a
general comprehensive work. The work required for the
investigation of these early phases include, for instance,
the study of the architecture, cytology and functions of
the normal nervous system ; of pathological processes of
the body in general and of the nervous system in particular
under the influence of hurtful stimuli such as poisons,
abnormal fatigue, diminution of food supply to the nerve
cells I of the development of the brain both phylogenetic-
ally and ontogenetically. This study from the standpoint
of phylogency and ontogeny is most important. For it
gives an insight into the laws which govern the dissolution
of the nervous system, the reverse process of evolutiotL
All mental and nervous diseases are manifestations cither
of the retrogressive process or of incompUtc and defective
evolution.

We can realize now how meaningless and futile mere
mechanical and microscopical work tn psychiatry may
become without correlative knowledge of the evolution of
the nervous system and of the functional inter-relation of

CORRELATION OF SCIENCES. 6^

its parts. Without such study microscopic work in the
nervous system is blind and does not know what to do; it
gropes in the dark and labors aimlessly in the hope of
making some valuable discovery by sheer accident.

Generally speaking, the organization of the nervous
system in relation to function may be described somewhat
as follows : The most supremely organized parts of the
nervous system, the last attainment in man's evolution,
the most precious part of the brain, which it has taken
eons of time to evolve, which gives man his discrimination,
his powers of ratiocination, his self-control, are the most
unstable parts of the make-up of the nervous system.
These higher and last evolved parts of the brain are prone,
in the presence of pathogenic stimuli, to become dissociated
from the remainder of the nervous system first and with
their dissociation appear the first beginnings of unsound-
ness of mind. It may be seen, then, how absolutely
essential it is to have the complete story of the evolution
of man's brain, both in the individual and in the species,
and to find out how this nervous system has been progress-
ively built up, one part added after another, corresponding
with higher and higher functions.

We may watch this in the development of species or in
the child's brain. When the child comes into the world it
has absolutely nothing to its credit in the functions of the
nervous system, except the operation of that lower part
of the nervous system which presides over the most
fundamental functions absolutely necessary for the main-
tenance of organic life, such as respiration, circulation and
a few reflexes. Little by little, higher and higher por-
tions of the nervous system develop. Slowly and pro-
gressively the sense organs transmit desultory and
aincorrelated messages of the physical aspect of things

64 CORRELATION OF SCIENCES.

in the outside world. Still later the messages Ifrom the
outside physical world are correlated in a simple and
elementary form and a low grade of consciousness and
recognition of things in the external world begins to dawn
upon the child. Ultimately, by the use of the very
highest parts of the brain which man possesses, the child
learns to discriminate among these impressions and their
correlations to the outside world, as to what is significant
and as to what is insignificant. Still further along, as the
child becomes older, by constant use and education of the
supreme and highest part of the nervous system, he learns
self-control and inhibition over the lower parts of the
nervous system and higher and more complex forms of
sjmtheses of consciousness.

These supreme centres of the nervous system, which
exercise control and inhibition and a bridling of the lower
parts of man's nervous system, which latter we share in
common with the animal, are the last to ripen and mature
in the education of our brains. The maintenance of this
part of the nervous system requires constant vigilance
and exercise all through life, and a great majority of
people never completely learn to make these centres less
unstable than they are bound to be through the laws of
evolution. A whole lifetime does not suffice for great
multitudes of people to gain sufficient stability of these
centres by constant exercise and training. The conse-
quence is that by over- fatigue, deficient nourishment, or by
poisoning of the nervous system, a progressive dissociation
and finally disaggregation of the nervous system occurs in
the reverse order of its evolution. The highest and most
complexly organized, and naturally the most unstable
portions become dissociated first, as witnessed in neuras-
thenia. Then in a steady progression the dissolution

CORRELATION OF SCIENCES. 65

descends to lower and lower parts of the nervous systems
until in dementia and idiocy but little else than the most
elementary systems of the brain presidinjf over vegetative
and automatic functions are left-intact. This is in brief
the epitome of the life-history of insanity.

As a contrast between the old and the new conceptions
of investigating the scientific problems of insanity let us
recur to the example mentioned in a previous chapter,
where it is pointed out how futile and impossible it is to re-
construct from a few observations of the last few stages the
whole life-history of the patient. Under the new concep-
tions of study, at our own Institute, for instance, the
problem is being attacked from several standpoints. In
the first place, we study the initial effects of alcohol upon
the nervous system, which is not accessible to investiga-
tions confined to the asylum. We study first the exag-
gerated effects of alcohol where it has acted as a deadly
poison, for instance in the brain of a case of fatal delirium
tremens. The selection of such a case is not by any man-
ner of meaoB a simple matter. We have to select an
individual dying of this disease in which we feel perfectly
sure that the alcohol poison is not complicated with other
diseases. We must find an individual whose nervous sys-
tem has not begun to grow old. He must be an individual
perfectly nonnal in all respects, so thai we may be per-
fectly sure that what changes we find in the nervous system
are due to the action of the alcohol and nothing else.

To obviate these difBculties, however, the problem
becomes much simpler in the investigation of the direct
action of alcohol on the nerve cells, by experimenting on
animals. This is a much more satisfactory investigation
in many respects than the study of the effect of alcohol on
the human nervous system. For, in the animal, we can

66 CORRELATION OF SCIENCES.

perfectly regulate the amount given, we can stop the
experiment at any stage, either at the beginning, middle
or the end, and study the brain cells at all stages during
the action of the alcohol.

In the light of these studies the effects of chronic
alcoholism in the human being may be studied with
greater profit. Here we get an inkling of the premature
senility which chronic alcoholism brings about in the
brain. We witness the effect of a failure on the part of
the myriads of tiny constituents of the nervous system —
the nerve cells — in their capacity to store energy, which
they receive in the food supply from the blood vessels.

Besides this, we investigate the phenomena of intoxi-
cation in an individual to whom the alcohol is given as an
experiment. We give him memory tests, discrimination
tests, study the quality and intensity of sensations, the
emotional character of ideas, the disorders of associations,
of judgment, and, in short, devise means to measure and
recount the interference with the working power of the
highest powers of his nervous system. Such experiments
are highly important because in the phenomena of alco-
holic intoxication we have a general outline reflecting all
the phases of insanity. The highest and most precious
portions of our brain being the last to become evolved and
educated, are also the most unstable, and are the most
ready to undergo dissociation under the action of noxious
stimulants. Alcohol, accordingly, begins its dissolution
of the nervous system at these very highest centres of
discrimination and self-control. ^The dissolution of the
nervous system progressively descends down to lowest
centres which preside over respiration and circulation, so
that finally in profound intoxication the whole nervous
system with the exception of the vital centres indispens-

CORRELATION OF SCIENCES. 67

able to the life-being of the organism is in a deep sleeping
state. If the poison by alcohol proceeds too far, even
the vital centres are suspended and death ensues. Thus
it will be seen that in this third line of study of alcoholic
insanity, the whole broad domain of the evolution and
reverse dissolution of the nervous system is involved, a
field conjointly demanding the attention of both the
psychopathologist and cerebral anatomist.

The same problem, from the standpoint of chemistry,
is approached more closely in the brains of the habitual
drunkard. We endeavor to bring the methods of chem-
istry to bear on this problem, to see what chemical
changes occur in the nerve cell in its degeneration from
the habitual use of alcohol. Hand in hand with all of
these investigations, are studies of the normal nervous
system by the microscope, which must go on for
many years before we are perfectly sure of a stand-
ard of comparison to judge of abnormal changes
in the brain. At the same time other investigators
are at work peering into the workings of the nerve
cell in some of the humblest living creatures. For
the nervous systems of the lower animals are far simpler
to understand. It is much more essential to arrive at
some of the fundamental laws governing the workings
of the nerve cell in some of the lowest creatures than
to attempt to ascertain these truths in the most com-
plicated form of the nervous system that can be found,
namely, that of man.

I can only touch in the most desultory fashion upon
the great number of pathways that have to be pursued,
and the great many side issues of the most profound
scope, which have to be taken into consideration, in study-
ing the initial stages of insanity. But this is the only way

68 CORRELATION Of SCIENCES.

we can proceed to study the more complex and advanced
stages in the hospitals for the insane. This elementary
sketch ought, at least, to show how many-sided the prob-
lem of insanity becomes when taken out in the outside
world beyond the scope of hospitals for the insane. Such
an illustration ought to show how enormously scientific
investigation of the insane broadens out, even when
we start at what is comparatively the simple end
the problem, namely, the study of the first phases oJ
insanity.

To sum up the practical difficulties liable to be met
with in establishing centres of scientific investigation ol
insanity they may be presented as follows:

1. The scientific centre must first identify and formu-
late its purpose and sphere of investigation; it must
deliberately choose its plan before the building materials
can be wisely selected ; afterthis the laboratory or scientific
centre must be given time to become equipped and organ-
ized and collect material for work; and also to apportion
its general themes and special work among the members
of its staff.

I, This work, from beginning to end, must take
precedence of everything else and should not be inter-
rupted by premature demands for the results of scientific
work and for publications to be completed simultaneously
with the organization of the laboratory, or by demands at
any time for scientific research to be made to order or
completed hastily.

3, The energies of the members of the staff must not
be wasted in instniction that is unprofitable, or in impart-
ing knowledge where a ground work of scientific training
I general pathology, psychopathology and neurology is
Instruction should only be asked when it can be

CORRELATION OF SCIENCES. 69

made profitable, in cases where a proper foundation has
been laid previously. It requires years of instruction to
supply this deficiency that ought to be made one of the
requirements of entering the hospital if men are expected
to do good scientific work.

If matters (2) and (3) be not held in the background
pending the organization of the laboratory, or if all three
of the subjects be attempted simultaneously it is quite cer-
tain that none of them can be done well, not to speak of
the danger of seriously retarding the growth of the labor-
atory or bringing its energies to a positive standstill.

Fortunately all these drawbacks have not been encoun-
tered in the inauguration of the Pathological Institute of
the New York State Hospitals. It has departed from pre-
cedent, and has been given the most cordial encourage-
ment from its colleagues in the commission and at the
hospitals, in insisting upon a broadening of the study of
insanity from the modem standpoint of the correlation
of many branches of science. Only through such en-
couragement have we been able to depart from the beaten
track, and insist that the study of material within the
asylums is not the whole essence of approaching the prob-
lem, and in fact constitutes but a relatively small part of
the work. The scientific staff at this institute has not
been hampered in the planning and direction of the
scientific research work. Proper fields of inquiry are sub-
mitted to their judgment and trained discrimination. We
have learned the value of the indirect study of insanity,
of approaching it through a number of avenues, which,
while not directly investigating the insane themselves, is
infinitely more valuable at the present time.

The Institute has the opportunity of studying the con-
ditions which lead up to the begininngs of insanity and of

70 CORRELATION OF SCIENCES.

observing people before they arrive at the asylum. It has
been permitted to study the effects of general bodily dis-
ease upon the nervous system, and has been situated in
the metropolitan centre of the State, where it might be in
touch with the acute general hospitals in the investigation
of the nervous system in the great mass of ordinary dis-
eases of everyday occurrence. Its energies are not wasted
by being compelled to study material which some one
has selected, who does not know how it should be studied
or whether such study would yield results of scientific
value.

The direction of the institute has been encouraged in
planning for the study of the evolution and the dissolution
of the nervous system.

Provisions have been made for the psychopathological
investigation of the various dissociations and syntheses
of consciousness in the abnormal individual as well as
experimental induction of these phenomena of conscious-
ness in normal men and even in animals.

The plan has been followed out in collecting material,
the investigation which seems, at first glance, but slightly
related to the elucidation of the life-history of insanity,
such as the brains of the lower and lowest creatures;
autopsy material from nervous diseases^ in contra-distinc-
tion to mental diseases; and also developing stages of
animal life.

The paramount value of facilities for animal experiment-
ation for the conjoint investigations of the physiological
chemist and the psychopathologist of the action of
poisons upon the nervous system has been recognized.

A very essential factor in the general plan of the work
of the Institute is the necessity of providing for and
stimulating research work in the study of the effects of

CORRELATION OF SCIENCES. 71

somatic or general bodily disease upon the nervous
system. To subserve this purpose the Institute has been
brought in touch through several of its associates with
several of the large general hospitals in New York city,
and thus has the opportunity of studying autopsy material
and investigations from a psychopathological standpoint,
particularly the changes in the nervous system associated
with the great mass of general body diseases.

Thus we have provided facilities for investigation of
the damage wrought upon the nervous system by the
great host of general body diseases. This method of
study, it will be seen, cannot be undertaken in the
hospital for the insane. It must be followed out in the
material from ordinary general hospitals and is most
feasible in the large cities. The effects of the great mass
of body diseases upon the nervous system are hardly at
all known as yet, and most important are the results of
future study in this field for the understanding of the
changes in the brain going hand and hand with insanity.

The phenomena of insanity are manifold and their com-
prehension can only be grasped when viewed from many
different standpoints — ^from the standpoints of many
sciences. A co-operation of many sciences will bring
forth a rich return of both theoretical and practical
results. A many-sided, comprehensive, scientific investi-
g'ation of insanity is at present an imperative necessity.
We are on the threshold of a new era in the study of the
nervous system in both its normal and abnormal manifes-
tations. The inauguration of this era not only requires
specialization but also interaction of the lines of research.
Different branches of science must be co-ordinated and
focussed together as a search-light on the mysteries of
mental diseases. They must all work hand in hand.

72 CORRELATION OF SCIENCES.

They must be linked together and correlated, otherwise
the whole aim of the work is defeated; the investi-
gation will become one-sided and restricted, and what
few facts are gained will not be open to comprehensive
interpretation.

In accordance with the tenor of these prefatory remarks
several departments of research ought to be established at
a scientific centre for the investigation of insanity. If I
may take the liberty of alluding to the scientific centre of
the New York State lunacy system — the Pathological
Institute of the New York State Hospitals — ^we may now
review the purpose of these several branches of science
as planned in this institution and observe the general aim
of the special and combined work. Such a review, how-
ever, must be made exceedingly brief and touch on salient
features only. It will at least tend to show that the
microscope, far from being the principal factor of psy-
chiatric research, plays an entirely subordinate part.

CORRELATION OF SCIENCES. 73

PART II.*

THE CORRELATION OF SCIENCES IN THE INVESTIGA-
TION OF MENTAL AND NERVOUS DISEASES.

Chapter V.

NORMAL PSYCHOLOGY AND PSYCHOPATHOLOGY.

The crowning glory of psychology in these days is its
emancipation from metaphysics. Psychology has become
a science. It has finally shown that the phenomena of
the human mind are not vague and mysterious, but that
their understanding is to be gained by methods of investi-
gation such as are pursued in elucidating the phenomena
of the world of life and matter generally; by means of
the same general methods of investigations used in gain-
ing knowledge of a distant star or a tiny organism. In
gaining knowledge of the physical world, we make use of
patiently observed phenomena, experiments and facts,
and starting out with these we work out laws and hypo-
theses governing these facts. Modem psychology is
proceeding in the same way with the phenomena of
consciousness on the inductive — deductive basis. It is
hard at work at the laboratory table, gathering facts,
using instruments of precision, conducting experiments,
assimilating similar work from kindred branches of
sciences. In brief, modem psychology is one of observa-
tion and experimentation as against speculation on the

•

* In this part an attempt is made to plan out in a general way the main lines
of research in mental and nervous diseases without much reference to the
details of their application except by way of illustration. Since the Patho-
logical Institute of the New York State Hospitals is largely based on this plan,
we take the liberty of alluding to it in the text. This Institute was established
in February, 1896. The departments of normal histology of the nervous sys-
tem, of experimental pathology and hematology, although planned some time
ago, are not yet in existence, but will be established, we hope, when more work
wiU issue from the already active departments.

74 CORRELATION OF SCIENCES.

nature of the soul. It is building a foundation of facts to
rest the superstructure of its doctrines and generalizations
and laws of phenomena of the mind. All this has been
brought about practically by the development of the
science in this century. Weber and Fechner founded the
domain of psychophysics. Fechner particularly invented
new methods to study the intensity of sensations. He
studied the laws governing the relations of the intensity
of sensations to their stimuli. Much of his work in par-
ticular and of the school of the psychophysicists in general,
following in Fechner's steps, though highly question-
able, is still useful for its negative results. Hemholtz
contributed much to psychology by his psycho-
physiological studies on sensations. His magnificent
intellect enabled him to apply the methods of not only
one science, as physics, but to a whole group of
sciences. For he was mathematician, anatomist, physi-
ologist and a brilliant technician and worker with the
microscope in unraveling the tangled fibres of the nervous
system. Wundt introduced into psychology the most
valuable of all methods in science, namely, the experi-
mental method. The amount of work which Wundt has
brought out from his Psychological Institute at Leipzig,
most of which though giving small results, justly pro-
claim him as the great modern psychologist. In England,
James Mill, John Stuart Mill, Bain, Spencer, Ward, Sully,
Stout and others; in Italy, Mosso and others, have con-
tributed their share to psychology. The names of Pro-
fessor James and Professor MUnsterberg are not to be
omitted in this hasty sketch of the evolution of psychology
into an exact science.

If the labors of general normal psychology have grown
more scientific and practical, the work of psychopathology

CORRELATION OF SCIENCES. 75

or abnormal psychology, embracing the psychological study
of abnormal or pathological cases, has turned out to be of
special importance not only from a theoretical standpoint
in revealing the inner organization of mental life, but also
from a purely practical standpoint, since // has furnished
the key to the understanding and even the treatment of
functional nervous and mental diseases. The results of
psychopathology, some of which were obtained in our
Institute, are brilliant in the extreme ; they may be con-
sidered a treasure for medical science in general and for
psychiatry in particular. No psychiatrist, no neurologist,
can be efficient in his respective science without a knowl-
edge of psychopathology. Functional neurosis, that
stumbling block of the medical profession in general,
and of the neurologist and psychiatrist in particular, can
only be intelligently studied and successfully treated
through the medium of psychopathology. Psychopa-
thology is the sine qua non of the science of insanity,
because insanity is a manifestation of more or less per-
sistent pathological phenomena of consciousness, and
psychopathology alone possesses the methods of investi-
gating these pathological phenomena.

The work of the French school is particularly important,
because of its remarkable contribution to the science of
psychopathology. The French school with Ribot, Binet,
and Janet at its head has been studying man's subcon-
scious domain, a subject of the most profound importance,
not only in that it touches at the heart of man's social
attributes, but that the understanding of the nature of the
subconscious is absolutely essential for any intelligent
conception of the origin and course of mental maladies.

Finally the brilliant psychological and especially the
psychopathological studies of Dr. Sidis on dissociations in

76 CORBELATION OF SCIENCES.

consciousness y linked with the parallel physiological dissocia-
tion of different realms of the brain ^ marks an important
stage in the progress of psychology^ and particularly psycho-
pathology. In Dr. Sidis* researches and studies of psycho-
pathological cases, parts of the brain were dissociated from
each other and the parallel psychic manifestations could
be studied by themselves. Such experimental and clini-
cal investigations help one not only to understand, but
also to treat the similar isolated and split oflE fields of
consciousness in diflEerent forms of nervous and mental
diseases. Psychopathology helps to clear up hosts of
difficulties that form almost insuperable obstacles in
neurology and psychiatry.

Psychiatry is especially indebted to psychopathology,
because it is only through the latter that psychiatry has
any hopes of becoming a science relevant to its subject
matter and have practical methods of treatment, based
not on the rule of thumb, but on a solid scientific founda-
tion. In fact we believe that psychopathology will ulti-
mately replace the present would-be science of psychiatry.
This sounds paradoxical, for psychiatry is generally con-
sidered to be the science of insanity. It claims the insane
as its own. Unfortunately, psychiatry is a science in name
only, it endeavors to be scientific, but fails in its attempt.

Psychiatry, in a certain sense, as hinted in a preceding
chapter, is an overgrowth of the application of the methods
of investigation of bodily diseases to those of the mind.
Now it is absolutely hopeless to expect that methods
applied to investigations of symptoms of somatic diseases
are fit to apply to the investigation of mental maladies.
These methods are absolutely incompetent, and even to a
certain extent irrelevant.

The observation of the abnormal phenomena in insanity

CORRELATION OF SCIENCES. ^^

relates to two groups of manifestations — the sofnatic and
the mental. The somatic or abnormal phenomena of the
body^ including the abnormal manifestations of the lower
parts of the nervous system, such as paralysis and the
coarser and more obtrusive abnormal symptoms of the
sense organs may be observed by the clinical methods of
investigation. But in the study of abnormal mental phe-
namena^ the disturbances of the higher forms of conscious-
ness and the whole domain of psychomojtor phenomena
concomitant with dissociations of the higher spheres of
the brain (where the nerve cells reach their highest com-
plexity of organization in communities, clusters and
constellations) lie beyond the scope of clinical methods
of observation. These phenomena fall within the province
of pathological psychology or psychopathology.

It should be more universally realized that there is a
sharp dividing line between the eflBicacy of clinical and
psychopathological methods of investigation in the study
of insanity. This is an important matter, and one about
which we should have clear and definite ideas in order not
to make the mistake of believing that mental phenomena
may be competently observed by clinical or somatic
methods of investigation.

Psychiatry obeying the natural laws governing the
general progress of science is still clinging to clinical
investigation, in attempting to explore a territory be-
yond the scope of these methods. No fault is to
be found with psychiatry for this state of affairs. If
any criticism were justifiable, it should be regarded un-
fortunate that the normal psychologist has been so back-
ward in taking up the study of pathological psychic
phenomena, or psychopathology, and paving the way for
the psychiatrist.

CORRELATION OF 3CIEKCBS.

In discofising advance work in the stndy of abnonnal
life in the hospital, let us relegate ciiHtcal
metboda of investigation to their proper province, and
not Attempt the impossibility of stretching them over into
the domain of abnonnal mental phenomena, whicfa can
only be efficiently investigated by the methods of psycho-
pathology. This same distinction between clinicai and
Ptyckopathological methods of investigation deserves reflec-
tion in the study of nervous diseases. Psychiatry ought
to embrace both fields of research in the study of insanity,
the mental as well as the somatic; mamely, the investiga-
tion of the abnormal somatic phenomena and the patho-
lofpcal phenomena of the lower parts of the nervous
syotem by clinical methods, and the investigation of the
pathological mental phenomena by the methods of psycho-
pathology.* It would seem appropriate, however, at
present, to pin psychiatry down to the former domain
where it belongs, and assign the latter to its proper
sphere, pathological psychology or psychopathology. It
is questionable if the psychopathologist would concede
that even the pathological manifestations of the lower
parts of the nervous system (and the effects of disease of
these lower portions upon the higer ones), especially
in functional diseases can be properly and completely
investigated by the clinical methods of neuropathology
and psychiatry. For all parts of the nervous system are
too intimately interrelated in an organic whole to expect
, that the normal or pathological manifestations of these
wer parts of the nervous system may be thoroughly
nprebended by being isolated from the rest of the

il DiBDiteBtBtiana are described br Dr. Sidls In a
It of Psychology and Psychopathology now
the AHCBIVES or NkuroLogy and PaVCHOP,

I
I

CORRELATION OF SCIENCES. 79

system and studied by themselves; or that the phenomena
of any part of the system may be fully explained without
a comprehensive knowledge of the phenomena of all other
parts, the highest, the lowest, as well as the intermediate
parts. Viewed in perspective the foreground of con-
sciousness looms up beside the activity of the highest
spheres of the brain composed of the most complex con-
stellations*^ of neurons while the vanishing point stretches
away far down beside the activites of the lower and
lowermost parts of the nervous system composed of
mere elementary groups \ of nerve cells. Thus psy-
chopathology dealing with the pathological manifesta-
tions of consciousness comprises a study of the phenomena
of the lower parts of the nervous system as well as of the
higher portions and embraces especially the interrelation
between the two sets of phenomena in functional diseases.

In the natural evolution of medicine, symptoms of
bodily disease were worked out and differentiated first,
then, after tedious halt behind all other departments of
medicine, insanity was finally recognized as the symptom
of abnormal conditions of the brain, and the methods of
studjring bodily symptoms were dragged over into the
field of mental symptoms. Psychiatry in this stage of its
evolution soon reached its limit of efficiency.

Psychiatry is an art and poses as a science. The
science is only partially relevant to its subject. As an art
it has done much. The simple recognition of the fact
that insanity is a symptom of abnormal brain conditions,
has overthrown the pernicious superstition of regarding
the insane as possessed of devils. This alone has accom-
plished an enormous amount of good, and has resulted in
an enlightened care of the material welfare of the patients

•Sidis, Psychology of Suggestion, Chap. XXI.
tLocCit.

CORRELATION OP SCIENCES.

in our present bospitala for the insane. Bat we ought
not mistake these advances in the art of psychiatry and
think that they are scieniific advances. In its wider
•eiue, Che art of psychiatry attends to the welfare of the
tfuane as a dependent and helpless class upon the
commanity.

The icience of psychiatry deals with the whence and
wherefore of mental diseases. The answer lo these ques-
tion*, however, psychiatry as a science, has largely failed
to accomplish. A very simple and most elementary stage
in the science of psychiatry was the recognition of the gen-
eral fact that insanity is the symptom of pathological brain
processes. This recognition rescued the insane from social
revenge; at a later period from social indifference, and
finally stimulated the active interference on the part of
society for their welfare and humane treatment in the
modem hospital of to-day. If all this progress in the art
of psychiatry has been bom of such an elementary and em-
bryonic stage in its evolution as a science, how much more
are we to expect in the prevention and cure of insanity in
the future progress of this science? For as a science psy-
chiatT}' is yet unborn, and can be brought into the world
only by the aid of psychopathology. We now realize
clearly the fact that writings from the standpoint of psy-
chiatry as an art, must not pass for scientific disquisitions.
The psychiatrist on account of the incompetency of his
methods is driven into the art field of psychiatry under the
delusion that he is doing scientific work. Many in the
field of psychiatry unconsciously bear out the criticism that
_aeientific methods of investigating the symptoms of men-
■|A|fUsease are merely an overgrowth of the methods used
^^■■investigating symptoms of bodily disease, by writing
^^■descriptions of the bodily ailments of the insane.

CORRELATION OF SCIENCES. 8l

Fractures and dislocations of the insane are written up
at length ; the formation of their teeth, their palates, their
hair, the occurrence of various complicating body diseases
in great variety, such for instance as a fever, erysipelas,
etc., are published in detail because the present psychi-
atric methods of investigation are better adapted to this
sort of observations than for the investigation of insanity
itself. Others find an opportunity for writing on medico-
legal matters relating to the insane. Still others find dis-
traction in the elaboration of statistics ; others again in the
field of therapeutics. Therapeutics, it is true, based on
empirical knowledge of drugs has the recommendation of
much common sense, because the knowledge gained
thereby is founded on experience; but experience without
reason is blind. The administration of drugs, particularly
to the insane must rest on a rational basis, and this rational
basis cannot come until we have an understanding and
scientific explanation of insanity. When that time
comes we may give fewer drugs, and perhaps in less
quantities.

The pointing out of the unscientific character of this kind
of literature may be unwelcome or unpleasant to many
who are in daily touch with the insane. But if larger,
broader and more inviting fields of real scientific inves-
tigation are indicated, no fault ought to be found with this
presentation of the status of psychiatry. This should be
reserved for those who criticise the work of the psychia-
trist unintelligently, and who offer no new pathways for
the old ones. It must not be understood that this pseudo
scientific psychiatric literature, substituted for scientific
work now possible by the advance of science, has no value.
It has its peculiar interest; the only trouble with this
kind of psychiatric literature is that its fields of investi-

lOS OF SCIENCES.

gation are so well burrowed and harrowed out that
further work is only a loss of time and labor.

The investigation of the somatic phenomena in their
relation to the pathological nervous processes and men-
tal manifestations in the insane is of vital importance
not only theoretically, but also practically, because from
the body is derived the nourishment and the source of
energy of the nervous system. It is, therefore, of the
utmost consequence to understand the relation of disor-
ders of the body to the interferences with the food supply
of the nerve cells and the influence of toxic agents on
these cells. The general somatic symptoms in insanity
should be rewritten and revised as often as there are new
discoveries and new theories in the progress of the
pathologj' of bodily symptoms. Moreover, the bodily
symptoms in each case in the hospital as an individual,
irrespective of its class grouping or particular form of
insanity, should receive detailed investigation because of
the importance of the relation of the body to the brain
in that the former provides the food supply, the source
of energy of the nerve cell. It is, however, the fluctua-
tions of neuron energy in their relation to the mental phe-
nomena manifested that have to be principally studied.

We must be in possession of all the knowledge possible
to gain about the bodily ailments of the insane and of those
things that pertain to psychiatry as an art, but many of
them are indicating a tendency towards stereotyped
routine in psychiatric journal literature. Frankly speak-
ing, gj'ntecological affairs, sprains, dislocations and frac-
tures, the symptomatology of mere secondary complicating
diseases of the body, such as fever, etc., are really rather
•ound-about ways of getting at the scientific investigation
m^ explanation of the mental sympioms in insanity.

CORRELATION OF SCIENCES. 83

Statistical work still leaves much to be done that is of the
utmost value. Still, all things considered, much of the
literature of psychiatry, even at the present day, is far
from being scientifically satisfactory.

As an example of the tangle in which psychiatry finds
itself at present, one may point to the hydra-headed
classifications of mental diseases with fifty-four varieties
of mania, and an equal number of melancholia, given in a
standard compendium. There must be something wrong
with a science that finds itself in such straits. Psychiatry
has no methods appropriate for the investigation of
abnormal mental phenomena; what wonder that it is
impotent and cannot progress. Psychiatry must broaden
out. As a science, psychiatry is absolutely dependent
upon psychology and psychopathology and their correla-
tive branches of science. Psychology and psychopathol-
ogy have developed the real methods for gaining the
facts, observing the phenomena and conducting the ex-
periments that psychiatry needs. The great value then
of pyschology and psychopathology is paramount in
reviving the suspended animation of psychiatry.

It is unfortunate that both neurologists and psychiatrists
have a tendency to view psychology as so much meta-
physics, or to sum up the whole practical utility of normal
psychology and psychopathology with the word hypno-
tism, as though the sum total of the immense value of
psychological and psychopathological methods of inves-
tigation and practical lessons of their teachings are
bound to be centered about the phenomena of hypnosis.
If there is to be any ultimate, tangible and firm basis
for the understanding of mental diseases, and a con-
sequent rational treatment and classification of them, it
is surely to come as a result of the use of the methods

«4 COUUCLATMHI Or SCIKKCIS. ^H

of tHychalocjr ud mfC^eptthotogy. Space forbids any
moM tbU ftB ftltoaiQD to the creat Talne of understanding
lh« pitycliio ptNaoBMSM o( tin normal indiridual by study-
tnK tl)c dbordmd pqr^k pbefrnmeoa in abnormal In-
divlduftU. SdvntUk raaeu<dws of normal mental and
nsrvoua procMMs aeltett h««« their full value without
the obMrvathm waA «tperta«it of pathological cases,
naluraV ttiiiipnaientSi. la nuBj fonns of insanity,
nntiin? Is itcrfv^rntitty •xparisMBtSt more ingenious and
VHlu«bli? fur atutly than tite p^ptkoloKtsc, lestricted to the
»tudy i>( the pfeMMOMMB of the nonoal consdonsness,
coulil 6V«r (levilK Nonnid ps^chokigy has mach to learn
and In fuet v«n ttttff mt b« firmtr established v<rithoQt a
previous thorou^ CKplanakn «f the domain of patho-
\tigi>M\ paytliotofjr.

In one tiwtftttOK at toast* <ader the direction of
KraepetiQ at H^Mbat^, hare tte ivsqIcs of stadies in
pathoto)ika) pqKholOBr ban watt satis£aciory in clearing
•w«]r M>m« of the wjnteiT aninMBding the origin of
taantal d ia a M aa. Tte aaMMim experiments at this
Bchool OB the aattjett o( tacigtte of Ae nenroos system
bava already atimvlaltd a men «nct aad broader view of
the stttdy of the *ymt»oua of lasaitltr. Bat even this
91A00I has failed to stvritr ntMal iMittaMB directiy at their
fbantain-he«d; it ia only thraagb such a wwfc that we can
fet an insigbt into the MMn of »etal abemiioas.
The Depa rt — M of fsnhoiogy and {^pt^opatboloe; at
^B iBstimte dtrretas its time mostlv to the stndy of
{■tbolOKical cases.

It win sot be iaammpriattt here to mahe « aaoe
fiff— *"■ to duee pnxaiaent cases in which the Depait-
t has aot oaly beared np m«eh of the -^t**— tfm
bat WQcfced am of A« lavs of Ae

■|^Ae syaap tom s bt

CORRELATION OF SCIENCES. 85

disease, the methods of cure, and applied them success-
fully. Psychopathology yielded definite tangible results
of the highest value.

The first case was from the Binghamton State Hospital,
and was studied in conjunction with Dr. William A. White.
The case presented limitation of the field of vision, ac-
companied by occasional attacks of delirium and many
other phenomena of mental dissociation. The case was
closely studied experimentally ; very important phenomena
were elicited and a general method for the investigation
and cure of similar cases discovered.

The second case was sent to the Institute through the
courtesy of Professor B. Sachs, of New York city. It was
one of functional hemi-anaesthesia and ataxia com-
plicated with organic disorders. Investigation controlled
and eliminated the functional disorders, which were of
long standing, and had previously resisted all attempts
at improvement.

The third case, known under the name of total
amnesia and ** double consciousness,*' yielded theoretical
and practical discoveries of the most brilliant nature to
science in general and psychology in particular. From
the investigation of this case were deduced laws guiding
treatment for future cases, which, up to the time of these
researches, were left to the care of Providence as lying
beyond the ken of human knowledge.

All of these cases were quite beyond the use of drugs,
and far beyond investigation by any of the methods which
neurology and psychiatry make use of, and in both cases
the treatment based on theoretical studies in psycho-
pathology was crowned with complete success.

This Department also works in the lines of cellu-
lar psychopathology^ correlating the different psychomotor

86 CO K RELATION OF SCIESfCCS.

maMtfesfalitms with the varied affeclums a/ the xenriM and
fitutxatioHi in neuron energy. This is as attempt, and the
fint of its kind, to biing into one comprehensive scheme
sad embrace in one formula exprtued in terms of the
fiuefualioni in neuron energy ■with llie c&neomitant psyeko-
mator manifeUations the infinite number of bewildering
phenomena met with in nervous and mental diseases.*
Alon^ with it the laws and principles of inter-relation of
the neurone are worked out ; these, we hope in due time
may lead to some important laws forming the scientific
basis of pathology in general, and of pathology of
oervons system Jn particular.

This same department in connection with that of
experimental pathology and physiological chemistry is alao>
cmdertaking work in comparative psychopathology. The
simulacra of diseases like catalepsy, paralysis agitass or
epilepsy, for instance, we are endeavoring to induce
artificially in animals. The manifestations are closely
studied and experimented upon, and are then correlated
with nervous diseases in men that give like symptoms
under the same conditions of experimentation.

This mere fleeting glimpse of the relations of psycho-
pathology to psychiatry does not, however, regard many
other great side avenues in other departments of abnormal
mental and nenrous life. In the prison, the reformatory,
the hospital for the epileptic, in the institutions for the
feeble-minded and idiots and for the general delinquent
and defective mental classes psychopathology has a great
field to reap. Its lines of research are the most prominent
1 and valuable in the institutions furnishing the meeting-
L'gnrand for the criminal and the victim of insanity-

CORRELATION OF SCIENCES. 87

hospital for the criminal insane. In fact the so-called
criminal anthropology is largely a domain of psychopathol-
ogy^ only the physical data and measurements properly
fall within the field of anthropology.

To strengthen the importance of the wider application
of psychopathology in medicine by enumerating the dis-
eases whose investigation demands its services is unneces-
sary since this would comprise nearly the whole great list
of mental and nervous diseases. While the most brilliant
domain of psychopathology is in the functional diseases of
the higher realms* of the nervous system including
neurasthenia, hysteria, epilepsy, etc. , the investigation of
the more focal or localized diseases of the nervous system
and nervous diseases generally has great gains to score
through the aid of pathological psychology. In nervous
diseases the absence of psychopatholog^cal investigation
has enforced an unfortunate negligence of the mental
phenomena in these diseases. In the study of lesions of
the *' silent" — although to psychopathology eloquently
silent — regions of the brain, especially the frontal lobes,
neurological methods have made a frank confession of
their defeat. In the whole group of apraxias, aphasias,
amnesias and the like are inviting arenas for psycho-
pathology. The vista of psychopathology stretches out
far and wide. The science will illuminate the darkest
recesses of the nervous system above all the brain.

Enough has been said to insist upon the maintenance of
a Department of Psychology and Psychopathology at the
scientific Institute of the New York State Hospitals, as
the one the most closely affiliated with, and in fact of
paramount importance in the study of insanity.

•Vide Psychopathic Waking and Sleeping States (Chart ID in ''Neuron
Bnergy/* Archives, Jan., '98.

88 CORRELATION OF SCIENCES. ^^H

This departnaent is provided with a reasonable outfit of
instruments. It is provided with sphymographs, cardio-
graphs, pneumographs, chronographs, ergograpbs, re-
action-timers, etc. Some of these instruments have been
made to order; others, bought in Europe. In fact, the
equipping of the Department of Psycholog}' and Psycho-
pathology takes an amount of time which seems unin-
telligible to those who might expect work to come forth
from an Institute of this kind with undue haste. The
apparatus of this department is as yet rather meagre, and
it serves only its roost fundamental requirements. In the
course of time, other instruments will have to be added as
the department and its work will grow and develop. It
cannot develop all at once and spring forth into full
activity, like Minerva from the head of Jupiter. It has
been thought unwise, therefore, to add apparatus to the
equipment of the department beyond what is absolutely
indispensable for the carrying on of the work on hand.
The same is to be said of every other department in this
Institute.

Within the brief space of the foundation of this
department its work has grown so extensive, the prob-
lems on hand are so numerous, that an increase in its
working force is absolutely essential. Without an assist-
ant the chief of this department must lose the oppor-
tunity of taking up works of the utmost value. Psycho-
logj' and psycho pathology has been the central inspiration
of all of the branches of research of this Institute for they
have infused into the several avenues of work a spirit of
philosophy, the soul of progress in any science. The de-
partment of Normal Psychology and Psychopathology is
under the charge of Boris Sidis,M. A., Ph.D., (Harvard).

CORRELATION OF SCIENCES. 89

Chapter VI.

NORMAL HISTOLOGY OF THE NERVOUS SYSTEM.

The story of the evolution of our knowledge of the
structure of the human nervous system is full of interest,
if not fascination, but we can only touch upon it here in
the baldest outline, sufficiently to appreciate its status at
the present day.

The first and very meagre chapter containing any real
insight into the marvels of the structure of the nervous
system, begins with Descartes. The keenness of percep-
tion of this remarkable man enabled him long before the
microscope had been invented, to portray the structure of
the nerve fibres, both in diagrams and in text. He
considered them as minute tubules which conveyed the
animal spirits from the brain to the muscles. If we
substitute for the word animal spirits the modem phrase
nervous impulse, Descartes in his idea of the nerve fibres
was not so very far behind our conception of this structure
at the present day.

After a lapse of some three hundred years, in the early
part of this century, the microscope demonstrated that the
nerve fibre was not hollow, but contained a solid core, or
axis. A little later in the early thirties, investigators
discovered that the brain not only contained untold num-
bers of these nerve tubules with the solid core, but myriads
and myriads of tiny lumps of protoplasm, the nerve cells.

At that day, workers in the field of the microscopical
anatomy of the brain were utterly unable to solve the
riddle of the relationship of the cells on the one hand
and the fibres on the other. No one knew where the
fibres came from, or where they ended, nor was any

90 CORRELATION OF SCIENCES.

one able to make out the least connection of the fibres
among themselves. The whole nervous system was an
inextricable snarl of an infinite number of fibres and
nerve cells, hopelessly tangled and mixed up together.
It was, therefore, impossible to obtain any idea as to how
this greatest marvel of creation — ^the human brain — did its
work. At this period, the microscope was in a crude
condition, as compared with the powerful instrument of
investigation of modem times. For to-day the construc-
tion of lenses has so advanced and their magnifying power
is so great that a unit of measurement for the minute
anatomist of to-day working with the microscope is only
„f^ of an inch long.

In the early thirties the brain histolog^st or minute
anatomist had to study his material in fresh condition.
He had no methods of preservation; nor did he enjoy the
advantages of being able to cut thin, diaphanous slices
from the brain to view under the microscope. To-day we
have the whole armamentarium of the chemist to preserve
the brain in a hundred different ways, which gives as
many variations of methods of study. We have appara-
tus for cutting thin sections of the nervous system, so
delicately contrived that twenty thousand of these sections
piled on top of each other would not be an inch high.
Moreover, to-day one has at hand a hundred aniline dyes
and other colors With which to stain these sections, color
and pick out selectively elements of the nervous system in
the sections under the microscope so as to suit his par-
ticular purpose.

The whole record of progress in the structure of the
brain invariably goes hand in hand with a similar record
of improvements in the microscope and other apparatus
and also in technical methods of investigation.

CORRELATION OF SCIENXES. 9 1

During the forties and fifties, investigators began to
shed some light on the obscurity of the structure of the
nervous system by discovering one exceedingly impor-
tant fact, namely, that the cells and fibres were not
independent of each other, but that the fibre was a pro-
longation of the cell, an outgrowth of its body. This at
least cleared up the question as to the origin of the fibre,
and physiologists derived comfort from this fact, in that
they had a reasonable explanation of how, in a funda-
mental fashion, the nervous system operated. The nerve
cell, so to speak, was the headquarters of nervous opera-
tions, and its enormously long outstretched arm in the form
of a fibre, was a device to carry the impulse to some distant
part. This important fact as to the connection of nerve
fibre and nerve cell did not contribute as much toward
advancing knowledge of the nervous system as might
have been expected. The connection of the nerve fibre
and nerve cell was only witnessed in the very simplest
parts of the nervous system, and not in its more com-
plex and most highly developed parts of the brain itself.
Besides this, while the early investigators were sure that
the nerve fibre came out of the nerve cell, they were still
ignorant of the course and termination of the fibre. They
saw the origin of one end of the fibre only, the part which
sprang from the cell.

Thus until fifteen or twenty years ago the structure of
the nervous system was still a riddle and a puzzle. The
whole nervous system was an inextricable maze of an
entangled net-work and its unraveling seemed impossi-
ble. It was hopeless confusion to attempt to follow
out the pathway of a single nervous impulse in this
labyrinthic net-work. Within the past ten or fifteen years
the obscurity that enshrouded the nervous system was

9»

CORRKLATION OF SCIENCES.

replaced by a clear and definite insight, that is almost
stanling. In 1873 a distinguished Italian investigator dis-
covered a method which revolutionized our whole knowl-
edge of the structure of the nervous system and opened
boundless fields of research in manifold directions. From
the results of this method of investigation, we have a final
solution of the structure of the nerve cell, the nerve fibre
and their connections.

The nerve cell is like a tiny octopus. Like this animal
it has a body whereby it attends to the process of digestion
and assimilation. In this body, a food supply from the
blood vessels is elaborated into materials which enable the
cell to do its work. Like the octopus, too, from one end
of the body of the nerve cell springs out a multitude of
branching arms or tentacles. From another part of the
cell body arises an arm different from the shorter arms or
tentacles. This arm is of exceedingly great length, and
passes away from the body to distances hundreds and
thoiisands of times the diameter of the cell itself. The
outstretched arms of the nerve cell octopus — the nerve
fibre — may pass to the outer parts of the body, where they
receive messages from the eye or ear, or other sense
organs. The long arm passes out to other parts of
the nervous system, to transmit impulses from one
part of the nervous system to another. These octopus
lite nerve cells are arranged in groups, systems, clusters,
communities and constellations'^ of exceeding complexity.

A given oerve cell octopus passes its long outstretched
arm so as to touch the tentacles or shorter arms of a
second octopus. The second one, in turn, passes its long
arm to the tentacles of the third and so on through an
infinite set of combinations which have their highest

■Siflis. PsyehDlogy of Suggest Ion, Ch. XXI.

CORRELATION OF SCIENCES. 93

complexity of arrangement in the highest spheres of our
brain, which are the last parts to develop, both in the
evolution of species as well as the individual, and which
are ever unstable and prone to disintegrate by reason of
the process of retraction of the nerve cells.

In the lower parts of the nervous system retraction and
the corresponding dissociation of the functioning groups
of nerve cells is less liable to occur under the influence of
pathogenic agencies. For here the functions are phylo-
genetically older and tend to approach more or less a
stereotyped nature. Since the stability of organization of
the different parts of the nervous system depends on the
frequency of the impulses transmitted through the group
of neurons, the lower parts of the nervous system are
more firmly united than are the highest spheres of the
brain.*

The most interesting feature of this latter-day concep-
tion of the make-up of the nervous system, is that the
nerve cell, like the octopus, possesses power of movement
over its tentacles, f Consider, for a moment, what happens
when the nerve cell retracts its tentacles. The message
can be no longer transmitted. The nerve cell has thrown
itself out of the circuit of the long arms of its fellow -asso-
ciates in a given group or community; they are no longer
in contact with the retracted tentacle. But we should
conceive that as a rule whole groups, communities, clusters

^Tbis was written before Apathy's view of the concrescence of neurons came
to our attention. We were thus, in a measure, prepared a priori to accept his
▼lews not for the whole nervous system but its lower and phylogenetically
oldest portions.

t Prom a study of the identity of differentiation which the gfeneral structure of
tlie neuron undergoes in the neuraxone in the form of long parallel filaments
incoriwrated with distinct microsomes with analogous modifications of the
cyto-reticulnm in other somatic cells (muscle cell, ciliated cell, leucocyte,
chromatophores, etc) subservient to motility, my own observations incline me
to believe that the azone may be the retractile and expansive structure of the
neuron as well as the dendrons or gemmules.

94 CORRELATION OF SCIENCES.

and constellations of nerve cells functionally correlated
retract en masse rather than individual cells. Cells cannot
work as isolated individuals in the higher parts of the
nervous system; they are invariably members of assem-
blages which have been physiologically linked together
by education, use and function. There may be partial
retraction of the individual members of one functionally
linked assemblage of neurons from another assemblage,
but in the phenomenon of retraction we are to picture
it occurring in a mass of nerve cells belonging to
some particular assemblage and occurring more or less
simultaneously.

A message can no longer be delivered and transmitted
from one part of the nervous system to another, if a mass
of these nerve cells break the circuit by retracting their
arms. This is the secret of many a puzzle and mystery
enveloping a very great mass of psychomotor manifesta-
tions of the human nervous system. The object which
the nerve cell apparently has in view in retracting its
arms is to avoid overwork, and withdraw itself from hurt-
ful stimuli. Retraction of the arms of the nerve cell is
apparently a signal of exhaustion of the dynamic energy
of the neuron.

Retraction is a remarkable adaptation of the higher
order of neuron aggregates to elude stimuli (energy
liberating impulses) which increasing in quantity or
degree would otherwise draught off deeper and deeper
levels of static neuron energy. And expenditure of static
neuron energy is a process marking the passage of the
psychomotor manifestations from the physiological domain
to the realm of disease. In other words retraction of the
neuron may be regarded as an adaptation whereby
increased resistance is interposed to energy liberating

CORRELATION OF SCIENCES. 95

impulses which have exhausted the high potential energy
stored in the neuron for the activities of the physiological
waking states.

Neuron aggregates are united to each other by training,
by function. The more simple the aggregates and the
more frequently they functionate together the more stable
is the union. The stability of the functional association
is established by routine use, by habit. On the other
hand the more complex are the neuron aggregates, that is
the greater variety and permutations of their association
with sub-aggregates, the less stable is the association.
Instability of neuron aggregations reaches its maximum
in the highest orders of constellations, for here there is
but little or no permanency of the functional interaction —
there is no routine beaten track, no set channels of the
associations in the highest order of constellations. In a
simple reflex arc the external stimuli are of a uniform
kind and always proceed in the same pathway. In the
highest constellations of neurons the stimuli come through
a great variety of avenues. At one instant the impulse
wells up through some particular avenue, at another in-
stant the stimuli preponderate in another channel. The
result is a continual flux in the functional association of
the higher constellations. The functional association is
subject to continual mutability, to continual forming and
unforming of the associations with other neuron aggre-
gates. This is in fact the physiological parallel of the
swell and play of the human mind, the infinite variety of
thought and reasoning. Association and dissociation of
the higher orders of neuron aggregates may be conceived
as continually taking place in normal mental life con-
comitant with the activities of the higher realms of con-
sciousness. As Sidis explains it '* under the action of the

gfi CORRELATION OF SCIBNCE5.

slightest external or internal stimuli unstable systems* or
constellations lose their equilibrium, dissolve and form
new systems or enter into combination with other con-
stellations. On the psycliical side we have the continuous
fluctuation of the content of attention. Tht chaTact eristic
trait of the highest type of psychophysical life under the
ordinary stimuli of the environment is a continuous process
of association and dissociation of constellations."

Association and dissociation of neuron aggregates then
form the physiological parallel of normal mental life.
Relraclion and expansion of neuron aggregates form the
correspondinf( physiological parallel of abnormal mental
life. In accordance with the laws of stability of neuron
aggregations the highest and last trained constellations in
the psychophysiological evolution offer the least resistance
to stimuli or agencies which liberate neuron energy. If
the stimulus becomes intense, or what amounts to the
same thing, is persistent although of mild intensity, the
most unstable constellations lose their dynamic energy
first. After the dynamic energy is exhausted retraction
occurs and the stimulus is evaded. Concomitantly with
the retraction of the least stable constellations a sphere of
consciousness is split off from the whole. If the stimulus
increases still farther the retraction progresses to deeper
and deeper levels in the organization of the nervous
system. Clusters of neurons offering less resistance in
their functional aggregation than the communities, be-
come retracted and fall asunder. With an increase of the
stimulus communities undergo dissociation among them-
selves and so on down to neuron aggregates which by

•Bym

soelalion ftbres neuron aggregates are built up froi
, Simple and througb function flrmlr Inlerwovoi

ocistlon flbres. SyBlBms arc orgnnlMd Inl

CORRELATION OF SCIENCES. 97

reason of stereotyped functional interaction are organically
united. In these lowest neuron aggregates the adaptation
of retraction and expansion is superfluous and might even
be inimical to life.

This retraction and expansion of the arm of the nerve
cell, in groups, systems and communities of brain cells,
drawing it in or out of the circuit of transmission of nerv-
ous impulse, is the final unveiling of the secret of a whole
host of mental phenomena which hitherto have seemed
mysterious to the last degree. These attributes of exten-
sion and expansion of the nerve cell cannot fall to attract
even those with the most casual interest in the operations
and development of the human mind, and holds one spell-
bound in the vast flood of light shed upon the explanation
of insanity. Mysterious cases, for instance, of individuals
who sometimes from a blow upon the head or other causes,
wake up and find their past lives a blank, and who virtu-
ally begin to live their lives over again as it were, in a new
world, such as a case recounted in Dr. Sidis* book ** The
Psychology of Suggestion " may serve as a fair example.
Such cases receive their only explanation in retraction and
expansion of the tentacles of the nerve cell octopus, disso-
dating functioning associations of cells.

The phenomena of hypnotism, hysteria, and of the
whole great important groups of psychopathic functional
diseases are to be explained in the same way.* Some of
the violent manifestations of insanity seem to be due to
the retraction of the highest constellations of nerve cells
that dominate and control the lower parts of our nervous
system. The lower centres being dissociated from the
control of the higher ones, give rise to the phenomena
found in some forms of mania (psychopathic). Discrim-

• The topic is further elaborated in the Principles of Psychopatholognr* a work
recently completed by Dr. Sidis.

ATION OP SCIENCES.

itiation as to significant and insignificant stimuli is cast
aside, so the maniac is prone to respond to any passing^
zephyr of stimulus with a storm of excitement. His
subconsciousness lacks the normal control and is most
prominently in the foreground.

The phenomenon of retraction of the neurons is also, I
most firmly believe, the explanation of the cardinal symp-
toms of epilepsy in the manifestations of the fit. Here
the retraction of the constellations and clusters in the
higher parts (association centres of Flechsig), from a
given stimulus is very sudden; the lower portions of the
brain (sensory spheres of Flechsig, particulary tacto-
motor zone) being suddenly loosened and dissociated from
the inhibition and control of the higher portions, the
energy of the neurons of these lower portions of the cor-
tex is suddenly liberated with the corresponding psycho-
motor phenomena.

Every one is familiar with those forms of insanity in
which the patient seeras oblivious to his outside environ-
ment, shown in some forms of melancholia (psychopathic).
There are again instances where the whole foreground of
consciousness has been partially split off by a retraction
of the nerve cells constituting the higher spheres of the
brain. A cleft lies between them and the rest of the
nervous system, caused by this phenomena of retraction.
Depending upon the quantitative degree of retraction
between various assemblages of neurons in the brain
some forms of psychopathic mania or melancholia might
result. Thus we see that one pan or another of the
brain may be dissociated from the rest, and naturally
the parallel manifestations of the mind are thrown out

t -~-

CORRELATION OF SCIENCES. 99

anatomy of the nervous system, perhaps, shows best of
all a faint glimpse of the directions we are striving in to
contribute something toward clearing up the explanation
of insanity. These introductory paragraphs ought also to
show how important this department is for the investiga-
tion of insanity.

I should not, however, be guilty of conveying the im-
pression that merely because the anatomist has discovered
these wonderful facts about the shape of the nerve cell
and its connections or that some evidence from my own
researches tends to prove the phenomena of retraction,
that the study of mental phenomena is superfluous. The
anatomist, the chemist cannot possibly disclose thoughty
consciousness from the material phenomena with which
they respectively deal. The work of the psychologist and
especially of the psychopathologist attains its highest im-
portance when the physiological processes concomitant
with the mental phenomena studied are constantly kept in
view. The dynamic theory of cellular life and the theory
of neuron retraction in fact can be most safely worked
out from the psychopathological standpoint in conjunction
with the study of general physiology. The anatomist or
the chemist do not have consciousness for their material.
Thought is not o, product of nerve cell activity in the same
sense as bile is a product of the liver. The brain
does not secrete thought, as the kidneys secrete urine;
thought is not a material thing; it can neither be weighed
nor measured. A sensation of color, for instance, as ex-
perienced by the eye, has no material existence in the
physical world. We can only speak of the phenomena of
consciousness as running parallel or being concomitant
with the metabolism of the nerve cell, lest we make of
consciousness a material body.

lOO CORRELATION OF SCIENCES.

To the psychologist belongs the study of psychophysi-
ological life; the details of structure fall within the sphere
of the anatomist. The object of reverting back to the
department of psychology and psychopathology is briefly
to point out the incongruity of setting forth the claims of
any of these departments of the Institute investigating
insanities as distinct, isolated methods of research. They
must all be linked together and work hand in hand, A
concrete example of this is the apportionment and yet
linking together of the work in the departments of
psychology and normal anatomy of the nervous system.
The psychologist, for instance, studies the manifestations
concomitant with the physiological process of retraction
of the tentacles of the nerve eel! octopus. Working
conjointly, the psychologist and the anatomist show, in
an ideally scientific way, the stages of the parallelism
of the physical process ia the nerve cell and the corre-
sponding psychic phenomena.

In the section devoted to the status of the science of
pathology in investigating the nervous system, the same
feature crops out again. In the abnormal anatomy
of the nervous system as well as in the normal anatomy
in the necessity for correlated work with psychologi-
cal and psychopathological investigation is still more
evident.

The anatomist, however, is not by any manner of
means in a position to write the last words about the
structure and architecture of the human nervous system.
This goal will not be attained for many years to come.
He has only been able thus far to straighten out the intri-
cate structure and connections of the comparatively ele-
mentary chains and series of the octopus-like nerve cells in
the lower and simpler parts of the nervous system. The

unravelling of the connections and associations of nerve
cells in the highest parts of the nervous system, where the
cells are evolved in enonnous complexity of connections
in the fonn of constellations, hardly has been begun. By
studying the developing infant, however, and patiently
working at the brain of the growing child, we hope to
attain in the future our best light upon this obscure
domain of the anatomist.

Professor Flechsig has, however, after twenty years of
work, formulated a plan of the brain which, it seems to
me, is the key for a final solution of the intricacies of
higher brain architecture. This plan was studied out in
the brains of human embryos, children at birth and
growing infants, where the different parts of the nerv-
ous system can be identified because they make their
appearance in a progressive series from the simple, funda-
mental and phylogenetically oldest parts to the more
complex, highly organized and most recently evolved
portions.

In accordance with this plan of Flechsig, but a small
portion of the brain cortex — only one-third — comes in con-
tact with the outside world through the chains and series of
octopus-like nerve cells connecting the sense organs, while
the great mass of the brain cortex — the remaining two-
thirds — has no direct connection with the outer world, but
connects and associates the scattered brain areas connected
with the sense organs or muscles.

This division of the braiu into these two parts — the
smaller portion known as the sensory spheres and the
larger the association centres — gives a wonderfully clear
view into many forms of insanity if we take into account
the concomitant psychomotor phenomena produced by
different degrees of retraction of these parts, but espe-

I02 CORRELATION OF SCIKXCES.

cially by retractions occurring in the association centres
themselves by retractions of communities, clusters and
constellations of nerve cells.

The sensory spheres are scattered about in the cortical
grey matter. A patch at the hind end of the brain
is the sensory sphere for vision, another corresponding
to the sensory sphere for sound is situated near the
apex of the temporal lobe. Similarly olfactory, gustatory
and tacto-motor sensory spheres are located in other parts
of the cortex. Between the sensory spheres are inter-
polated the association centres. The more fundamental
portions of the association centres operate to render possi-
ble a simple order of recognition of the impressions
received in the sensory spheres by associating them
together. In the higher regions of the association centres
a still more complex order of recognition of sensory and
motor impressions is possible. Finally the constellations
of nerve cells probably located in the frontal lobes afford
a basis for the highest forms of synthesis of con-
sciousness. This is the association centre of association
centres.

It is in these association centres and in their connections
with the sensory spheres that the phenomena of retraction
of the nerve cell plays such an important part. One can
well conceive the chaotic condition of ideas, or imperfect
power of recognition, and a host of other abnormal mental
phenomena, when retractions occurring in the groups, com-
munities, clusters and complex constellations of nerve cells
split off the association centres, from each other or from
the sensory spheres, and produce corresponding dissocia-
tions in consciousness. In the lower animals the associa-
tion centres grow smaller and smaller, and finally, say for
instance, in the lower mammals, the sensory spheres lie

CORRELATION OF SCIENCES. I03

contiguous with hardly any vestige of the association
centres between them.

For the study of insanity, the understanding of the stnic-
ture of these higher spheres of the nervous system is of the
most vital importance. It is the instability of these high-
est parts of the nervous system which is the essence of the
whole question of insanity. Hence, when we consider this
aspect of the value of the department of normal histology
of the nervous system, we find that its ofiBces are abso-
lutely indispensable.

With the exception of the discovery of the neuron theory,
Sidis' psychophysiological theory of association and dissocia-
tion, the theory of the retraction and expansion of the
neurons, the theory of neuron energy fluctuation, and Flee h-
sig's plan of the association centres and sensory spheres of
the brain are the greatest discoi'crics which have ever been
put forth in the history of our knowledge of the nervous sys-
tem. The effect of the application of these great hypo-
theses (for observations* at present in ray own belief, at
least, are increasing their validity) will indeed be revolu-
tionarj' in the domain of mental and nervous diseases.

Oae standpoint in this chapter I taist is clear, and that
is, we thoroughly understand that normal histology of the
nervous system should not be confined to a study of the
mere static side of mental and nervous life but should go
hand in hand with a study of its dynamics. We cannot

MBCEDtypei] func

erCectly t(

Retraction
muit be populated fi
Apatl))-'a theory, in i
tbcory ; his theory d

:»I1yBiidth(ilinpiili

ed by phyaioloKicBl uonloct.
partsoE the nervous ByMem. but
e highest portions at the brain.

'hole nervon« system, bot to its

grasp the laws govemiDg the djTiamics of life by the study
of morphology. One cannot see physiological processes in
cut and dried sections through the microscope. Life phe-
nomena are manifestations of energy. To understand the
dynamic side of life phenomena one must use the principle!
of general physiology. For this science studies the real,
internal causes of the activities of living matter in energy
and the laws of the equivalence of cause and effect in the
phenomena of life in the liberation and restitution cycles
of energy. The operations of mind however, are not
modes of motion although running parallel with them.
Life and matter fall within the monistic principle of energy,
but mind is something apart and cannot be explained by
the doctrine of energy. Physiology stands far above anat-
omy in its philosophy. Psychology occupies a still higher
plane, for in addition to the knowledge of both that of
consciousness is required.

Although realizing the great necessity of establishing
the department of Normal Histology, I have not, in view
of the considerable sum already expended in organizing
and developing this Institute, had the temerity to ask for
further expenditure in obtaining a salary for the associato
in this branch until some tangible results in scientific work,
have been brought forth. I would now, however, makt-\
claims for the necessity of this branch of work, so that
within the future, perhaps the ensuing year, a recommen-
dation for its establishment may seem reasonable and fit.

It is appropriate to intimate that the associate of this
line of research should pursue his studies of the normal'
histology of the nervous system, only after a very thor-
ough antecedent study of the minute anatomy of all other
parts of the body in order that he may be sure to have the
.light of analogy of the neuron with other cells of the bo<^
■constantly in mind.

CORRELATION OF SCIENCES. I05

Chapter VII.

COMPARATIVE NEUROLOGY.

The value of the comparative study of the nervous sys-
tem in both health and disease, has been hinted at in the
argument for the practical value of the department of
cellular biology in the scientific study of insanity. Man's
nervous system is a recapitulation of the progression of
development of the nervous system in animals. This re-
capitulation of the nervous system embracing its evolution
throughout the whole animal kingdom is too complex to
be understood without going back to the prologue in the
history of the development in the lowest animals that
possess nervous organs.

Apparently the first nucleus of a nervous system is
found in the fresh water hydra. This creature can
expand and retract a portion of its substance by a very
simple mechanism, which is the combination of both
the nervous and muscular systems. This animal appre-
ciates stimuli from the external environment by means
of a most elementary sensory apparatus, the fore-shadow
of the nervous system in higher animals, and reacts
by means of a primitive muscular mechanism. These
two sets of mechanisms are not differentiated as in the
higher animals into two distinct organizations, but are
so alike and undifferentiated that it is difficult to dis-
tinguish the one from the other.

In a somewhat higher form of development, as in an
ascidian, the motor and nervous systems have become
differentiated. This creature has an outer tunic, an inner
digestive coat and a muscular sac lying between the two.
The nervous apparatus is exceedingly simple. It is merely
a chain composed of very few nerve cells, one end of which

Io6 CORRELATION OF SCIENCES.

touches the outside tunic, and the other end the muscular
coat. When stimuli from the external environment are
conveyed to the tunic, the creature, by means of this nerv-
ous system, transmits the impulses to the muscular bag,
and responds by muscular movements to these stimuli.
The very simple nervous system in this creature is the fun-
damental basis for the building up of the nervous system in
the higher animals. This tiny arc of nerve cells passing
between the muscle and the skin in the ascidian is the
starting point which nature builds upon in evolving the
wonderfully complex nervous apparatus in higher animals
and in man himself. Roughly speaking, the difference
between man's nervous system and that of the ascidian is
not in any essential distinction in the shape and constitu-
tion of the nerve cell, but in the fact that man possesses
numerically millions and millions more, in infinitely com-
plex adjustment, of these tiny nerve cell arcs found in the
ascidian.

Passing upward in the scale of evolution from the
ascidian, as more and more of these nerve cell arcs make
their appearance, and are evolved into increasingly com-
plex adjustment to each other, the animal gains more and
more highly developed functions. In the lowest forms
of animal life possessing the nervous system, the
nerve cells are arranged in simple chains or series,*
as the evolution of the animal grows more complex,
the simple series make a greater variety of combi-
nations with each other, so that they become gathered
together vaXa groups * As the scale of evolution becomes
still higher, groups of nerve cells make increasingly
complex adjustments in the form of clusters.* In still
higher forms of animal life, the adjustment of clusters

r-Bychology of SuKgeation, Chap. XXJ,

CORRELATION OF SCIENCES. IO7

of nerve cells become complicated into covtmujiities.'* In
man we find all the evolutionary series compounded into
one complex whole. The elementary' form of the nervous
system in the lower animal represented in a simple chain
or series of nerve cells, is present in the lower and more
fundamental parts of his nervous system, such as the
sympathetic. The more complex forms are built up into
groups, clusters, communities, and ultimately in the highest
parts of man's brain, the commufiities are gathered to-
gether in such a variety of combinations as to form an
infinite number of highly complex constellations. *

In building up this plan of the nervous system from the
lowest to the highest creatures, nature makes no sudden
strides or leaps. It is a steady progression of piling up
the simple series of nerve cells, such as found in the
ascidian, in increasing numbers and complexity of combi-
nation until we reach the form of constellations in the
highest portion of man's brain. His intellectual attain-
ments, his highest form of consciousness, his self-control
and dominance of the lower parts of his nervous system
run parallel with the activities of these constellations.

Comparative anatomy of the nervous system is invalua-
ble as a method of going back through past ages, and of
witnessing how man's nervous system has been built up
from the simple to the complex. All the chapters in the
history of brain evolution are to come from the researches
of comparative neurology. We must not expect to com-
prehend the architecture and phenomena of man's nerv-
ous system by considering it as something apart from the
nervous system of the creatures whence he is derived.
Nature did not make man's nervous system by a special
fiat, nor in evolving it did she consider him to be any more

•See Sidia '* Psychology of Suggestion," Chap. XXI.

loS CORRELATION OF SCIENCES.

or less than the final member of a continuous series in the
progression of the evolution of life forms.

Man is to be looked upon as a creature of the past. For
nature in the evolution of the nervous system has built man
on the same fundamental plan with that of an ascidian.
Man's nervous system is a magnificent organization, but
in plan of structure it is the same in the ape, the dog or
even the earth worm.

Comparative anatomy of the nervous system has often
given us the most striking answers to complicated ques-
tions in man's brain. For instance, when certain animals
leave their aquatic habitat and spend the rest of their exist-
ence leading a terrestrial life, special sense-organs become
useless and disappear during the terrestrial life. The fol-
lowing out of the changes of the brain, incident to the loss
of these sense-organs has thrown most important light upon
some of the complicated questions of the nerves in man's
brain. The enfeebled development of eyesight in the
mole, and the deficient development of the portions of the
brain concerned with its visual impressions have helped
us in understanding the central mechanism of vision in
man's brain. The enormous development of the sense of
smell and of the parts of the brain devoted to the reception
of olfactory impressions in the lower animals has been of
much service in contributing to the knowledge of the
structure of the parts of man's brain connected with his
delicate but uncomprehensive sense of smell. In fact, in
the study of man's brain, we are constantly driven back
into the past when it was in a simpler form, in order to
understand its mechanism and operations.

Comparative neurology is of value, not only in helping
us to understand the architecture of the nervous system,
^t it is also destined to be of great importance in imparting

CORRELATION OF SCIENCES. I09

knowledge of the organization of the nerve cell as an indi-
vidual^ through the study of cofnparative cytology of the
nerve cell. An individual nerve cell, a single one of the
myriads and myriads composing man's brain is a micro-
cosm taken by itself. We are far from knowing, aside
from the problem of how nerve cells are connected with
each other in the brain, how they work as individuals,
how they live and die and pass through their whole life
history. If we had the most perfect knowledge of
all the combinations, adjustments and associations of
the countless hosts of nerve cells in the brain, in
short a perfect knowledge of the architecture, it would
be of comparatively little value in the study of insanity,
unless we understood the 7utvc cell as an individual.
No one could build a bridge, even with the most perfect
and detailed working plans, without knowing the constitu-
tion of the building materials. So it is with the nervous
system. We may know much as to its architecture, and
in fact are actually daily gaining more and more of
this kind of knowledge by a great variety of methods, but
we know comparatively little of the working units of the
nervous system, the nerve cells.

The internal constitution of the nerve cells is the most
pressing question of the day in the study of insanity. The
all-important question is how the nerve cell works as an
individual, how it conducts nervous impulses, how it assim-
ilates food, and the mechanism of elaboration of energy
from the crude food supply which the nerve cell obtains
from the blood vessels. If there be one all-important
question in the production of insanity, it relates to the
balance between food supply of the nerve cells and the work
performed or withdrawal of nervous energy This is a
practical question, because everyone knows that if more

no CORRELATION OF SCIENCES.

energy is drawn off from the nerve cell than can be pro-
duced from its food supply, the result is bankruptcy of the
nervous system. Anyone may see this in his daily walks
of life in the man who overworks and overfatigues his
nervous system. We see this debit balance in the energy
of the nervous system everywhere about us in the
endeavor to cheat time in the pressure of hurry and haste
in the activity of large cities. People expend more
energy from their nervous system than they supply
through food and rest. Yet such a vitally important
question as to the details of the cycles of expended energy
of the nerve cell, with relation to food supply, is almost
unknown. Here again we must have recourse to the aid
of the comparative neurologist, but above all to the
science of general physiology. We must ask him to
tell us the internal structure and constitution of the
nerve cells in the lower animals, because here the prob-
lem may be studied under its simplest condition. We
ask him to make experiments, and to select some
favorable animal to illustrate the changes of fatigue
in the nerve cell, to tell us what happens when the nerve
cell is deprived of its food supply, to recount to us the
changes in the constitution of the nerve cell, when it is
called to expend more energy than it receives in nour-
ishment. Such questions as these are of the utmost
importance.

As a concrete illustration of experimental work in
comparative neurology I might mention an off-hand ex-
ample in some work which we had undertaken some
three years ago in the electric torpedo to determine what
happened in the nerve cell when overfatigiied. Two
torpedoes were placed side by side. One was irritated at
regular intervals with a sharp instrument, until his electric

CORRELATION OF SCIENCES. Ill

shocks became less and less and finally disappeared.
Thus the nerve cells in the brain governing the electric
organ were completely tired out and could no longer work.
Without giving these nerve cells time to recuperate, or
to gain new energy by assimilating food from the blood
vessels, the animal was killed and the cells compared
under the microscope with those of the second torpedo
which remained completely at rest. Thus we had side by
side under the microscope, the overworked fatigued cells,
and those in a perfectly normal resting condition, which
had a full supply of energy. The problem was to deter-
mine not so much any outward changes in the form and
shape of the cell, as its interior mechanism. Definite
changes were found between the two sets of cells, changes
that throw some light upon the all-important problem of
how the nerve cell does its work, and carries on its life
operations.

It should not be understood, however, that the fallacious
view is entertained that comparative histology of the
nervous system, any more than any other purely mor-
phological study, can investigate function by merely
studying shape and form. Such study is not adapted to
investigate the activities of life. The phenomena of life
are caused by mutations of energy. The analysis of life
phenomena on the basis of energy should form the gliding
principles of morphological studies. Morphology can get
no deductive sweep over its provinces without a study of
the cause of life phenomena — cycles of liberation and res-
titution of energy. Comparative anatomy of the nervous
system must then be inspired by comparative or general
physiology. Since the phenomena of consciousness may
•enter into the subject psychology also comes into play.

As a basis for future investigations of this department.

112 CORRtLATlON OF SCIENCES.

biological material has been collected quite extensively,
more particularly marine forms.

Collections oE material like these are not to be
worked through blindly aud merely to store facts. The
facts sought for should be of qualitative rather than
of quantitive value. The facts sought should be those
that may be used, and to use the facts one must have
some notion of the cause and effects in life phenomena.
In short, comparative niorphologj- should derive its
guiding principles from the standpoint of general physi-
ology. Morphology then becomes a philosophic study,
involving the verification of causes and a fitting in of its
facts with the modus operandi of life phenomena. Physi-
ology contains the philosophy of morphology. Deeply
impressed with this idea, I trust that comparative anatomy
of the nervous system, in the plan of a coalition of sciences
in psychiatric research, may be continually stimulated by
the ideas of general physiology by carrying on some of
its researches in the marine biologieal laboratories, such,
for instance, as the one establised at Wood's HoU. Dur-
ing the summer season the department should transfer its
work to such a centre and study the nervous system in
closer relation to the general biological sciences. This
branch of investigation is under the guidance of C,
Judson Herrick, A. B., (Dennison University),

Chapter VIII.

DEPARTMENT OK CELLULAR BIOLOGY.

Cellular biology, lying rather remote in its field of study
from the province of the asylum, those who are in touch
with the insane may not wholly realize that this science
forms one of the comer-stones in a rational system eA
investigating insanity.

CORRELATION OF SCIENCES. II 3

The science of the cell has accomplished marvels within
the past few years, and from the days of Schleiden,
Schwann, Purkinje, Von Mohl and Miiller vast strides
have been made. Inasmuch as the whole body is a vast
commonwealth of these tiny cells, some working together
in a community, as in the kidney, other communities in the
liver, and still others in the brain, it ought to be easy to
understand that the whole ultimate solution of the work-
ings of the body, both in health and disease, resolves itself
into a study not only of the statics of the changes but of
the dynamics of the individual cells themselves. Yet as
Loeb, who has a profound insight into the true philos-
phophy of the general dynamics of life, points out*
general physiology cannot be restricted to the study of
special organs, nor to that of particular cells, amoebas
and the like, nor can it be made identical with a study of
cellular physiology unless we understand by the latter an
inductive and deductive application of its laws to the zl'/wIc
realm of life phenomena. Virchow, fifty years ago, fore-
cast that the ultimate study of disease processes, particu-
larly in their beginning and essences, must be devoted to
the cells themselves. The student of cellular biology
looks upon the cell as a microcosm in itself, and his in-
vestigations have been so searching as to point to the
path toward the solution of the problem of the physical
basis of heredity. If the study of the cell would be rather
of dynamics than that of statics, the path itself would be
nearer in sight.

In studying the egg cell, just after it has started on its
growth, to produce a new member of the species, the
biologist has found that equivalent and equal amounts of

^Einig^e Bemerkunj^en ueber den Be^iflF, die Keschichte und Literatur der
alleg^emeinen Physiolojfie. Physiological Archives, Hull Physiological Labora-
tory, Vol. II.

■ 14 CORKELATIOK OF SCIEKCES.

a certain element of the cell are derived from both the
father and mother. He has shown, furthermore, that
these two equal and equivalent paternal and maternal
elements are woven together, and by a most intricate pro-
cess, distributed in equivalent amounts to every cell in
the whole body. It is on this ground that Huxley says
the entire organism may be compared to a web of which
the warp is derived from the female, and the woof from
the male. It is certainly wonderful to stand at last face
to face with some intelligent and fact-supporting basis of
the mechanism of heredity.

We can now have some ghmpse of how immutable are
the laws of heredity. This material — the germ plasm —
transmitted in equal amounts from both parents to the
new individual, will surely pass on damages incurred by
the ancestors. If a man exposes his germ plasm to the
poisonous influences of alcohol, or still worse, syphilis,
such damage is not confined to his individual life only but
passes on to the next generation. This damage plays a
part in subtracting from the full development of the
organism, especially in the most complicated tissue of the
body, the nervous system. This subject of heredity
is of great importance in the study of insanity, but it
were well that discussions of heredity in insanity might
more generally rest upon the scientific basis of ourpresent
knowledge of the genn plasm and the theories of inherit-
ance. For if Ihe theories be applied deductively to the
phenomena of inheritance in insanity two benefits result.
The facts are rearranged and marshalled in order.
This being done it is to be expected that the theory will
be tried and fortified. Light will then be reflected upon
the theory from an inductive standpoint,

Cellular biology has also another province which cannot

CORRELATION OF SCIENCES. II5

be disregarded and that is embryology, which in a certain
sense is correlative with the study of pathological states
and conditions. The most reliable method of gaining
knowledge of the architecture and function of the nerv-
ous system is to watch its growth in the successive stages
of development of the embryo. Here we are able to
realize the functional value of diflEerent parts of the nerv-
ous system, by stud)nng their various stages of growth as
the embryo passes through its phases of development.
First, the lowest and most fundamental parts of the nerv-
ous system appear, which have to do with the mere organic
and vegetative functions of the body. Little by little the
higher and more complex parts appear in their turn, so
that we can trace, in the growth of the embryo, chapter
by chapter, the whole story of evolution in a recapitulated
form. The particular value of this method lies in the
fact that we are enabled to determine, in a general way,
the function of different parts of the nervous system, as
they make their appearance in serial order in the embryo;
the lower and fundamental parts always come first, the
highest and most specialized in function last. The early
stages of this study of the embryology of the nervous sys-
tem, naturally fall within the province of cellular biology,
for it is in the developing egg that this science has gained
its most brilliant achievements.

The province of cellular biology in regard to touch-
ing on the province of insanity, is so intimately linked
with the scope of pathological anatomy that it is difficult
to dissociate the two sciences, and discuss them separately.
Briefly stated, pathological ayiatomy^ or the science which
treats of the structural concomitants of disease processes,
can make further progress only on cojidition of using the
science of the cell, I mean by the science of the cell not

Il6 CORRELATION OF SCIENCES.

only a study of its statics bat also of its dynamics. Cellular
statics is only a stepping-stone to the elaboration of the
laws of energy applied to the phenomena of life.

The department of cellular biology in the modem
centres for scientific investigation of the insane is abso-
lutely indispensable. The whole study of changes
wrought by disease processes in the nervous sj-stem is
absolutely dependent upon the principles and methods of
cellular biology. Such a department is constantly con-
sulted by the pathologist, and it is due to this department
that he is able to interpret the changed condition of the
brain in disease, which he views under the microscope.

Perhaps the strongest argument for the value of
cytology or cellular biology in the study of the pathology
of mental diseases can be reahzed when we perceive that
Nissl's method itself is really an outgrowth and an appli-
cation of the principles and exact methods of cellular
biology to the nervous system. Without in the least
detracting from the fame of its discoverer and the value
of his great work, Nissl's method is to be considered more
as an extension of the general cytological methods of cell
study to the nervous system than as an innovation in a
particularized technical method. If the application of
Nissl's and similar methods to the nervous system be re-
garded in this hght — as extensions of the methods of cel-
lular biology and requiring a knowledge of the functional
organization of the nervous system when these methods
are used — they can be used broadly and intelligently in
the investigation of the pathology of mental diseases, and
are destined to accomplish startling advances within the
next decade.

Nissl's method and its congeners should be viewed as
methods of cytopatbology which expose the morphology

CORRELATION OF SCIENCES. II7

of the whole interior organization of the nen^e cell in
contradistinction to the crude and restrictive methods of
the older pathological anatomy. These latter methods
merely brought to light the external form and shape of
the cells and gave an account only of the coarser and
grosser morbid changes which were so far advanced
as to be destructive, inducing obtrusive changes in the
external form and contour of the cells. Nissl's and the
cytological methods generally (for Nissl's method of stain-
ing is but one of many of these cytological methods), ex-
posing the internal organization of the cells, present a
hitherto entirely hidden view of structural changes paral-
lel to the whole fiormal and pathological metabolism of the
nerve cell ; that is, as far as the process can be compre-
hended from a morphological standpoint unaided by the
conjoint application of the general physiology. It is
herein that the Nissl type of method is so valuable
for investigation of the diseases of the nervous system,
for we are able to see the initial stages of disease
process in the interior of the nerve cell. But to speak
of seeing stages of disease process because through the
microscope we see certain alterations of structure
in cells is to fall into a somewhat prevalent error
of accepting descriptions of abnormal structure for ex-
planations of pathological life activities.

Disease is a process not an entity. One must have
a dynamical and not an ontological conception of it.
The phenomena of disease are expressions of cycles
of liberation and restitution of energy. One must
have something more than a knowledge of altered
structure in cells to comprehend the real process of
disease. One must have a conception of the true cause
of disease, namely, energy and the play of factors which

ii8

f OF SCIENCES.

enter into its mutations which are food supply and
external energy liberating impulses or stimuli, as they
are called in the domain of life. The man who sticks
to what he can observe through the microscope in dis-
eased tissues will have a hard time attempting to see
energy and its cycles of liberation and restitution which
constitute disease processes. Therefore he hardly gets an
inkling of what the whole great drama of disease really
means. By the aid of the microscope the process can be
indirectly verified but not directly observed. If he would
know the meaning he must possess the key to the
understanding of the dynamics of life, which is, that life
phenomena (excepting consciousness) are mutations of
energy. In short, he must use the genius of general
physiology for the mental elaboration of his facts. For
this science has for its province the deductive and induc-
tive application of the laws of physics and chemistry to
living matter. It should be clear, then, that we mean by
cellular biology a more comprehensive standpoint than
cell morphology. Its standpoint is morphology plus
genera/ physiology.

The whole Ufe-history of all forms of mental and nerv-
ous disease, except the last chapters, goes hand in hand
with morbid changes in the internal organization of the
nerve cell. When the morbid process has gone on so far
as to induce defects in the external configuration of the
nerve cell, it marks the closing scenes of its life. The
ner\'e cell then passes over into the grave; for these
changes are beyond reparation; its life-history is closed,
its cycles of metabolism have ceased; its delicate mechan-
ism subservient to the expenditure and restitution of
nervous energy is irrevocably damaged and no further
expenditure of energy is possible, except that issuing from

CORRELATIOX OF SCIENCES. II9

the organic dissolation of the cell manifested in non-
nenrons energy or energy liberated in the form of heat, or
chemical reactions of organic destruction. One can
realize how much, then, in the morphological basis of the
life-historv of .mental and nervous diseases has been
ignored in the study of late destructive lesions of the
nerve cell by the crude methods of pathological anatomy,
and how much is to be learned through the services of
cellular biology in donating to psychiatry and neuro-
pathology the Xissl type of methods of investigation.

Future advances in the whole province of the patho-
logical anatomy of mental as well as nervous diseases
depends upon the application of the principles and
methods of cellular biology.

One exceedingly important topic also falls within the
province of cellular biology, when linked with the investi-
gation of medical sciences, and this is the study of disease
processes artificially induced in the lower animals. The
lower animals, even down among the invertebrates,
offer opportunities for elucidating wider and more funda-
mental truths concerning the cell microcosm than the
higher animals, especially man.

Experimental work on these lower animals made up of
relatively small colonies of cells in a simpler and more
elementary form, constitutes one of the most fruitful fields
of inquiry as to the behavior of the cell in the environment
of disease processes. In man, and even in the higher
animals, when disease processes are experimentally in-
duced, the conditions are much more complex, so much so
as to hide frequently the fundamental changes of the re-
action of the cell as an individual. Since man is simply
an aggregation of cells, the same general laws that gov-
ern the individual cell must also govern his organization.

ISO CORBEt^TION OF SCIENCES.

The experimeDtal indactioQ of disease processes in the
lowly and more elementary organism with a view to study
the reaction of the cell in abnormal environment of patho-
genic stimuli, under the simplest conditions, seems again,
at first glance, to be straying from our proper pathway, the
study of insanity. This, however, is not so. The nerv-
ous system is made np of myriads and myriads of these
same kind of cells, matvelously compounded into one
organic whole. No other cell in the whole body can com-
pare with the nerve cell for complexity of shape and
internal organization. It is not sensible to attack the
problem of cell-dissolution by selecting for study the
most complicated cell in the whole body. It is plain that
the proper way is to study first the course of disease pro-
cesses in the simpler cells. Having learned this, we can
forecast what ought to happen in the complicated differ-
entiation of the ordinary type of somatic cell into a nerve
cell, and be prepared to understand what the changes
in the nerve cell mean when it comes in contact with
abnormal stimuli inducing disease processes.

As a general rule it is to be expected that the funda-
mental conceptions of cellular statics and dynamics are to
be verified or induced by a study of the lower order of
cellular units in the organization of the complex media of
life, such as man, or in the whole scale of life itself. For
the external complexities of stimuli are simpler and more
controllable in the study of the lower orders of cellular
tmits. The neuron furnishes a striking exception to the
generally safe rule in solving many problems in ascending
from a lower to a higher order of complexities. The
euron is the highest differention of the cell complex, yet
8 study furnishes an insight in the energy basis of the
imena of life incomparably more valuable than a

CORRELATION OF SCIENCES. 121

Other order of cells in the whole organism, or, indeed, in
the whole range of life organisms. In the course of evo-
lution it proved most useful to the organism to have in
the neuron the maximum of dynamics. In seeking for
the laws of the transmutations of energy as the modus
operandi of life phenomena the study of the bacterium,
the amoeba, the unicellular organisms and lower metazoa
is indeed valuable, but still I think that no member of the
cellular hierarchies ontogenetic or phylogenetic sheds
such a flood of light on the cycles of energy liberation
and restitution unfolding life phenomena, as the neuron.
The study of the dynamics of the neuron furnishes the
key to the energy theory of life. We may see, therefore,
that a study of the highest units in life may unfold gen-
eralizing principles whose grandeur and sweep are but
dimly outlined in the study of a lower order of units.
The phenomena of life are most emphasized in the
activities of the neuron.

We may be sure of one thing, that the nerve cell was at
one time much like any of the simpler cells of the body,
and that all these complex structures in the nerve cells are
not new creations or fiats in its evolution from the simple
cell, but are merely devices and modifications of the
structures present in its simply organized ancestor, fn
other words, a cell of simple structure like the general
type of somatic cell, in undergoing the phylogenetic evolu-
tion into the nerve cell, has not created new and specific
elements, in order to accomplish the duties of a nerve cell,
but has used its old and elementary structure and by
diflEerentiations and modifications made them fit to accom-
plish the offices of the nerve cell. In studying the cyto-
pathology of the nerve cell one should hold in mind that,
notwithstanding the marvelous adaptations of the cyto-

133 COHRELATION OF SCIENCES.

reticulum and cyto-lymph of the nerve cell wrought by-
evolution out of these fundamental cytologic structures
common to all cells, the nerve cell should not be considered
apart from the other cells of the body. The neuron is
not a specific creation, it is after all a cell; its struc-
tures are homologous with other cells of humbler organiza-
tion in the body, and obeys the same general basic laws
governing normal and pathological metabolism like its
humbler associates in the cellular body colony.

The laws which govern pathological processes (and
some day these, it is to be hoped, may be expressed in
terms of cell energy) operate uniformly for all of the cells
of the body. The laws make no special reservations or
exceptions for the cells of the nervous system, even its
most highly organized spheres. Disease is one general
process, but as this process manifests itself in a great
variety of phases corresponding to a Protean expression of
symptoms often grouping themselves in a distinct type
as a distinct malady, one, therefore, must be careful not
to wrongly consider the phases of the single process as
individual entities and distinct processes. Various kinds
of inflammations and cellular degenerations and other
pathological processes should not be spoken of as indi-
vidualized processes, they are merely phases of the same
general process.

The more cellular biology, including both cellular statics
and dynamics, is used in the study of pathological anatomy,
the less tenable becomes the idea of individualizing specific
morbid processes with specific diseases. When, therefore,
we are attempting to study the changes in the bram, we
must never forget to summon to our aid cellular biology
to help us understand the meaning of the pathological
processes in the nerve cells.

CORRELATION OF SCIENCES. 1 23

Let US glance for a moment at the reciprocal benefits
to be gleaned from a broad union of the medical and
biological sciences and especially at the influence of the
marine biological laboratories on the progress of medicine.
The value of the application of the theories of evolution
as guiding principles in pathology and patho-anatomical
research as well as the light reflected back on the theory of
evolution urgently demands a strong, well studied render-
ing. I can only call attention to the subject and cannot
in the least fulfill the task.

It might seem, at first sight, as if psychiatric research
were straying far away from its legitimate territory in
extending its work into the marine biological labora-
tory, but it is a sad mistake to draw lines between
the medical and the biological group of sciences. Psy-
chiatric research stands in need of the study of the
neuron in its cellular individuality, and such study should
be judged by general knowledge of the cell theories.

Under Professor Whitman's inspiration the Marine
Biological Laboratory at Wood's Holl, Mass., is fulfilling
the ideal of correlating the biological sciences. It is a
school where, happily, a spirit of philosophy is in the
foreground with guiding principles for the gathering of
facts.

The Marine Laboratory of the United States Fish
Commission, at Wood's Holl, opened again for scientific
work through the broad-minded spirit of the present
Commissioner, Mr. Bowers, is seeking the same ideal
under the direction of Professor Bumpus, an ideal which
we hope will not be abandoned, but striven after with
even greater perseverance.

If the ideals of these laboratories were carried a few
steps higher, by including pathology in the family of

134 CORRELATION OF SCIENCES.

biological sciences, the plan would be still more perfect.
The phenomena of pathology and the £acts of pathological
anatomy are in great need of gniiding principles from the
theories of inheritance; of variations; of cellular adapta-
tions: and, above all, from general physiology. For these
phenomena and facts are still in confusion and have not
found their fnll value from the standpoint of the energy
basis of life phenomena. In pathology and pathological
anatomy facts are greatly in excess of ideas wherewith to
estimate their value.

The great question behind the study of structure is
what animates the mechanism, and how is it animated, in
normal or abnormal life? The question is not answered
by reducing the structures to smaller and smaller units
of divisibility. In passing from the grosser topographical
investigation of raorpliological changes in organs to the
individual cell or changes in the particles of the cell,
pathological anatomy only evades the question. To
face the problem of the modus operandi of disease
process, one must approach the phenomena of disease
from a more general standpoint and reflect on the fact
that the degenerative changes in a cell are things left
behiad after somethiag else has departed. The thing
which has disappeared is energy. The changes in the
dead cell do not constitute the process of disease any
more than the charred remains of the gun powder
constitute the explosion.

To face the problem of the dynamics of life, and this is
the ultimate problem of vital phenomena, one must con-
ceive that a// phenomena of vitality are modes of nwtioH
and that in life t/ie same laivs are operative as in the ittor-
ganie ■a.orld. In the problem of the activities of life the
processof storing latent energyin the cells by assimilation

CORRELATION OF SCIENCES. 1 25

and the liberation of energy by the overcoming of resist-
ance by other impacts of energy or stimuli must be taken
into consideration. These processes cannot be grasped by
study of structure alone. Other methods of investigation
than the purely morphological, and different trains of
thought, are required.

Yet I do not want to undervalue the study of morphology
in disease. It is of the greatest value, if inspired by phil-
osophy and a proper general groundwork for inference
from the general principles of energy as the basis of life
phenomena. I merely emphasize the import ayice of study-
ing function and structure hand iii hand. Medical sciences
will receive their impetus from the biological sciences,
from the standpoint of function^ of energy manifestations.
General physiology is indeed the central inspiration of the
medical and biological sciences.

One must make use of deduction and formulate the
problems before working at the facts. If the idea is
wrong, its imperfections will be brought to light in the
process of verification by the facts. It is better to use the
facts in pathological anatomy to test theories than to have
an expectation of finding some truth by delving out
facts at random.

Physiology as it is generally taught in medical schools
has also much to gain from the suggestive touch of the
marine biological laboratory', for this form of physiology
is special in its character, it is addicted to the investigation
of the function of particular organs. Its specialization is
somewhat at the expense of the comprehensive sweep of
general physiology, which is not limited to organ, tissue,
amoeba cell or individuals, but works out the laws of the
dynamics of living matter throughout the whole realm of
life.

196 CORRELATION OF SCIENCES.

At the same time it is to be hoped that the marine
bioiogical centres will turn their attention and devote
more of their time and work not only to dead, but also, if
not principally, to living cells. It is somewhat strange
that studies of the living cells have been so much
neg:lected by the morphologist, or that he had not more
extensively observed the living side by side with the dead
cells, and varied the environment of the former with
regard to restitution and liberation of energy. It is unfor-
tunate that many are content to believe that descriptions
of mechanism are explanations of its activities.

The advantage, however, of joining the medical and
biological scientific communities in a more intimate philo-
sophical relationship by no means confers a one-sided
benefit on the medical group. The biological federa-
tion of sciences and the student of evolution miss a
great opportunity in neglecting comparative pathology,
human pathology and pathological anatomy.

In disease the expenditure of cell energy proceeds at a
faster rate, and the restitution through assimilation at a
slower rate, than in normal cell life. The process is not
essentially dilferent in normal and pathological states.
The difference is only in degree. In pathological pro-
cesses, greater degrees of resistance are overcome, deeper
levels of energy are unfolded and more intense stimuli
come into play. Into the flux of all these factors enters
the play of change, both of kind and degree, of the
cellular food supply, and also the factor of predisposition
diminishing the resistance present in normal life. The
plsy of all of these factors opens a sweeping vista into the
niral and dynamical life-history of the cell which is

Edimly outlined to biologists who restrict themselves
e observation of the normal cell.

CORRELATION OF SCIENCES. I 27

In disease external circumstances act on the cell, change
the environment and call forth corresponding adaptation
in the cell. In this experiment we find an opportunity of
studying cellular adaptations and variations that throw
some light on the theories of evolution. One point of
reciprocal benefit to pathology and biology in the marine
biological laboratory is an interweaving of the theories of
evolution with pathological phenomena. The pathologist
can hardly expect any ultimate explanation of pathological
processes without having a general knowledge of the
theories of evolution and heredity combined with the
broad working hypothesis of the mutations of energy,
applied to pathological and patho-anatomical processes.

On the other hand, the student of biology may have a
flood of light reflected upon the theory of evolution by in-
cluding the domain of disease within his horizon. The
theory of evolution takes account mainly of external con-
figuration or gross morphology with respect to phylogeny.
Variation and its growth with selection must have similar
underlying modifications in the cells. The fundamental
factors creating phylogenetic variations in cells are food
supply, the storing of energy in the cell and energy liber-
ating impulses or stimuli, which overcome resistances and
set free the latent energy in the cell. The play of all these
factors in creating variations in the cell is most promi-
nently brought to the surface in the observation of patho-
logical cellular processes. The principles of evolution
should be carried more extensively into the province of
the cell considered as a chemical machine, through which
energy is stored from food supply and liberated by the
agencies of stimuli overcoming resistance.

The germ plasm is to be considered the same way.
Changes in environment is the great modifying factor in

128 CORRKLATION OF SCIKNCES.

evolution. These disturb the external circumstances,
modify both food supply and stimulus, and hence modify
the cell itself, and determine the persistence of the varia-
tion as an adaptation. Since the phenomena are mutations
of energy, morpliology alone cannot fully grasp them.
The great field for future studies in evolution is
pathology, or rather pathological physiology.

The study of evolution has passed to the investigation
of the cell. Much of this, although greatly centered
about the egg cell and its immediate progeny in onto-
geny, also takes account of phyiogeny. Still the study
of the cell is not sufficiently illumined by the energy
basis of life phenomena. The study of evolution de-
pends too much on morphology, and too little on general
physiolog}'.

At present there is a growing demand for a sounder
and more extensive inductive basis for the study of
evolution. This is realized for instance in the work of
DeVarigny. In the problems of life, however, too great
a reliance on the inductive method is unsafe, because of
the mutiplicity and conflicting nature of the proximate
causes. The causes themselves have to be regarded
deductively. In extending the study of evolution into
the domain of pathology there is opportunity for a keen,
powerful weapon of thought in an intimate union of both
methods. On the one hand is the ultimate cause, energy%
the guiding principle for deduction; on the other are the
most magnificent experiments of nature in disease pro-
cesses, as a basis for the inductive method. By the
reaction of each method on the other, I think that the
expectation is not exaggerated that evolution would gain
a new standpoint of thought as startling as that of
Darwin's.

CORRELATION OF SCIENCES. I 29

There is a particular reason why the study of evolution
should consider human pathology, because of our knowl-
edge of man's psycho-physiological life. Pathology (the
study of the dynamics of disease process) and pathological
anatomy (the study of the structural alterations in disease)
are in much the same position as the biological sciences
at the time of Darwin. If a second Darwin could arise for
the pathological sciences, he would find the storehouses
of these sciences almost bursting with facts requiring
generalization. The Darwin of pathology will find the
suitable environment for his genius in general physiology.
From its principles, he will descend upon the phenomena
of pathology, and the facts of pathological anatomy, and
weave out of them not only a classified, but a consistent
body of knowledge in relation to the laws of energy. He
will not be confused by founding his deductive basis on
the proximate causes of disease, the energy liberating
stimuli, but will have the ultimate cause of morbid pro-
cesses — cell energy — as a commanding eminence to survey
the majestic drama of disease. The uttermost details of
structural changes will not be of vital concern to him, nor
will the finding of the uttermost explanation of the source
of energy itself interfere with the consummation of his
ordained work. He will conceive that the laws of evolu-
tion pertaining to the organism as a whole also hold
sway over the individual cells. He will perceive that the
same struggle for food supply in the outside world goes
on in the body in the growth of its units. He will see
the perishing of the weak cells in disease and the survival
of the stronger ones with greater degrees of resistance to
liberating impulses. In brief, this man will possess a two-
edged weapon with the deductive principle of energy on
one side, and the great experiments of disease as an

130 CORRELATION OF SCIENCES.

inductive standpoint on the other. With it he will wrest
out great victories for patholog}'^ and perhaps still
greater triumphs for the theory of evolution.

If the pathological anatomist would borrow a suggestion
from the theory of evolution with its fundamental prin-
ciple of the struggle of organisms for food supply, he
would get a broad hint of the explanation of hyperplasia.
He would at least see the hollowness of certain glib
phrases which simply gloss over the difficulties.

The physician, the clinician, the practitioner whom the
'* scientific** laboratory pathologist regards as unscientific
stands nearer the fountainhead of disease and is in a far
better position to observe and follow the energy muta-
tions of pathological processes than his colleague, the
pathological anatomist. This which seems at first sight
rather strange, if not paradoxical, is not at all surprising.
For the reflective physician is really a physiologist, or
to make a rather unnecessary distinction, a pathological
physiologist. He observes the living phenomena, and
manifestations of liberation of energy are obtrusively
and dramatically put before him every day in rise of
temperature, convulsions, oedema, delirium, the epileptic
fit, and manifold other phenomena of liberations and
restitutions of energy, called symptoms. He has an idea,
vague and unformulated though, of the coming to the
surface of the energies of life in disease. The patho-
logical anatomist, however, sees nothing but the husk
and the shell of something that has gone. He sees
hieroglyphics graven on tissue or cell, but he is not able
to interpret them until he knows of the invisible force
that wrote them.

I think, then, that the influence of a closer union of
biology and evolution on the progress of medical sciences

CORRELATION OF SCIENCES. I31

becomes deeper and more important the further we go
beneath the surface of things, the more we realize that
the great inspiration to scientific progress is in new ideas,
new trains of thought, and altogether in the subordination
of observation and experimentation to guiding principles.

If the general subject of pathology profits by affiliation
with the ideas governing biological research, psychopa-
thology must gain as well, and likewise the subdivision of
pathology which is concerned with nervous diseases.
The marine biological centres at Wood's Holl concentrate
a wide diversity of attention on the biological sciences.
Representative men in all provinces of biology from
nearly all the prominent universities in the United States
gather at these centres. By means of lectures, con-
ferences, seminars, individual discussions, ideas are ex-
changed and the results of research compared. The
danger of isolation in work is warded off. Fortunately as
this Institute is but a few hours away from these centres,
and as they are essentially summer schools, no practical
difficulties stand in the way of profiting by the far-reach-
ing influence of the biological sciences upon the progress
of the medical sciences and especially on psychiatry. We
have recommended, therefore, that during the summer
season the departments of cellular biology and compara-
tive histology of the nervous system should transfer their
work to these biological centres of research.

A most unfortunate gap lies between cellular biology
and the pathological anatomy of the human body — cyto-
pathology — a term but newly coined. I do not hesitate to
say that the overlapping of cellular biology and pathologi-
cal anatomy opens the richest of all domains for the future
progress of medical science. If our endeavors to bridge
over these two fields of science, so that they may work

132 CORRELATION OF SCIENCES.

hand in hand, be made plain, I need say little more
to defend the importance of cellular biology as one
of the most powerful factors that contribute to successful
organization of a centre for scientific investigation of the
insane.

The department is under the guidance of Arnold Graf,*
Ph. D. (Zurich).

Chapter IX.

PATHOLOGICAL ANATOMY, BACTERIOLOGY AND PHYSIOLOGICAL

CHEMISTRY.

The departments of Pathological Anatomy, Bacteriology
and Physiological Chemistry are so intimately linked to-
gether in the investigation of insanity that they may be
dealt with collectively.

Pathology being the science concerning the origin,
course and results of disease, had very simple begin-
nings. At first evil humors were supposed to gain
access to the blood and to cause the departures from
health. If we translate the term "humors" into the
modern expression of toxic substances circulating in the
blood, the older pathologists are not so far from the
truth as regards the proximate causes of disease. But
whence the humors arose and how they gained access

* As these sheets are ptassing through the press we are struck by the sad tid-
ings of Dr. Graf's untimely death. This is a deep loss to the science of biology,
especially in the field of cytology and cytopathology. Dr. Graf's gfreat work,
** Hirudinien Studien,*' including his theory of the physiology of excretion is
being published by the Leopold Carolina Academy. His last work. Studies
on the Nucleolus, will be edited by Professor T. H. Montgomery, and appear
shortly. His work on fatigue of motor neurons in certain chelonians, his
researches in the cytology of the human nervous system in a case of a criminal
executed by electricity and his studies on the subject of the excretion of meta-
plasm gn'£inules in the neuron under pathological conditions, the latter under-
taken conjointly with another investigator, are left unfinished. Unfortunately
these latter works are left as fragments, and it may be impossible to collect
them for record. An account of Dr. Graf's life and genius is now in preparation.

CORRELATION OF SCIENCES. 1 33

to the blood was all guesswork and speculation, and
** humoral" pathology was a mere makeshift to define
an unknown something which circulated in the blood and
set free the phenomena of disease. In later days those
who were concerned in the investigation of disease pro-
cesses observed with the naked eye what they could of the
changes in the body after death from any given disease,
and were able to see that many of the symptoms corre-
sponded to gross, coarse and destructive changes in the
various organs. As the microscope improved, and ideas
of the cell as the elementary unit of the whole body be-
came more definite and coherent, the pathologist studied
these coarser and grosser changes in the organs under the
microscope, but even here he saw results rather than be-
ginnings of the processes. The observation of some final
members of a series of morphological changes could hardly
give any idea of the whole complicated range of the ante-
cedent members, much less furnish any explanation of the
true cause of these effects and its modus operandi in mani-
festing abnormal function in disease. Professor Pnidden
quotes a line from Oliver Wendell Holmes, in which the
work of the earlier pathologist is compared to an inspec-
tion of the fireworks on the morning after the show.

In those days the practising physician was also the
pathological anatomist. He combined both functions.
He observed disease in the living and sought to find
its havoc amid the body structures after death. His
methods, however, were limited to the study of the topog-
raphy of the lesions of the disease, and not to t/ic patho-
logical processes themselves constituting it. In short, he
saw results, but knew not whence and how they came.
For the origin of these morphological concomitants of dis-
ease processes can be found, not in the gross and terminal

134 CORRELATION OF SClEXCtS.

changes in great communities and masses of cells, but
within the subtle recesses of the cells as individuals.

For many years the pathologist went along bewildered
by the phenomena of inflammation. He was able to de-
scribe with much precision facts and observations, but he
failed to understand their significance. Meanwhile cellu-
lar biology progressed with rapid strides and disclosed the
marvels of the cell microcosm. The older pathological
anatomist was in somewhat of a Rip Van Winkle attitude
pending this march of cellular biology, and awoke in
bewilderment at finding that all his work in the study of
morbid structural changes stopped short of the real origin
within the cell as an individual. He neglected the begin-
ning and saw only the end.

The advances in cellular biology are destined to give an
enormous impetus to the future investigations of pathol-
ogy. What, perhaps, puzzled the pathologist the most, be-
fore "he had learned to peer into the cell microcosm for the
solution of his problems, was the great number of important
and serious diseases of everyday occurrence which seemed
to leave no traces whatsoever upon the body. This was
especially the case in many diseases of the nervous system.
It was exceedingly perplexing, for instance, to under-
stand how such a dramatic and dreaded attack of the nerv-
ous system as hydrophobia should leave no traces after
death. The same might be said of epilepsy and many
forms of insanity. These the pathological anatomist set
down as diseases *'5/;/r materia'* or cast them into the
makeshift category of 'Afunctional" or idiopathic diseases.
To-day, however, we are in a more fortunate position to
understand why it seemed that no traces were left in the
body from such serious diseases as these. The secret lies
in changes in the very inmost recesses of the nerve cells
themselves.

CORRELATION OF SCIENCES. 135

The older patho-anatomist concerned himself but little
with the cell as an individual. If its shape, form and
contour were unchanged, it passed muster as sound
and normal, without regard to a whole world of changes
which might be present in its internal organization. In
scrutinizing the effects of disease he looked at the outside
of the cell, and not at its vital organization within, as one
might attempt to understand the contents of a book by
looking at its binding. Thus, naturally enough, the
knowledge of the structural changes of a whole host of
diseases, particularly of the nervous system, was passed
over unnoticed.

It is different to-day. The pathologist has borrowed
the searching methods of the modem cellular biologist,
who looks into the inner constitution of the cell and
beholds a world of changes in the cell in general, and in
the nerve cell in particular — changes which until now
were entirely ignored. At the present time the anato«
mist in stuyding the diseases of the nervous system is
actually peering into the mechanism of life operations
going on in the laboratory of the cell. He is endeavoring
to study the changes in the body of the nerve cell —
changes going hand in hand with its assimilation of food
and elaboration of energy. He is able to study the
changes which happen within the cell when its food
supply is interrupted or interfered with. Through this
refined study of the organization of the neuron cell body —
the headquarters of operations in the cycles of neuron
metabolism — ^we realize that the oft recurring phenomenon
of nerve fibre death so characteristic of subacute and
chronic diseases of the brain and nervous system, is not
the result of primary processes in the nerve fibre itself
or in the surrounding neuroglia elements, but is entirely

ij6

couxLATKm or sciences.

in the interior of the

tbe secxundarf effect <

ceUbody.

When tbe food supply o€ the nerve cell is br slight
increments qiutlitatiTelf or quantitatively diniintsbed, or,
Od tbe other band, the nerve cell expends more eneT]gy —
in states of patholofrical fatigue — than can be recmited
from tbe food supply in the blood plasma, tbe nerve
casts off deati material which is removed by the lym-
phatics. The excretion of these particles — ike metaplasm
granule^ — is most important in presenting a physical
ba»s and a measure of the slow destructive pathological
metabolism of the nerve cell which is snch a prominent
factor in the genesis of very many mental and nervous
diseases. When the nerve cell begins to excrete these
particles it is an indication of a lack of balance between
the crude food supply of the cell frxMn the blood vessels
and the expenditure of energy. This excretion of the
nerve celt is also the indication of senile degeneration,
and it is most interesting to view this indication of
senility of the nerve cell advancing prematurely in a host
of mental and nervous diseases where the expenditure of
energy of the nerve cell has been of a pathological and
persistent character.

The excretion of the mataplasm granules is an indica-
tion of the slow, gradual and long continued liberation of
neuron energy. The appearance of these granules seems
a sure indication that tbe descending metabolism has
gained vantage over tbe ascending process and little by
little lower and lower levels of neuron energy are dravim
off. Hand in hand with this the neuraxon dies. First the
peripheral end dies and ascending metabolism becoming

> Van Glesfio: Toiic Buit ol Neural DiiwaseB. StaM Hoipitala BuUctlu. 1(97.

CORRELATION OF SCIENCES. 137

continually of shorter range the death of the fibre from
lack of food supply from the neuron cell body continually
approaches the cell body. In the decrease of the range of
restitution of energy a shorter length of the neuraxon can
be supplied with energy. In peripheral neuritis, in tabes,
in general paresis, in amyotrophic lateral sclerosis, in per-
nicious anaemia, in chronic alcoholism and under many
other conditions numerous observations of the excretion
of metaplasm granules from the neuron cell body confirm
my conception of the nature of nerve fibre death.

The excretion of metaplasm granules from the neuron
cell body means that the tide of neuron energy is slowly
ebbing away. Each incoming wave of restitution of
energy may indeed almost rise to the level of the preced-
ing outgoing wave of liberation of energy, but in time, if
there be no turning point where flood outmasters ebb, the
neuron is marked for destruction.

The most important bearing of the discoveiy (unless by
this time it be well known) of the excretion of the neuron
under pathological conditions is the indication of deficient
food supply. This is a factor of profound importance in
the genesis of mental and nervous diseases, and is also of
extensive application. During life we have at present no
adequate means of determining the factor of deficient food
supply to the neuron cell body, nor can we fully realize how
often mental and nervous diseases depend upon this factor
which virtually means declining capacity or the storing of
neuron energy. In the excretion of metaplasm granules
from the neuron cell body (and especially in motor cells,
the migration of the nucleus) we have a new and very
delicate proof of deficient food supply for the nerve cells.
If in the future we shall be able to determine a means of
indicating the excretion of the ganglion cell during life

}

138 CORRELATION OF SCIENCES.

by the tests of the physiological chemist,* another dis-
covery of the ntmost practical importance will be added
to this great question of the variations of food supply
for the neurons.

I do not hesitate to say, therefore, that the tae(afi/asm
excretion of the neuron, the working out of its signifi-
cance and that of the mtgration of the nwUus are
discoveries not only of considerable theoretical, but also
of practical importance. Of course the length of the
fibre and the relative amount of work done by various
neuron aggregates enter into the discussion of deficient
food supply of the neuron. These points, although of
much importance, can here only be hinted at and must be
taken up elsewhere.

The patliologist is now busily seeking the degenerations
occurring in the interior of the ganglion cell when ex-
posed to poisons, especially to those generated in the
great mass of general body diseases. In the poisoning
of the nervous system from general body disease, the
pathologist is able to show changes within the interior of
the nerve cell which go band in hand with the liberation
of neuron energy in the delirium in typhoid fever, influ-
enza, sunstroke, etc.

We are able in these days, thanks to the aid of cellular
biology and its methods, to study the changes in the
nerve cell wrought by fatigue, to watch the nerve cell
grow old and perceive the signs that indicate the approach
of its decadence. It is particularly interesting to watch
the premature senility and shortening of the life of the
nerve cell by chronic alcoholism and syphilis.

Definite laws of the fluctuations of neuron energy, the

CORRELATION OF SCIENCES. 1 39

expenditure of energy of the diseased nerve cell^ the restitu-
tion of energy in recovery from disease^ with their con-
comitant psychomotor manifestations* formulated at this
Institute are helping to clear away the mystery of the
modus operandi of a whole host of mental and nervous
diseases.

The rise of bacteriology is too familiar and of too recent
occurrence to need any detailed account of its relation to
pathological researches in the nervous system. Bacteri-
ology in its great public practical services to sanitation,
its application by boards of health in the prevention
of infectious diseases, the almost miraculous practical
outcome of bacteriological studies in the anti-toxine treat-
ment of diphtheria, its great service in protecting and
forewarning the healthy against disease, all these one
cannot help acknowledging as being of great benefit
to humanity. The services of bacteriology show clearly
that it is an important department in medicine for finding
the proximate causes of morbid processes and thus indi-
cating practical measures to the prevention of disease.

The department of bacteriology, it should be expressly
understood, does not undertake to carry on researches in
the whole domain of the biology of bacteria in general,
but restricts its energies to useful ends in the study of
insanity, namely, the identification of bacterial poisons
associated with nervous or mental diseases. This depart-
ment, however, keeps in constant touch with the broader
aspect of bacteriology in general, as a science, and keeps
cultures of many forms of bacteria for the purpose of
determining, experimentally, the action of their poisons
upon the nervous system of animals.

•Vide "Neuron Energy and its Psychomotor Manifestations," Archives,
VoL I, No. I. A further study will appear in the Archives in monograph
form.

I40 CORRELATION OF SCIENCLS.

When the pathologist beheld the action of these disease-
producing bacteria, he at last began to approach the
proximate explanation of many morbid processes. He
now sees that these disease processes are liberations and
restitutions of static cell energy initiated by chemical re-
actions between the cell molecules storing latent cell
energy on the one hand and forms of energy liberating
impulses embodied in poisons and other pathologenic
stimuli. The cell stores latent energy by assimilation in
building up its complex molecules. This energy is set
free by impacts of kinetic energy acting on the cells from
without. These external impacts of energy acting on the
latent cell energ>^ are stimuli or energy liberating forces.
These stimuli are comparable to the spark which ignites
gunpowder and liberates its energy. The spark is not the
true cause of the explosion. The true cause is the latent
energy of the gunpowder itself. The spark is a liberating
impact. It is an impingement of active energy on latent
energy overcoming its resistance and thereby setting it
free. If the latent energy of a cell is easily liberated the
resistance is correspondingly small. If the cell energy is
liberated with difficulty, that is, if it requires a strong lib-
erating impulse or stimulus, its resistance is great. Bac-
terial and other poisons overcome resistances of latent
cell energy beyond the range necessary for response to the
stimuli of normal physiological life. Bacterial and other
pathogenic poisons are energy liberating impulses. They
seem to operate on the cell by chemical reactions whereby
the cell molecules are reduced to lower and lower orders
of complexity of organization. With each descent in the
tearing down of the cell molecules more energy is liberated
and also more resistance interposed. Predisposition,
which means a diminution of resistance, is a pivotal factor

CORRELATION OF SCIENCES. I41

in pathological ranges of energy liberation, but the con-
sideration of this factor is full of difficulties. The process
of disease should in the future be discussed in terms of
fluctuations of cell energy.

As a rule bacteria are not harmful by their mere
mechanical presence, but on account of the powerful
poisons which they give rise to. It now seems that in-
flammation is the expression of a conflict between the cells
of the body on the one hand and the bacteria with their
associated poisons on the other. The idea of a conflict,
however, in inflammation between cells and bacteria is
somewhat unfortunate, for it hides a broader explanation
of the phenomenon which can be better understood by
thinking of the relation of cells to their food supply — and
the energy basis of disease processes in general.

The conservative nature of disease processes is most
beautifully shown in inflammation. Inflammation is
found to be a protective mechanism in the struggle of the
organism for its life existence, and is the outcome of a
long series of adaptations on the part of the cell. This
protective mechanism against the proximate causes of
diseases extends throughout the whole scale of animal life,
even to the amoeba. Were it not for this protective
adaptation on the part of the body cells, the highly
organized forms of animal life, as well as the human race,
could not exist, for by long odds the conditions producing
disease are in the ascendant over those contributing to
normal life.

We must not, however, overestimate the direct bearing
of bacteriology on the study of insanity. Bacteria are
very seldom directly responsible for mental maladies, and
comparatively rarely for nervous diseases. They do not
attack the brain directly, nor is it to be supposed that

I4«

COmSBLA-nOK OF SCIENCES.

there are specific bacteria ityr individtial diseases of the
tten-otts system. The actkm of bttcteha in damaging the
oervoas srslem is ira^rect. The brain is so well protected
against their incarsioos, that th^ generally attack some
other pazt ot the body. The oerToos sy^em b injured
by tbe fvisims which bacteria give rise to. The bacterial
pTodacts eater tbe circolatioo cnr lymph spaces, come in
contact with the serve cells, and poison tbem, that is
liberate neuron eu«rgy. JTot an tncoosiderable share of
diseases ot tbe nerwius system in genera] tate their
primary origin in bodibr diseases. These general body
diseases, such as tndwid rerer, paemDooia, ^rphilis, small-
pox, iodueaza, scarlet fever, etc. etcher by their poisons
or by interference with the food sappty of the nerve cell,
cause it to degetterue. tn $h<Ht. bacteridoey and patho-
logical anatomy are clowty interrelated. It is not alone
sufficient for the pathologist to recount the snbUe changes
occurring within the nerve cell in disease and render an
opinion, to tb« effect tbst tb^e changes aie due to the
action of « pvisoa. We most know what tbe poison is. and
when» ii comeii from. In tbe solntioo oc this question.
bacl«rtol(>gy atMl physit^ogtealcheaustrr are indispensable.
Th* phytuological chemist goes far deeper than the
bactcriulogijit to ideatity,ng the proximate pathogenic
atimuli. Tb« d«vwlee«o£ iuedi<:ai sdeoce. particular^ of
patholu|fiv'«l wuiloaiy and pathology, are curnisg in eager
mttcipatiou Ctf tbe svWnce ut pby^oiogical chemistry for
a (.Wv-vvr «ohitK>tt vt tbe «{uet>tioa of cuocomitance <d
vhvMti<.'it' ctiangc^ and ceU degeneracwosL What the
pattU'lL'gvst i>bficrv«» under the raicroaaipe even tn tbe
WUDM tWUi,-«t«> ctuLiige» of ceil organiaatian. ts reaUy far
|i aboft vi * vduikid «x,ylaiUktion uf di:$e«e pcoceffies. Be-
KUu| «U UMi«« uK.'iybvti.igH.'iU (.'hanges m tbe ceQ ts a si

CORRELATION OF SCIENCES. I43

of most complex chemical adjustments, and behind these
adjustments or concomitant with them are the cycles of
liberation and restitution of cell energy.

All diseases as well as normal processes run parallel to
cycles of chemical analysis and synthesis in the cell. Cell
chemistry is still in its infancy. Its great motive is to
furnish the chemical steps of normal and pathological
metabolism of the cell concurrent with the corresponding
cycles of energy. It is by means of this science that we
can have any hopes of discovering the chemical com-
position of the cell ; the reactions of the cells to poisons;
the nature of these pathogenic poisons themselves, their
origin, their interference with the food supply provided
by the blood to the cells for the elaboration of their
energy. When all these problems are solved, the abnor-
mal changes in cells, seen under the microscope, will be
more fully explained, because we shall be better able to
assign to such changes their dynamical valuation. The
province of physiological chemistry is the connecting link
between the concomitance of pathological cycles of cell
energy liberation and restitution on the one hand and
structural changes on the other. Beside each increment
or decrement in cell energy I imagine a corresponding
chemical (or physical) change, and beside each chemical
change, a corresponding physical alteration. But what
we see of structural changes under the microscope must
be very fragmentary counterparts of the chemical changes
parallel to the energy fluctuations in the cell.

As physiological chemistry advances it would seem that a
more complete series of the chemical concomitants of cell
energy fluctuations would be furnished than can ever be
given of the structural effects of these fluctuations of cell
energy by morphology. While physiological chemistry is

144 CORRKLATION OF SCIENCES.

Striving to fill up the gap between structural changes and
cell energy fluctuations, it seems best to apply the theory
of cell energy deductively to pathological cell changes and
describe these changes as effects of cell energy fluctuations.

Physiological chemistry has its specific ro/e in the inves-
tigation of insanity. Few of us realize the fact that at
every moment of our lives poisons are generated in the
body itself, poisons which in health are taken care of and
eliminated. When, however, some slight hitch occurs in
the delicate equilibrium of the chemical reactions going
on in the complicated laboratory of the body, widespread
havoc may occur. A poison generated within the body
may escape into the blood, and while it may do compara-
tively little damage to the more lowly organized and more
resistent body cells, it may still harm the sensitive and
highly organized ner\^e cells. Of all parts of the body the
nervous system is the most sensitive to toxic substances.
The sensitivity of the nervous system to pathogenic
stimuli make it a delicate index of the presence of poisons
generated within the body itself.

The conviction is daily gaining ground that many forms
of insanity which arise so insidiously are initiated by self-
poisoning. The microscope may show us traces of these
poisons on the cell, but their source and nature can only
be discovered by the methods of physiological chemistry.
The microscope is, no doubt, powerful, but it cannot pene-
trate into the depths which physiological chemistry can
reveal. Beyond a certain region of morphological research
into the mechanism of the nervous system, the microscope
alone proves an utter failure. These poisons generated
by the body are of such subtle origin that it would seem
almost beyond the power of science to identify or trace
them. The physiological chemist attempts to identify

CORRELATION OF SCIENCES. I45

them by examining the secretions, or the blood. If un-
able to identify and separate them directly from other
components of the body fluids, he is still able to indicate
their presence — he injects the body fluids into animals and
watches the physiological effects by which he is enabled
to tell whether the body is generating poisonous matters.

In identifying the poisons associated with bacteria the
researches of the physiological chemist have been attended
in many instances with brilliant success. In tetanus, for
instance, the bacteriologist at first identified the bacteria
of tetanus, has studied their whole life-history and habits,
and has even found this germ in the wilds of Africa,
where the natives smear their arrows with mud of certain
swamps which become partially dry during the summer
season. This earth contains the spores of the tetanus
bacillus, and thus the strange fact explains why the
victims struck by their arrows often die of tetanus.

The physiological chemist, however, has gone further
than this. He has succeeded in isolating the poisonous
principles associated with the tetanus bacillus, and is
actually able to separate them in the form of a powder so
that one might carry round in his vest pocket a real liber-
ating agent of tetanus, were it not so sinister a substance
and so extraordinary a poison, for 0.065 of a gramme is
absolutely fatal to animal life. Such a poison transcends
in intensity almost anything that we know of among drugs
and inorganic poisons. A little of the tetanus bacillus
poison goes a good way, and it is not unlikely that many
other bacterial poisons are almost as powerful. The
poisons formed within the body itself seem to be less ful-
gerant in their action; they are mild in intensity and
operate insidiously; but, unfortunately, they offset this
mildness by their tendency to remain persistent. This

146 CORRELATION OF SCIENCES.

presents a great barrier to the restitution of the nerve
cell, for it is deprived of an opportunity to rest and
recover its pathological expenditure of energy.

Seeing that not an inconsiderable proportion of mental
diseases is initiated by the action of poisons upon the
nervous system, especially those of general bodily disease,
it is of the utmost importance to trace them and use, as
far as possible, practical measures against them. I think,
therefore, that pathological anatomy, bacteriologfy and
especially physiological chemistry need no further words
of explanation of their place in the investigation of
insanity.

We must not, however, fall into the error of believing
that the researches of pathological anatomy, bacteriology
and physiological chemistry, no matter how brilliant or
searching they are, can give any explanation of insanity.
If proximate causes of certain phases of insanity, mere
neuron energy liberating impulses, are discovered in the
form of toxines and bacteria, the modus operandi of abnor-
mal mental life is not all explained. The discovery of
these proximate causes is, no doubt, of great benefit from
the standpoint of treatment, but this, however, is far
from being sufficient, something more remains to be
accomplished. We must explain the phenomena as well
as the agents which set them in operation. Least of all
can the microscopic study of fragmentary morphological
traces of the ebb and flow of neuron energy furnish so
much as an inkling of abnormal mental life. It is really
time that the idea of patterning psychiatric research after
medical investigation were abandoned.

If we wish to gain an explanation of insanity it must be
plain that the first and main thing to do is to study in-
sanity itself, to investigate the living phenomena of

CORRELATION OF SCIENCES. 1 47

abnormal mental life. This the branches of medical
research cannot accomplish. The phenomena of con-
sciousness are beyond the grasp of medical sciences, and
it is a delusion for medicine to pretend that it can
investigate mental life. This belongs to psychology.
Psychological investigation of abnormal mental phe-
nomena themselves will furnish guiding principle of
the modus operandi of insanity. Once this is accom-
plished the various medical and biological branches im-
mediately fall in line; their investigation subserve a
purpose and can be guided to bear on the explanation
of insanity. Psychiatry can go on indefinitely under
the guidance of the medical conception of research and
profit only by piling up inco-ordinated details of anatomi-
cal, physiological and chemico-physiological observations,
if this be of any real scientific profit, and still be no nearer
to any great co-ordinating principle of the phenomena of
abnormal mental life. The most that can be gained by
the present medical methods is the discovery of some of
the proximate causes without attaining at any real insight
into the nature of the psychopathological processes that
give rise to the symptoms of mental diseases.

With all of these wonderful avenues of investigation
recently opened in the research of nervous and mental
diseases, when it comes to the explanation of the phenomena
of abnormal mental life, neither the pathologist, nor the
physiological chemist, nor the bacteriologist can go be-
yond the mere description of facts and observations. The
real meaning of the great majority of all the changes in
the nervous system^ in niejital maladies^ the significance of
the manifestations associated with these changes during the
life of the patient can only be made clear through the
science of psychopathology.

148 CORRELATION OF SCIENCES.

The futility of attempting to understand the workings
of consciousness by the medical conception of becoming
familiar with its mere utensils, — through the study of
anatomy, physiology and chemistry is charmingly ex-
pressed by Professor Ewald Hering's fine essay "On
Memory and the Specific Energies of the Nervous Sys-
tem:" " The nervous system, and above all, the brain,
is the grand tool-house of consciousness. Each one of
the cerebral elements is a particular tool. Consciousness
may be likened to a workingman whose tools gradually
become so numerous, so various, and so specialized that
he has for every detail of his work a tool which is espe-
cially adapted to perform just this kind of work most
easily and accurately. If he loses a tool he still possesses
a thousand other tools to do the same work, although
with more difficulty and loss of time. Should he lose
these thousand also he might still retain hundreds with
which he can possibly do his work still, but the difficulty
increases. He must have lost a very large number of
his tools if certain actions become absolutely impossible."

** The knowledge of the tools alone does not suffice to
ascertain what work is performed by the tools. The
anatomist, therefore, will never understand the labyrinth
of cerebral cells and fibres, and the physiologist will
never comprehend the thousand-fold action of its irrita-
tions, unless they succeed in resolving the phenomena of
consciousness into these elements in order to obtain
from the kind and strength, from the progression and
connection of our perceptions, sensations and conceptions,
a clear idea about the kind and progression of the material
processes in the brain. Without this clue the brain will
always be a closed book."

**We can, indeed, compare the brain to a book. A

CORRELATION OF SCIENCES. 1 49

book is anatomically a number of rectangular white leaves,
bound on one side, and marked on their pages with
numerous black spots of different form and size. Under
a microscope the leaves will be seen to consist of delicate
fibres, and the black spots of minute black granules. A
chemical analysis will show that the leaves are cellulose
and the spots carbon and resinous oil. If all has been
investigated and ascertained with the utmost accuracy, we
do not know, in the least, why the black spots are ar-
ranged just in this and in no other way, why some spots
are large and others small, why some occur frequently,
others rarely, why the single leaves follow one another in
this and in no other order, and altogether what the book
really means.**

** Whoever wishes to know what the book signifies must
know what is the function of the specific energy of each
single letter and of the individual energy of each single
word — ^in short, he must know how to read."

The interpretation of the book is indeed sealed to purely
medical methods, notwithstanding the amount of analysis
that may be performed by the mainstays of medical re-
search. To know how to read the book we must turn to
the science of the phenomena of consciousness — psychol-
ogy — and above all to the science of the phenomena of
abnormal mental life — psychopathology. The medical
sciences can never furnish the key to the book. Once
psychologfy and psychopathology yield the key, the medi-
cal sciences have great value, the analysis of the form of
the letters, the ink, the paper, yield a meaning and have
a purpose.

A curious division has arisen between the practical fields
of nervous diseases and mental diseases, a split that has
created a very unfortunate and artificial gap in scientific

150 CORRELATION OF SCIENCES.

research. However important it may be from a practical
standpoint to separate nervous diseases, that do not inter-
fere seriously with the intelligence from mental diseases
that require a radically different treatment, the division in
the scientific investigation of the two sets of diseases has
been a distinct drawback in the progress of knowledge of
each. The progress of knowledge of mental maladies has
suffered the most in being considered a field of investigation
apart from that of the nervous diseases. The damage in
nervous diseases involves the lower and more simply con-
structed parts of the nervous system, and were the under-
standing of these simpler conditions applied to the domain
of mental diseases, greater advances would have resulted.
One distinct aim of the Institute in many of its depart-
ments is to bridge over this artificial hiatus in scientific
study betzveen nervous and mental diseases.

Now we find that the nervous system (even in its high-
est spheres) behaves like other parts of the body in the
presence of disease processes. It was suggested in the
preceding section, that the nerve cell ftiay exercise a
protective agency against hurtful stimuli by retracting its
arms, which also provided a period of rest for the cell to
recuperate pathological expenditures of energy from its
food supply. When the hurtful stimulus becomes more in-
tense, as in the case of poisons coming in contact with the
nerve cell, notwithstanding the higher organization of the
neuron, it behaves just like its humbler associates in the
liver, kidney and elsewhere. It may undergo changes in its
internal organization in contact with the poisons of dis-
ease ; its food supply may also be interfered with. We then
perceive, under the microscope, sigfns of degeneration of
the nerve cell as witnessed in other parts of the body,
when their cells are exposed to the influence of poisons.

CORRELATION OF SCIENCES. 151

But even under the influence of poisons, the nerve cell has a
wonderful degree of vitality and a large capacity for resti-
tution, when the disease-inducing poisons are withdrawn.

It is a very important view to consider that the brain
behaves like other parts of the body in disease pro-
cesses. Guided by this view we can avoid the pitfalls
of error into which those investigators are apt to stumble,
who are prone to think that the brain has its own disease
processes radically different from those of the body in
general. In studying the changes in diseases of the
nervous system one must always hold fast to one funda-
mental truth, that the brain in disease must not be
regarded as something apart from the rest of the body,
and must not be isolated as an organ sui generis having
inaccessible mechanisms and mysterious powers.

Whether in health or disease the nerve cells are like
other cells only more highly organized. They must obey
the laws of cell life in general. For it must always be
borne in mind that even the highest constellations of the
brain are not composed of elements distinct from the
humblest parts of the nervous system, not even different
from the simplest nerve that pursues its pathway any-
where in the body. The fundamental structure of the
constituent elements is the same everywhere whether in a
simple nerve trunk or in the noblest and highest regions
of the brain itself.

Enough has been said, perhaps, to indicate the very
comprehensive character of pathological research at the
present day, and the fact has been emphasized that patho-
anatomical process in the nervous system, and above all
the brain should always be considered in the light of
analogy of the general patho-anatomical occurring through
the body at large.

tS» CORRELATION OF SCIKNCES.

The study of pat ho -anatomical processes in the nervous
system then, in this Institute, must always be guided by
a most comprehensive knowledge of these same processes
occurring throughout the whole body. It is, however, ex-
tremely difEcult for any one individual to have a working
knowledge of the morphology of disease processes in the
body in general, and at the same time know enough of
the nen'ous fystera to extend into this field the broad
conceptions o( ^f/ifra/ pathological research.

The application of pathological anatomy to psychiatric
research is liable to be shorn of its full value. The opinion
seems to be held that a single individual can command
the whole sweep of pathology in centres for psychiatric
research. The idea still hangs on that patho-anatomical
research in psychiatry is to be given over to the specialized
pathological anatomy of the nervous system. As a
matter of fact the whole field of pathological anatomy is
needed. In centres of psychiatric research then, it is
best to provide for a co-ordination of the several fields of
pathological anatomy by two or three workers in this
branch who can pursue the several subdivided special
lines of investigation and yet correlate them in order not
to lose tract of the generalized influences of pathological
anatomy as a whole.

Taking our own institution* as an example, we may say
that the department of pathological anatomy is some-
what at a disadvantage in not having a sufficient working
force to cover the whole field. We have, practically, but
one associate to take charge of the manifold bearings of
this branch of the investigation of mental and nervous
diseases and of its interrelation with other departments
in the Institute. Another representative is needed in

CORRELATION OF SCIENCES. 1 53

this field of study, especially in collaborating and extend-
ing the work among the members of the staffs of the
hospitals, for most of our colleagues in the hospital choose
pathological anatomy as their favorite work.

This insufficiency of working force in the department of
pathology, has also been a very serious drawback in the
acquisition of that particularly valuable kind of material
for investigation which is not to be found within the
asylum. The opportunity for acquiring this material, so
valuable in the investigation of insanity, largely deter-
mined the seat of the Institute in the great metropolitan
city of the State. This material is derived from autopsies
on cases in which the nervous system is damaged by the
great host of general bodily illnesses. The making of
autopsies; the acquisition of autopsy material of nervous
diseases; the preservation of this material with the
requisite great care and detail, all involve an enormous
amount of work, and we have been unable to take full
advantage of the very opportunity, which led to the
inauguration of the Pathological Institute in New York
city, namely, the acquisition of material and facilities for
the study of the first stages of insanity, the importance of
which was emphasized in the introductory paragraphs of
this paper.

Finally, let us be quite clear as to the distinction be-
tween pathological anatomy and pathology, a distinction
which, unfortunately, is too often lost sight of. Patho-
logical anatomy is concerned with the study of the struc-
tural changes associated with disease process. Pathology
is the study of the disease process itself. Cell changes or
other structural lesions are effects, traces of the process of
disease. Pathology has for its province the study of
the phenomena, the manifestations of the abnormal

'S4

CORRELATION OF SCIENCE!

function in disease, Pathology is a study of the dynamics
of disease, whereas pathological anatomy is an investiga-
tion of its statics. In studying disease we should not be
content to stop with making observations of pathological
structure. This is but a small part of the problem. We
should endeavor to go beyond this and explain the facts
from a consideration of abnormal function. Pathology is
the guide of pathological anatomy. Pathology, however,
to be a trustworthy mentor of morbid anatomy, should be
inspired by general physiology, the science of the general
laws of the physics of function.

The comparison of the work of the earlier morbid anato-
mist to the inspection of the fireworks the morning after
the show is still quite true to-day. The path o- anatomist of
the present day is not far from the same position. In the
contrast of the great progress of his deeper powers of
analysis with the crude methods of his predecessor, the
pathological anatomist of the present time is, I think, too
prone to think that the force of Holmes' epigram has
lapsed. In connection with the enormous amount of work
rather heedlessly running into the channel of morbid struc-
tural changes it is quite as forcible as ever, and it will
remain so as long as the study of morbid structure piles
up its facts in delirious haste with too little reflection
that only through the study of abnormal function can
these observations have any broad interpretation. I mean
by the study of abnormal function, not only the abnormal
function of particular organs, but also the general princi-
ples of function in terms of cell energy, the province of
general physiology. Pathological anatomy should turn to
;y, and this latter science to general physiology
e intrepretation of the structural changes in disease,
problem, as to the cause and modus

CORRELATION OF SCIENCES. 1 55

operandi of the lesions, is still before the patho-anatomist
of the present day. He has approached a little nearer to
its solution, that is all. Like his predecessor, he still
comes around after the show is over. The only difference
between the two is that at present the inspection of what
is left of the fireworks is much more extensive and pene-
trating. The patho-anatomist has passed from the ob-
servation of topographical lesions in organs and tissues to
the minutiae of cytological changes. Even so, the display
is over. The living phenomena are gone and with them
the key of explaining the meaning of the structural
changes. This consists in expressing the structural
changes in terms of function, of dynamics. Only the
results, side products, impresses of the active phenomena
of abnormal function are witnessed under the microscope.
The observation of the finest minutiae in cell structure is a
long way off from the explanation of the energy process
accompanying or rather giving rise to the cytolytic lesions.
Since the brilliant discoveries of bacteria and their
toxines, and with the progress of seeking autogenous sub-
stances, the patho-anatomist of the day may be lead more
than ever to think that the application of Holmes' epi-
gram is a thing of the past. The difficulties of explaining
the nature of pathological metabolism lie before us not
behind us. The bacteriologist and the physiological
chemist share honors in pointing out their discoveries as
the causes of disease. The pathological anatomist points
to the changes in cell, or organ, or tissue, when these
causes are introduced into the body. It would appear,
then, that the work of all three explained the modus
operandi of the phenomena of disease. From the labors
of the bacteriologist and physiological chemist, it would
seem as if we had on the one hand the causes, and the

156 CORRELATION OF SCIENCES.

Other hand, in the observations of the anatomist, the
effects. The causes, however, are not the true essential
cause; they are only proximate causes; and the effects
are only a part of the operation of the true cause. The
things which the bacteriologist and physiological chemist
have found, although discoveries of brilliant importance
in practical utility, are merely what touches off the fire-
works; what sets free the pyrotechnic display. These
bacteria and toxines, while greatly advancing our knowl-
edge of the nature of disease, are merely sparks, as it
were, which ignite the fireworks. Hence, these three
scientists are rather prone to fall in with the idea that
each particular disease corresponds to a particular set of
fireworks, which can only be ignited by a particular kind
of a spark. This is an extremely shortsighted view of the
problem. A knowledge of the igniting impulse or a
study of the remains of the fireworks or both combined,
do not explain the process of combustion.

Because his two co-workers have discovered the agencies
which set the fireworks free, the patho-anatomist must
not lose sight of the fact that he is still inspecting the
fireworks after the show is over. The man who actually
witnesses the display is the physician^ the clinician^ but
even he, on reflection, will confess that his methods are
not searching and that he perceives only a small part of
the process and its manifestations. In fact what is needed
is the wand of the science of general physiology to guide
pathological anatomy, bacteriology and physiological
chemistry. The great science of life in disease and health
is general physiology^ the science of function. There is no
need of qualifying physiology in its application to the
study of abnormal function. For function in general is
the central province of general physiology. The duty of

CORRELATION OF SCIENCES. 1 57

this science is to formulate function in terms of energy.
When general physiology enters more extensively into the
study of disease we shall see that the process of disease is
one of mutations of cell energy and realize more fully the
deep meaning which is conveyed by Sach's substitute in
the term energid for the rather meaningless word — cell.

The department of Pathological Anatomy is under the
charge of Henderson B. Deady, M. D. (Columbia Univer-
sity), and Bronislaw Onuf, M. D. (University of Zurich).

The department of Bacteriology is under the guidance
of Henry Harlow Brooks, M. D. (University of Michigan).

The department of Physiological Chemistry is guided by
Phoebus Levene, M. D. (Imperial University, St. Peters-
burg), and S. Bookman, Ph. D. (University of Berlin).

Chapter X.

PATHOLOGICAL PHYSIOLOGY.

I have endeavored to show in some of the preceding
sections that in these days of great specialization and
subdivisions of the fields of pathological research, it is out
of the question for any individual to have the capacity to
cover the entire territory. Twenty, perhaps even ten
years ago, when methods of investigation in pathological
research were in a comparatively elementary stage of de-
velopment and were used uniformly for the investigation
of disease processes in all parts of the body, a single
individual mastered the whole territory and was a general
practitioner and pathologist to boot. He could observe
symptoms during the patient's life, bridge over the chasm
of death, as it were, and write the sequel of the story of
the disease by observing the changes in the organs under
the microscope. At the present time, the problems of

158 CORRELATION OF SCIENCES.

pathological research have grown vastly more complex.
The examination of different constituents of the body
forms distinct and specialized territories of research, each
having particular and intricate methods adapted for its
special purpose, which cannot be used uniformly for the
investigation of all parts of the body. Thus the changes
in the blood alone, associated with disease, constitute a
distinct field of research with specialized methods of
investigation, and within the past few years an extensive
literature has grown up emphasizing the importance of
specialized micro-chemical investigation of the blood.

The study of the general changes linked with disease
processes throughout the body at large, including the
study of tumors, constitutes a very wide field of research,
and is more or less subdivided into distinct branches of
investigation. The study of morbid processes in the
nervous system constitutes another field of pathological
research, which is in turn subdivided into many special-
ized branches of investigation. The investigator who
would explore this field must first traverse the domain
of general pathological anatomy, must then learn the
intricate architecture, construction and function of the
nervous system, in order to apply to it his knowledge
of the general nature of disease processes.

Pathological physiology in its turn constitutes a highly
important and specialized domain of pathological investi-
gation. Studies in this field of research that seek to
investigate pathological function on a basis of physiology
and induce disease processes experimentally require special
skill in conducting operations on animals, and of watching
the abnormal physiological manifestations of the animal
after the experiment has been performed. It can be
seen then that this territory merges over into that of

CORRELATION OF SCIENCES. 1 59

physiology. If pathology be restricted to the mere observ-
ation of changes in form within the organs and their
constituent cells during the processes of disease, its power
of investigation terminates quite abruptly in very many
directions; in fact it almost loses its whole dignity and
philosophy as a science. Most pathological laboratories
are not laboratories of pathology, but of pathological
anatomy. We must not only observe the alterations
in form and structure within the cells during disease
processes, but also interpret structural changes by the
study of the changes in the functions of the organs and
of the cells themselves. In brief, pathological physiology
takes into account the abnormal physiology of organs
and cells when exposed to environment simulating that
of disease. This most important branch of research in
pathology, respecting the abnormal physiology of the
organism during disease, is best conducted from the
standpoint of general physiology, and should make con-
stant use of the methods of experimental pathology.
Pathological physiology fills up the gaps in the knowledge
of disease processes gained by studying them in the human
subject alone. These gaps are indeed wide and deep.

Anatomy deals with the structure of the normal organ-
ism. Physiology is the science of function.

Each of these two great sciences of life is specialized on
various provinces, which need not be considered here
except as relating to the divisions made in the study of
disease. Both of these sciences become subdivided into
specialized fields of inquiry depending upon the normal or
diseased condition of the organism. Thus we speak of
normal anatomy and histology as the branches which in-
vestigate the structure of the normal organism. Similarly
normal physiology is used to designate the study of

l6o CORRELATION OF SCIENCES.

normal function. Pathological anatomy and histology in-
vestigate the structural changes concomitant with the
process of disease. Pathology is the study of function in
disease, and is, therefore, really identical with physiology.
Pathology is an application of general physiology to the
investigation of changes of function in disease. Pathol-
ogy, however, is so often confused with pathological
anatomy that it seems well to emphasize the fact that the
great and guiding study of disease is not one of structure,
but of function. The investigation of the disease process
is not pathological anatomy, it is a physiological study
and has a higher dignity as a science than morbid anat-
omy. In fact pathology should be the guiding science
for pathological anatomy. In order to bring into greater
prominence the necessity of physiological methods of in-
vestigation into the province of the study of disease, we
have, therefore, used the term pathological physiology —
the physiology of disease. Throughout this chapter the
application of pathological physiology has been given a
rather specialized character in being limited to the study
of abnormal functions of particular organs in disease, both
in the human subject and by experimental work on
animals. In the future, after this department becomes
established and grows, we shall endeavor to have its work
guided by the broad principles of comparative or general
physiology — the study of function in general on the energy
basis of life phenomena. We should remember that the
process in disease is not different in nature from the pro-
cesses of normal life. In disease normal physiological
processes take on a wider range. Cycles of cell energy
liberation and restitution in disease are not different from
the cycles in normal life. The range of the oscillations
of the cycles are merely wider.

CORRELATION OF SCIENCES. l6l

If the nonnal physiologist would have a flood of light
shed upon normal function of cells and organs he should
study the process of disease. // is only through a study of
the abnormal^ the patfiological, that we can hope to under-
stand the normal. This fact is not sufficiently understood
by the devotees of the various normal ^^ ologies,**

As normal physiology deals with the functions of the
different tissues or organs in the normal organism, patho-
logical physiology investigates the abnormal functions in
the diseased organism. But the questions which patho-
logical ph>^iology has to decide are much more compli-
cated than in those of normal physiology, because of the
protean aspects of disease and the great variety of phases
of the pathological process. Disease is very seldom so
simple a phenomenon as the expression of the abnormal
functioning of a single organ of the body. The body is a
united whole, and the various organs are so indissolubly
interrelated that abnormality of functioning in one organ
may produce a widespread effect on the functions of the
other organs. Disease is a complex whole of abnormal
functions of various organs, although primarily it may
result from the departure of a single organ or tissue from
its normal functions, chemistry, and structure. In disease
the pathological physiologist is, as a rule, confronted with
a whole complex group of abnormal functions of several
organs, and he has to sort out and differentiate how far
the abnormal functions of each organ contribute to the
general symptomatology and to discuss the interrelation
of the abnormal functions of the several organs.

Before long he should, from the general biological study
of function, discuss the functions of diseased organs in
terms of cell energy. This will give the key to the
explanation of the morphological changes in disease.

l62 CORRELATION OF SCIENCES.

We must not be carried away by the fairly widespread
example of centering pretty much the whole of scientific
inquiry of medicine about the microscope, the crucible
and the culture tube. Let us keep in mind that clinical
work, the study of the living phenomena^ the strict scien-
tific investigation of psychomotor manifestations, is just
as much a great department of scientific research as those
laboratory investigations in pathological anatomy, bac-
teriology and physiological chemistry. In fact, I think
that the study of the living phenomena is far more im-
portant than the other studies, for the simple reason
that only through the study of the living phenomena
of disease can we arrive at broad, guiding principles
to direct and interpret the work of the laboratory
sciences. The study of the living phenomena then, far
from being put in the background of medical science by
laboratory workers should stand foremost; it forms the
mentor and the guide of these other sciences.

Clinical investigations conducted on the strict basis of
general physiology and psychopathology give a basis for
deductive reasoning, for scientific co-ordination of the
scattered facts of the laboratory sciences. The clinician,
fortified by the great principles of general physiology,
pathology and psychopathology, armed by the methods of
scientific observation and experimentation stands close
to the highest plane in medical science — the observation
of living phenomena, the manifestations of disease. At
present, however, the methods of the clinician fall short of
this standard — they are not wholly adequate and searching.
A whole host of phenomena slip out of his grasp or are
but dimly perceived by him. Physiology, functional
pathology and psychopathology possess the methods of
studying the living phenomena accurately and compre-

CORRELATION OF SCIENCES. 1 63

hensively. By pathological physiology, functional path-
ology or simply pathology, I mean to indicate the study of
life activity in disease by the methods of a science which
considers such phenomena as manifestations of energy.
Clinical research, based on the principles of pathological
physiology, ought to take precedence over the other medical
sciences, such as pathological anatomy, bacteriology and
physiological chemistry, and to lead them in thought.
The study of function in terms of energy states the problems
which are to be verified by the statical sciences. Through
the leadership of physiology dealing with the ultimate
cause, energy, the scattered, disjointed facts of pathologfi-
cal anatomy, physiological chemistry and bacteriology
will become scientifically useful and yield material that
can be used for theory^ generalizations^ laws — the ultimate
aim of scientific research.

Inasmuch as we are largely debarred from controlling
diseased human beings for the application of physiological
methods of inquiry, we must obviate these diflficulties by
inducing morbid function in animals. This will not in-
validate at all the soundness of the general principles of
the modus operandi of abnormal function. These general
principles (the nature of excessive ranges of cycles of
cell energy liberation and restitution, and the nature of
stress or resistance of latent cell energy to stress remov-
ing impacts) we should determine first through compara-
tive or general physiology. We shall then be in a better
position to reason from these generalities respecting cell
energy as to the nature of functions of cell communities
in the particular organs and tissues. General physiology
of disease comes first; special physiology of diseased
organs should be pursued in the light of the former
study.

CORRELATION OF SCIENCES. 1 65

through experiments in pathological physiology. In
fever, for instance, the modifications induced in the ab-
normal functions of the body by antipyretics or a cold
bath are useful applications of the experimental method
in pathological physiology.

The opportunities for using experiment in abnormal
physiological manifestations of human beings in disease
are seldom afforded. Hence we have to make use of
experiments on animals and compare the results with
the phenomena of morbid processes in man. It may
be said that pathological processes induced in animals
cannot be compared with those occurring in human
beings, for the organization of each is different. This
is certainly true to some extent. There are, for instance,
pathological processes of the gravest import to human
beings, which, as yet, we have not succeeded in repro-
ducing in animals, such as tumors, syphilis, epilepsy, the
small-pox group, etc., and many diseases of the nerv-
ous system. There are again certain factors vaguely
grouped under the terms predisposition and immunity
which make an individual of the human species prone to
a disease process and shield an animal from the same
process, and vice versa. The idiosyncrasies of man to
many diseases from which animals seem shielded go
*to show how much we still have to learn of predisposi-
tion, immunity, and the factors of heredity and vulnera-
bility in disease. These facts in themselves, on the other
hand, emphasize all the more the imperative necessity of
the more extensive application of the experimental method
in pathology, for the diseases which seem beyond the
reach of the experimental method were formerly and are
now precisely the very ones the explanation of which is
most obscure and unsatisfactory. In many instances.

l66 CORRELATION OF SCIENCES.

fortunately, one is quite justified in considering the ab-
normal functions of the organ in an animal, when a
given disease process is induced experimentally, as
equivalent to the abnormal functions in a human being
in that disease.

The cardinal functions of the corresponding organs are
the same in all animals with higher organization, and the
structure of these organs resemble each other very
closely. If, then, having produced in an animal the
same lesions corresponding to the ones found in the
human subject, the animal is found to manifest the cor-
responding set of symptoms, the causal relations of the
abnormal functions to the structural change rest upon a
firm basis. This is the way that the brilliant and practi-
cal results of bacteriology have been achieved. Without
the use of experimental pathology, bacteriology would in-
deed have been a sterile science in the practical domains
of medicine. It would have resulted in a piling of Pelion
on Ossa of mere facts of the life-history of bacteria, and
their all-important pathogenic qualities would have
remained comparatively imexplored.

We should not strive always to experiment on animals
which, by the high and complicated development of their
organization, are more or less related to human beings,
but, on the contrary, greater extension of the experi-
mental method in pathology should be made on the lower
animals where the brilliant work of Metchnikoff has
given the key to the explanation of the phenomena of
inflammation. The less complicated the organization of
the animal, the less complicated arc its specific functions,
and the easier it is to comprehend its structure and
functions in either health or disease. But this field, ex-
perimental pathology in the lower animals, belongs to or

by HitxTg and P : ;u^ sr :±ie sxi 3t s

tion, Tbey rrntaaod
of the brain vxth an
ooQtractioQS in
having scch a grctt

deistandxng of pSirssoSogr of tbe VrA> : . pCsT-ec rr*r &
more important part in tbe ptbcCri^sT' arc — ibe Lxial-
ization of fnnctioos of dircren Taars ?: tr* rKrrms
system.

These experiments enabicd i!
a living man a tnnxir of ibe

direct the knife to its kxa ik 'n with al^LZssz nithen=ri-
cal accoracT. E xp e rim ents of this cnc c^rrrio: rated tbe
differentiation be tme exi focal and essetitial etxlet>?v, and
it is to be hoped that the dav is tiot far czSisziz wben
the simulacrum of epilepsv may be artifrlaZj inc-ced in
animals throngh the labors of experitnertal pathology.
If the simulacra of epileptic phenomena co:ilc be ex-
perimentally and permanently induced in animals, it
would furnish tbe key to the explanation of this obscjre
process. All the facts which the pathological anatomist
and physiological chemist have gained in the study of
this dire malady give no explanation of the process that
gives rise to the epileptic phenomena.

Animal experimentation has also proven that extirpa-
tion of certain portions of the cortical part of the brain
always produces a degeneration in the same nervous
fibres, proving thereby the neuron theory and showinsr
the location and topographical distribution of different
groups of functionally related neurons. Many more
examples could be added, showing the value of patho-
logical physiology for the study of the nervous sv^tem.

Par from being fit to investigate the phenomena of

1 68 CORRELATION OF SCIENCES.

animal experimentation conducted along certain lines
peculiar to this branch of science.

Like every other branch of medicine, experimental
pathology or pathological physiology is closely, even
organically, related with the other branches. It is a con-
necting link between pathological anatomy^ physiology^ bac-
teriology and physiological chemistry on the one hand, and
clinical medicine and hygiene on the other. Its work
is indispensable, not only for the progress in the treat-
ment of disease, but also for advances in the highest art
of medicine — the prevention of disease. Its greatest pro-
vince is to guide the work of pathological anatomy, bac-
teriology and physiological chemistry, and furnish the
standpoint for explanation of this work. Progress in
modem surgery, in serum therapy, in the prevention of
epidemics, in immunization, public hygiene and antisepsis
owes a great debt to experimental pathology.

The study of the pathology of the nervous system is
more dependent upon pathological physiology than that
of any other system in the organism. All the other
organs of the body difiEer from each other by ana-
tomical structure and by function, while different parts
of the central and peripheral nervous system have the
same anatomical structure and still their functions are
entirely different. We can hardly see, for instance, any
morphological or chemical difference between some parts
of the brain, the irritation of which produces contractions
of the muscles; or other parts of the brain, the irritation
of which produces contractions of the circulatory system,
rise of temperature of the body, and so on.

The fact that every part of the brain has only to
perform a certain part of work in the physiological
division of labor in the nervous system, was shown first

CORRELATION OF SCIENCES. 1 69

by Hitzig and Fritscli by the aid of animal experimenta-
tion. They irritated certain places in the convolutions
of the brain with an electric current and always received
contractions in certain muscles. These experiments
having such a great theoretical importance for the un-
derstanding of physiology of the brain, played even a
more important part in the pathology and in the local-
ization of functions of different parts of the nervous
system.

These experiments enabled the physicians to find in
a living man a tumor of the brain, and the surgeon to
direct the knife to its location with almost mathemati-
cal accuracy. Experiments of this kind corroborated the
differentiation between focal and essential epilepsy, and
it is to be hoped that the day is not far distant when
the simulacrum of epilepsy may be artificially induced in
animals through the labors of experimental pathology.
If the simulacra of epileptic phenomena could be ex-
perimentally and permanently induced in animals, it
would furnish the key to the explanation of this obscure
process. All the facts which the pathological anatomist
and physiological chemist have gained in the study of
this dire malady give no explanation of the process that
gives rise to the epileptic phenomena.

Animal experimentation has also proven that extirpa-
tion of certain portions of the cortical part of the brain
always produces a degeneration in the same nervous
fibres, proving thereby the neuron theory and showing
the location and topographical distribution of different
groups of functionally related neurons. Many more
examples could be added, showing the value of patho-
logical physiology for the study of the nervous system.

Far from being fit to investigate the phenomena of

lyo CORRELATION OF SCIENCES.

consciousness^ morphology and chemistry alone are not,
and never will be, able to explain all the phases in the
function of the nervous system, not only because we are
unable to difiEerentiate morphologically or chemically one
pathological process in the brain cell from another, but also
because the same pathological process of two different parts
of the brain, if their functions are different, can have a
different influence upon the organism as a whole. It is,
therefore, not sufficient to study the morphological and
chemical changes of the nervous system in its pathologi-
cal state. We must also see what influence such a dis-
eased nervous system has upon the different systems of the
organism, such as the action of the heart, the blood press-
ure, the respiration, the general metabolism, and so on,
as these all depend upon the nervous system, and must be
changed when the latter is changed. Conversely the
effects of changes in circulation, respiration, general meta-
bolism and changes in organic and vegetative somatic
functions upon the higher parts of the nervous system
must also be taken into account. This latter topic must
be studied by the pathological physiologist and psycho-
pathologist conjointly.

We can illustrate our point best by the plan of study-
ing the influence of drugs or poisons on the nervous
system. Let us suppose that we introduce into an animal
certain drugs that produce convulsions or sleep; no matter
whether we find morphological or chemical changes in the
nervous system or not, we will not know thoroughly the
nature of the action of these drugs until we examine, by
all the physical and physiological methods at our com-
mand, the influence of the drugs upon the nervous system
Itself and all other systems of the body, the action of which
is regulated by and depends upon the nervous system.

CORRELATION OF SCIENCES. 17I

From one particular standpoint, however, this branch of
research deserves special emphasis, for it relates to some
questions of ultimate and practical importance regarding
the insane. One of the specific rdles of pathological phys-
iology, in psychiatric and neurological research, lies in
the deterviination of the action of drugs upon the ftervous
system^ and above all the brain. It must be confessed,
that in the treatment of the insane, our knowledge of
the effects of drugs upon the metabolism of the nerve
cells is very obscure. No one will deny that it is of the
utmost importance to know what we are doing to the
nerve cells in administering drugs to the insane. At
present the knowledge of the action of the drugs given
to the insane, is known simply by the general physiolog-
ical effects, and not by the chemical reaction between
the constituents of the nerve cell and the drug itself. Our
knowledge of the action of drugs on the nervous system is
empirical to the last degree. In epilepsy, for instance,
I do not hesitate to say that in very many cases the ad-
ministration of bromides on this entirely empirical basis,
although relieving the symptoms, may actually in the
course of time damage the nervous system severely. The
bromides, if given continuously, may constitute an actual
poison to the nerve cells, and in this disease one evil
may be added to another, in that the ravages of the
disease process of epilepsy is augmented by poisoning
the nerve cells by a drug, whose action upon the delicate
organization of the nerve cell is altogether unknown.

Epilepsy seems to be due to the action of some stimulus,
which though mild in intensity, may, by its persistence,
act in the higher spheres of the brain. This stimulus may
come from a variety of places in the body. It may arise
from the intestines in the form of a mild poison, which

172 CORRELATION OF SCIENCES. •

may escape into the blood from some departure in the
complicated chemical operations attending digestion; it
may travel up one of the many nerves of the body from
some irritation which involves the ends of these nerves; it
may be due to the irritation of a tiny splinter of bone
pressing on the brain after a blow upon the head, etc. In
an individual of inherent instability of the higher spheres
of the brain, this constant stimulus finally causes a sudden
dissociation of this part of the brain from the lower
spheres beneath, by means of the retraction of the ten-
tacles of the nerve cells. These nerve cells in the upper
spheres of the brain become fatigued, through the con-
stant reception of the stimulus, and retract their arms to
avoid the noxious and offending impulse. But in the
sudden retraction of the upper spheres of the brain, which
grasp and control the lower portions, the energy of the
latter is suddenly unbridled and loosened, and the epilep-
tic fit results. Now it is quite probable that in deadening
and benumbing these upper spheres of the brain by the
use of bromides, so that they no longer exhibit a sense of
fatigue to the stimulus much harm is being done. It is
quite true, that the symptoms of epilepsy may be con-
trolled in this way, but are we not poisoning the nervous
system to gain this end ? It were far better to ascertain
the cause of the epileptic fit — ^the persistent stimulus
coming from some distant place in the body — and at-
tempt to remove this, rather than to injure still further
the highest spheres of the brain, by benumbing with a
poison their sense of fatigue.

If the large and continuous amounts of bromides be
given to animals, as has been determined in some research
work in one of the State hospitals, the result is the poison-
ing of the nerve cells manifested by the phenomena of

CORRELATION OF SCIENCES. 1 73

degeneration. While the drug is not given in epilepsy in
such poisonous amounts as in these animals, nevertheless
it must act in the same way, though to a less degree. If
a perfectly sane man were continuously dosed with bro-
mides, it would seem almost certain that in the course of
time he would begin to show a dissolution of the higher
spheres of the brain, whose activities are concomitant with
the manifestations of the highest forms of mental opera-
tions. It must appear, then, from this single example,
how important it is to know the action upon the nerve
cell of these drugs. Hence I would enter a plea for pro-
visions in pathological physiology at this Institute, the
more so as I have already mapped out an extensive series
of experimental researches to determine the action on the
nerve cell of the drugs used in the treatment of insanity.

In addition to the determination of this important and
practical question by this department, many problems re-
lating to self-poisoning in the body fall within its scope.
Subtle disorders of a whole system of organs within the
body whose duty is to maintain the blood in a proper equi-
librium, may induce a poisoning of the nervous system
with grave results. A very large share of our knowledge
of diseases that spring from disorders of the organs
producing the blood and maintaining its chemical and
morphological equilibrium has been derived from the re-
searches of pathological physiology. A large share of
work still remains to be done in this field, and facilities for
the experimental study of the relation of changes in these
blood- producing organs, to poisoning of the nervous sys-
tem in mental and nervous diseases, ought to be provided
for at this Institute.

We have no one on the staflF at present who has the
requisite time or specialized training to undertake work in

174 CORRELATION OF SCIENCES.

the field of pathological physiology. An associate in this
department should be able, in addition to his own special
investigations, to perform all the operations on animals
desired by the other associates in the course of their
researches, or to devise new operations and experiments
as may be necessary in the course of psychopathological,
pathological, bacteriological or chemico-physiological in-
vestigations. In addition to this, he should conduct all
the physical and physiological parts of the examination,
transfer and apportion the morphological, chemical and
bacteriological material to their respective departments
for detailed investigation after the experiment has
terminated.

Chapter XL

THE INVESTIGATION OF BLOOD IN INSANITY.

The investigation of the blood in insanity derives its im-
• portance as a distinct field of research, from the fact that
this is the medium of conducting the food supply to the
nerve cell. When the nerve cell works, it expends
energy, and the elaboration of energy is carried on within
the body of the nerve cells .from crude food materials
derived from the blood vessels. The theory has lately
become more and more substantially founded upon facts
and observations, that not an inconsiderable share of
mental and nervous diseases are due to the actions of
poisons upon the nerve cell. These poisons, which com-
prise a very large group, are sometimes bred within the
interior of the body; they are often derived from bacteria
and frequently taken into the body from extrinsic
sources.

There is, however, great danger of carrying this ex-
planation of the action of poisonous substances upon the

CORRELATION OF SCIENCES. 175

nervous system, too far, and thereby underestimating the
equally important factors of deficient food supply a7id patho-
logical fatigue of the fierve cell in the production of jiervous
and mental diseases. In observing the actions of poison-
ous reagents upon the nerve cells, the concomitant impair-
ment of their food supply in relatiofi to the work they
perform must also be jointly taken into account, par-
ticularly where the poisons, although mild in intensity,
are of a dangerous character from their persistence and
chronic action.

Investigations of the blood in the living patient, then,
are of paramount importance, because in changes in the
blood we have a barometer^ so to speak^ of the fall or
adulteration of the food supply of the nerve cells. We
have not only to consider the specific action of poisons
upon the nerve cell, but the secondary factor of the inter-
ference and adulteration of food supply of the nerve
cell which this poison causes by circulating in the blood.
In one of the commonest forms of insanity — general
paresis — constituting a considerable per cent of the
patients in the hospitals near the large cities, the cause of
the disease seems to be a slow, gradual, unrelenting pro-
cess of diminution of the food supply brought by the
blood, thus inducing starvation of the nerve cells.

The investigation of the blood in insanity has proved of
snch practical importance as to enable one to base on it
therapeutic measures and to indicate the percentage of
cases that may be benefited by a particular line of treat-
ment. Herein is certainly a practical application of the
value of investigation of the blood of the insane.
If there be one factor more important than any other in
the production of mental and nervous diseases, with the
exception of toxic agents, it is the quantitative and quali-

176 CORRELATION OF SCIENCES.

ficative impairtnent of the food supply carried in the blood
vessels to the nerve cell.*

Much important work remains to be done in establish-
ing more definitely the factor of impairment of food
supply to the nerve cell in relation to the genesis of men-
tal and nervous diseases, and the Pathological Institute of
the New York State Hospitals can ill afford to neglect this
branch of research, not having the aid of an associate in
pathological physiology.

This once more may serve as a good example to show
the inefficiency of the working force of the department of
pathology, in having only one associate. Pathological
research work covei's so many specialized fields of inquiry
that a staff of at least three associates is required. I think,
however, that both pathological physiology and the investi-
gation of the blood of the insane may be carried on by a
single investigator.

To sum up, it is advisable, if not indispensable, that
three sub-branches should be provided for pathological
research in the investigation of the insane, each under
the charge of a single associate. These sub-divisions are:

I. General pathological anatomy.
II. Special pathological anatomy of the nervous
system.

III. Pathological physiology, including the patho-
logical histology of the blood.

* Some of these details respecting the significance of the excretion of the meta-
plasm granules from the nerve cell in relation to deficient food supply and
pathological expenditures of energy are worked out in my paper ** The Toxic
Basis of Neural Diseases," now in press for a future number of the ARCHIVES

OP NEUROLOGY AND PSTCHOPATHOLOGY*

CORRELATION OF SCIENCES. 177

Chapter XII.

ANTHROPOLOGY.

The importance of heredity as a factor in the pro-
duction of insanity has been hinted at several times in this
text. In the previous section on cellular biology, atten-
tion was drawn to the fact that the advances in that
science had set forth a working hypothesis for the physi-
cal basis of heredity; that the cell scientist had been able
to select a certain element in the egg cell which in its
fecundation was mingled with an equal amount of the
same element from the sperm cell; that these two
paternal and maternal contributions to the beginnings of
the new being were intimately wrought together and dis-
tributed in equal amounts in the process of cell division
to every individual cell in the whole organism of the new
individual. Hence the new being bears the stamp of the
characteristics of both parents.

The facts of the relation of heredity to insanity are to
be interpreted only by applying to them the remarkable
advances of cellular biology into the nature of the germ
plasm and the investigation of variations in general
through the study of evolution. The whole essence of
the problem of heredity in insanity lies in a thorough
appreciation of these researches of the germ plasm and
of the nature of variations, and the psychiatrist who does
not familiarize himself with these investigations in the
community of biological sciences can hardly expect to
gain any clear insight into the factor of heredity in in-
sanity. The discussions of this subject frequently carried
on with but vague and hazy recognition of the present
status of cellular and other biological researches into the
physical basis of heredity bears testimony to the isolation

178 CORRELATION OF SCIENCES.

of psychiatry from all other branches of science. Psy-
chiatry is its own worst enemy in not stepping forth and
affiliating with the biological and medical group of
sciences.

Changes in the germ plasm from either the paternal or
maternal side or both, operate most powerfully to deter-
mine the weal or woe of the progeny, according to
whether the nervous system grows up from normal germ
plasm full, sound and stable, or contains as a result of
pathological germ plasm some hidden, subtle, instability
of the highest, most delicately organized and precious
upper centres of the nervous system, endowed with the
highest intellectual attainments and control over the
brutal, credulous, immoral and aggressive sub-conscious
self.

What are the agencies which damage the germ plasm
and cause departures from its normal constitution ?
Precisely the same agencies, to a certain extent, which
cause degenerations or induce disease processes in other
cells of the body besides the germ cell. It is not a trans-
mission of acquired characteristics. The germ cells are
damaged principally by the same agencies as produce the
variation and not necessarily or, only to a slight extent, the
operation of the variations themselves. These agencies
may be summed up under poisons and factors which
depreciate the food supply of the body cells.

While in their whole life-history the germ cells are sup-
posed to be set apart from the rest of the body cells for
the distinct and sole office of continuously propagating the
species, it is not possible for nature to colonize them so
completely as to shield the germ cells from the damage
inflicted by poisons or deficient food supply. Thus,
for example, the poison of syphilis and the chronic and

CORRELATION OF SCIENCES. 1 79

persistent poisoning of the body by alcohol, both of which
seem to operate largely by diminishing quantitatively or
qualitatively the food supply of the body cells, not only
cause degeneration of the nerve cells, but damage the
germ cell simultaneously and during the growth of the
embryo inflict other ontogenetic variations also. This is
the reason that the progeny of parents whose nervous sys-
tems are poisoned by alcohol and syphilis is notoriously
defective in the weak organization of the superiative and
most intellectually endowed spheres of the nervous sys-
tem. For if a very slight defect or chemical change or a
change in the configuration of atoms occur in the gigan-
tically complex molecules, the germ plasm as a result of
the action of these poisons, the effect in the next genera-
ation will crop out in the highest and most complexly
organized parts of the body rather than in the more lowly
organized and comparatively undifferentiated parts. This
is why the nervous system, and above all, its most lofty
portions, are found wanting in perfection when the germ
plasm is in a pathological condition.

According to the degree of pathological changes in the
germ plasm do the defects of development of the progeny
pass successively from higher to lower and lower planes of
organization in the nervous system so that all grades of
degeneracy and mental instability may be witnessed down
to the weak-minded, the imbeciles, and idiots. The ex-
ceedingly complex molecular constitution of the germ
plasm and the complicated process of reduction or halving
of the germ plasm in maturation of the egg and sperm
cells in relation to the action of toxic agents and deficient
cellular nourishment is of such urgent importance that we
ought to try to devise plans for the department of cellular
biology to approach the problem from the experimental

l8o CORRELATION OF SCIENCES.

Standpoint among invertebrates which afford good oppor-
tunity of applying toxic agents to the germ plasm.

During childhood such inherited incapacity of the
energy of these higher parts of the nervous system does
not always appear, unless the hereditary effects due to
damage of the germ plasm or other ontogenetic variations
be of a certain degree of intensity or persistence, for at
this period such higher centres are comparatively little
used. During adolescence and later life, however, when
these higher centres of the nervous system are called upon
for the greatest and most extensive expenditures of their
nervous energy they may fail. We then perceive the
outcropping of hereditary influences in a defective mech-
anism in the neuron to elaborate energy from its food
supply. It becomes worse in the next generation, for the
reason that this unstable brain energy in the first genera-
tion is liable to cause the individual to commit excesses;

to set aside moral laws in decent, wholesome living,
tamper with the nourishment of the body and introduce
alcohol or other poisons into the circulation of the blood.
Thus the germ cell in the second generation becomes
still further degenerated in that it suffers from this
exposure to poisons and imperfect food supply in the
blood. Degeneration of the germ plasm in the second
generation is liable to bring about pathological conditions
in the nerve cells and other somatic cells disturbing the
general metabolism of the body or inducing a craving for
toxic substances (alcohol) in the third generation. This
reacts upon the germ cells in the succeeding progeny and
their degeneration is advanced in progressive generations.
Degeneration of the germ plasm once established tends
to set up a vicious circle increasing the degeneration in
each successive progeny, unless somewhat mitigated by

CORRELATION OF SCIENCES. l8l

crossing with undamaged germ plasm. The third genera-
tion of such a succession is liable to become quite unstable
in the energy of the higher portions of the brain which
hold the lower spheres in check. It is from this or suc-
ceeding generations* that are recruited the inmates of
the prison, of the lunatic asylum, of the reformatory and
of the hospital for the epiletic and idiot.

We are, however, in such a backward state of general
knowledge of all these phenomena among the masses that
we cannot mitigate these agencies (better control of
syphilis) or seize the earlier phases of generation psycho-
pathies in the beginning, where they ought to be taken in
hand, but must wait for the end, so that the State has to
spend millions taking care of sickly and incurable
degenerates. Spontaneous variation and environment
must, of course, be taken into consideration in the march
of degeneracy. But from whatever sources or combina-
tions of these sources the degenerate and the candidate
for the prison and the asylum springs, we must identify
him and have knowledge of him in the earlier stages of
his pathway.

Now as to the use and purpose of anthropology. The
relations of anthropology to medical science are somewhat
vague. No one seems to define clearly and exactly just
what anthropology is to do, or what results we may expect
from it; consequently one may avoid the ponderous defi-
nitions usually given and attempt to explain in simple
language the use of anthropology in the science of
medicine. Anthropology, in relation to the medical
sciences, is simply a convenient term to indicate that two
or three sciences are made use of collectively to study not

• Vide consideration of liberation of energy throughout successive genera-
tions In the paper on Neuron Energy.

iSa CORRLLATION OF SCIENCES.

only individual cases, but also large bodies of men. In
this way the science simply makes use of anatomy, physi-
ology and psychology, more or less simultaneously, in in-
vestigating norma! and abnormal phenomena of human life.

Now our object with anthropology is to conduct these
anatomical, pbysiologpcal and psychological investigations,
to determine the characteristics of men with abnormal
nervous systems as compared with the normal. We wish
to identify the degenerate; we wish to leam departures in
the physical and psychical charai:t eristics of men at vari-
ous stages along the pathway toward the prison and the
asylum. At the asylum we already know fairly wfill what
departures the insane show from ihe average normal man.
In the asylum, however, only the last stages of mental and
physical abnormalities preponderate, and we depend on
anthropology to work out the initial and intermediate
stages in the course of degeneracy.

The first stages in the history of the degenerate, in a
great majority of cases, is some defect of the germ plasm,
and this or other ontogenetic variations give rise to the
stigmata or marks of degeneration, both mental and
physical, found in many of the inmates of the prison, of
the reformatory, of the hospital for the epileptic and for
the insane. In determination of the mental character-
istics of degeneracy, anthropological investigation must
be under the guidance of psychologj' and psycho pathology.

Undoubtedly one of the most resourceful fields of
anthropological research in its bearing on abnormal men-
tal life is the study of the psychopathic and neuropathic
criminal. The larger part of the sphere of what is called
criminal anthropology really belongs to pathological psy-
chology, since this possesses the methods of analyzing the
abnormal mental phenomena shown in a certain proportion

CORRELATION OF SCIENCES. £83

of criminals and can furnish the ideas, the philosophy of
correlating the facts. The other side of the investigation
in criminology, the determination of the physical abnor-
malties, belong properly to anthropology. A union of
both lines of research would seek out both the psycho-
motor and physical departures in the criminal, their inter-
relation, and ultimately, laws and principles governing
these variations.

By criminal anthropology we understand then a coali-
tion of powers of research grasping at both the physical
and psychical variations of the criminal in so far as his
acts ^e symptoms of a defective organization or manifes-
tations of pathological processes. Criminal anthropolog}'',
if I understand it aright, is the study of the psychopathic
and neuropathic^ criminal. It is the study of those criminal
classes only who are of a psychopathic or neuropathic
nature.* This requires the combined work of psychology,
psychopathology, anatomy and physiology. The socio-
logical aspect concerns us very deeply in that it may
furnish aid by contributing to some gliding principle of
the research, but any specialized work along the lines of
sociolog}^ lies outside of our sphere. Yet a co-ordinated
study of the defective or diseased criminal ought to be
productive of useful material for the sociologist to apply
in his own especial problems.

It will be necessary from our standpoint to take a
cursory glance at the development and aims of anthro-
pological study (including above all the psychopathologi-
cal investigation) of the diseased or defective criminal, for
criminology has but comparatively few students. Students
of this subject have a hard road to travel both as to the
discouragingly difficult nature of the subject matter and

• See article ** Nenron Energy . "

1S4 CORRELATION OF SCIENCES.

the lack of encouragement and even the discredit they
receive from other workers in science.

Possibly several things have combined to make criminal
anthropology seem an unproductive or unattractive field
of work. One reason for the lack of enthusiasm in the
study of the criminal is that the science in itself is exceed-
ingly young. It has barely bad sufficient growth to
establish ideals and plans of work. Consequently the
study is somewhat vague in its outlines. It has not
developed enough to map out pathways of investigation
that others may follow with profit. Like many other
branches of science dealing with life phenomena, general
principles and working hypotheses are exceedingly diffi-
cult to ascertain by confining the research exclusively to
the subject itself. It would be far better to study the
pathological phenomena shown by some of the criminals
where similar phenomena are greater in degree or are
proceeding at a more obvious rate. One might then
from such sources find some general theory, even if it be
only provisional, to test the same in criminals and to see
if the manifestations of the criminals are in accordance
with the truths that have been learned about abnormal
physical and mental variations elsewhere.

Another cause, perhaps, that has depressed the study is
that among the laity especially, there is a feeling of
distnist that the tendency of the advancing study of
the criminal will be to ease him of responsibility and
make crime attractive by making excuses for it under
the guise of psychopathic maladies. In fact, the prac-
tical application of scientific analysis of criminal actions
has often been abused in the halls of justice, and it is
liable to be done often again in the future, as long as
such evil systems of ascertaining scientific truths as that

CORRELATION OF SCIENCES. 185

of ** expert testimony"* prevail. Still in the long run
progress in the study of criminology cannot fail to right
such evils and to call for a less backward attitude of the
law to regard the scientific side of criminal acts.

One other reason that may be given to account for the
spirit of indifference in relation to the study of criminal
anthropology is that its exponents have worked with
fallacious methods of research.

The study of the criminal, in so far as he is neuro-
pathic or psychopathic, hinges largely on the questions
of the laws of human inheritance and human variations
both physical and psychical ; and these are the most vexed
questions of the day. Progress has advanced so far only
as to state them and point out the direction of the inquiry
rather than to make an attempt to answer them. These
questions point conclusively to the fact that the study of
the criminal must be guided by general biological and
psychological standpoints.

The obstacles in ascertaining the laws of mental and
physical variations in man by focussing the study on the
psychopathic or neuropathic criminal are altogether too
great. In a study surrounded by fewer complexities, the
method would be to assemble the principal external facts
and by rising from them through the resources of the
methods of induction arrive at the laws. But in criminal
anthropology the difficulties are too great and transcend
the powers of this method. It will be necessary to go to
many outside fields of research in general biology and
psychology to arrive at some standpoint for the guide of
the investigation of the criminal.

To carry on work with the methods of induction experi-
ment is necessary. In working with these methods we pro-

♦See Van Gieson and Sidis "Expert TcRtimony," State Hospitals
Bulletin, 2897.

ISO CORRELATION OK SCIENCES.

ceed by noting certain external phenomena or effects and
by successively varying the surrounding circumstances,
eliminate irrevalent pertubations until, finally, we arrive at
the essential interrelation and correlation of the phenom-
ena, that is, we discover their laws. Two conditions are
requisite in this method, first to vary, by experimentation,
the conditions surrounding the phenomena, and secondly
to observe the particulars or analyze the components of the
phenomena after the experiment. In the investigation of
the criminal classes it is very difficult to do either. In the
inductive sciences we can control the phenomena and hence
are able to experiment. In the study of the psychopathic
and neuropathic criminal classes it is rather difBcult to
employ the experimental methods. The student may
note a whole multitude of facts, but to assemble tiiem in
orderly fashion, to estimate the relation they bear to each
other, and to harmonize the relation of their segregate
and aggregate value with our accredited knowledge and
most certain experiences of other physical, mental phe-
nomena will indeed be a hard task. The observer stands
in danger of becoming lost and hedged in in his own mass
of facts. From this standpoint the study of the diseased
members of the criminal classes might go almost indefi-
nitely and do little more than wander about in the maze
of its facts without finding an outlet, for in the concentra-
tion of observation in the field of the criminal alone, no..
foothold can be promised for reflection and inference.^
from the facts. Criminal anthropology no more than
psychiatry or any other life science can be isolated from
other fields of knowledge. Otherwise it loses its philoso-
1 phy and its dignity as a science, and the finest and most
Lpatient of observation fails Co be effective without the
[tidance of and reciprocal impetus to theory.

CORRELATION OF SCIENCES. 1 87

Perceiving then the present narrow standpoint of crim-
inal anthropology, what other recourses are open? It is a
question well worth while to inquire into; for the most
important thing is to have some definite standpoint from
which to conduct the lines of the research instead of
catching hold of facts wherever we can or in whatever
order they come along. One must endeavor to see
through the relations of things instead of blindly hitting
upon these relations through one successful efjort in a
series of chances. If a man is to make ten or twenty
thousand measurements of criminals and the like, he is
indeed expending energy and conducting close observa-
tions, but he also ought to have formulated clearly in his
mind beforehand the precise object of these results and
what use they are in relation to our stock of knowledge
of mental and physical variations in man gained in other
directions. If such a set of measurements are undertaken
to verify a theory established by a substantial number of
facts in human and general morphology, or from the
standpoint of general study of the laws of variation and
inheritance, no fault is to be found. But, on the other
hand, if the investigator does the work at a venture and
says that he cannot predict what startling results may not
come forth from the computations, and has no well defined
object in view except that he expects to hit upon some
generalization from these bald columns of figures, I feel
that it is not a high form of scientific work. It seems a
little like the method that people use in solving mechani-
cal wire puzzles by adjusting and turning them over in
the hands until some one of the random attempts succeeds.

Criminal anthropology is as yet in too early a stage of
development to seize upon the phenomena of its special
field directly by the inductive method. It must first have

l88 CORRELATION OF SCIENCES.

theory, even if faulty, and make a little further progress
on this basis in the marshalling of the facts. From this
induction may be used then further deduction. By alter-
nately passing from the one method to the other slow,
gradual progress can be made. For this is the history of
the first stage of growth of science in general. The facts
lie before us all the time. But in the complexities sur-
rounding the phenomena we are not able at first to unearth
them and to have all at once perfected methods of inquiry
to discover them. The most valuable facts lie beneath
the surface and often defy the most ingenious methods of
exploration. At the beginning, science has relatively
few facts and these lie upon the surface and are obvious.
Theories have to be invented and a modus operandi estab-
lished for the succession of the phenomena from their
antecedents and gradually the theories become more
perfect.

To work out some guiding theories criminal anthro-
pology needs the methods of deduction. In deduction we
invent certain principles in the mind and descending upon
the phenomena verify them to see if they agree with the
hypothesis. In this way facts refractory to control and
experiment, although yielding to observation, may be
brought under the dominion of the hypothesis.

How can this deductive method be brought into play in
criminal anthropology? We have two things to consider,
the mental and the physical variations of psychopathic and
neuropathic elements of the criminal classes, and we are to
get at some principles for the co-ordination and succession
of these phenomena. For the verification of the former set
or phenomena, it seems best to select some opportunity
where the psychopathies are more outspoken and not
complicated with legal considerations, where the process

CORRELATION OF SCIENCES. 189

is proceeding at a faster rate. In other words, it will be
best to select the material with great care.

la some particular phase of the psychopathic process
corresponding to definite sets of psychomotor manifesta-
tions, the components, although difficult enough to analyze,
are far simpler for investigation than the actions of the
psychopathic or neuropathic criminal, complicated as they
are by sociological and legal considerations We should
study, therefore, some very carefully selected case furnish-
ing the simplest and most controllable components in the
process, as, for instance, from the group of neurasthenias,
hysterias, amnesias, etc., or other forms of dissociations
of consciousness Working at such a case from the stand*
point of a coalition of several branches of research on an
inductive deductive basis, we may form some certain con-
clusions as to \Aie modus optramii of \.h.e whole psychopathic
process. These conclusions, increasing in value and truth*
n proportion as we increase the extent of the study
plesof psychopathic disease from which they are
f be then used deductively to verify the phe-
tive or diseased criminal by specialized
a scheme has at least some merit, for
; to method. It has a groundwork
array the external facU

student of criminology

broaden out the mental

their values with other

his gliding principles

ibc continually in mind.

analogy and com-

the time compare

mental pfae-

190 CORRELATION OF SCIENCES.

nomena in the diseased or defective representatives of the
criminal classes with the more outspoken stadia along the
whole pathivay of abnormal mental life. It is particularly
necessary that the study of the psychopathic or neuro-
pathic criminal be made one of the integral parts in the
organic whole of a coalition of sciences — psychiatric and
neurological research. This is the most favorable stand-
point for criminal anthropology to conduct its researches
and make advances.

In regard to the physical variations in the criminal, we
might proceed in the same way as in the investigation of
the mental variations, that is, it will be necessary to
have some principle to start with; some preliminary
guiding idea as a groundwork for the collection and
arrangement of the facts of the physical variation in the
defective or diseased criminal.

Very little, if any good, can be gained by simply investi-
gating these variations en masse y in the way one would use
a net to entrap anything that comes in its way. The
statistical elaboration of human physical variations en
viassc is liable to be of no use to the investigator himself
or to others armed with some working hypothesis of varia-
tion and heredity. If the study of the variations is guided
by some theory of the general operations of variation, even
if the theory be faulty the facts will stand a better like-
lihood of being available, if not at present, at least in the
future, as the general study of evolution finds more and
more adequate theories.

One is not to collect, elaborate and make averages of
measurements of so many hundreds or thousands of crim-
inals because it may have happened that someone else has
made a fewer number of measurements or by a different
method, or because it seems a golden opportunity to fill up

CORRELATION OF SCIENCES. I9I

some minute crevice in anatomical observations. These
things should be done with the distinct purpose of solving
sofne problem in tnan's biological relations^ and the state-
ment of the problem should be deliberately formulated
beforehand. To formulate the problem before beginning
the observations brings out the all-important motive of the
investigation. This motive is the guidance of the obser-
vations from a general study of heredity and variation and
the states and value of the various working hypotheses of
these two subjects. Without the motive the investigator
lacks discipline and runs great risk of going astray and
getting completely confused amid the facts collected.

How shall one find a guiding theory for the co-ordina-
tion of these physical variations among the defective or
diseased criminals? By confining himself to the criminal
alone, it is certainly hopeless to find any guiding prin-
ciple. The facts of variations in man are indeed unique
and highly valuable. Galton, the pioneer in the study
of human heredity and variations, has reached many
conclusions agp:^eing with many points worked out
independently by Weismann, notably in the continuity of
the germ plasm and the weak influence worked on it by
the individual. But notwithstanding Galton's brilliant
work anthropological studies in man alone have and can
never form but an iota of the great drama of evolution,
heredity and variation. Neither man nor any other living
thing is intelligible if taken by itself. The phenomena of
the whole organic realm are so interwoven that they must
be surveyed throughout the whole series. Thus the study
of variations and heredity involves the work in botany,
zoology, paleontology and embryology, physiological as
well as morphological. If, therefore, one would study
intelligently the physical variations of the diseased or de-

192 CORRELATION OF SCIENCES.

fective portions of the criminal classes, he must prepare for
his work by gaining some general knowledge of evolution
and variation and from this select his guiding principles
for the formation of his facts. A difficulty arises imme-
diately, for none of the theories of variation and heredity
are at all adequate. Prof. Osborne points out the fact
that the trend of study of evolution and heredity is now
seeking a more well defined inductive and experimental
basis. And with this established, the unknown factors in
evolution may be brought to light, more probably through
the labors of physiology than of pure morphology.

The questions in evolution have been stated rather than
answered, and, as Osborne says, **we are entering the
threshold of the evolution problem instead of standing
within the portals. The hardest tasks lie before us, not
behind us, and their solution will carry us well into the
twentieth century."

The differentiation of palingenic from cenogenic varia-
tions, of the time zvhen a variation arises in the life-history
of individuaJ^ whether in gonagenic, gamogenic, embryo-
genie or somatogenic periods, and the investigation
of the relations of the ontogenetic to phylogenetic varia-
tions are all factors of fundamental importance and can-
not be cast aside in study of the human variations in
anthropological investigation of the criminal or other
defective classes. In short, he who would pursue the sub-
ject of the physical variations of the defective and dis-
eased portions of the criminal classes must be a student
of evolution and heredity.

And despite the excessive complications of the study of
evolution and the wide range of its inquiry and the
inadequate state of onr knowledge, he must seek some
guiding standpoint from the present working hypotheses

CORRELATION OF SCIENCES. 1 93

in evolution at large, and proceed from it deductively in
the study of pathological elements of the criminal classes.
In this way even if the hypothesis has to be abandoned or
modified in the future, the facts have been marshalled in
an orderly way and are of service for re-elaboration, when
the working theory becomes perfected. Difficult and com-
prehensive as is the study of variations in man in a certain
small fraction of the race as in the criminal or defective
classes, we may, nevertheless, hope that in the course
of the deductive application of some working theory
gathered from the general stock of knowledge of evolution
some light will be reflected back on the general stock of
our knowledge. The greater the number of standpoints
sought after, the greater will be the progress, provided
there is co-ordination with the diverging lines of other
sciences.

While the great length of time elapsing in rendering a
progressive variation continuous, is exceedingly discour-
aging and makes steady research in a particular instance
well nigh impossible, there are opportunities for studies
in man which, although limited, are nevertheless quite
unique. We have in the first place the influence of
experiment on the subject of ontogenetic variations and
their relations to phylogenetic variations. I do not mean
experiments such as can be devised and controlled by the
investigator, but such as are already performed for him,
by disease processes. These are in every sense of the
word experiments of the most beautiful and ingenious
kinds — nature's experiments. In the analysis of the
several stages of formation of ontogenetic variations there
certainly ought to be fine opportunities of research in the
action of toxic agents, or other pathogenic stimuli (also
defective cell food supplies) on the gonagenic variations

194 CORRELATION OF SCIENCES.

as well as on the variations arising during the several
periods of embryonic development. The phenomena of
immunity, predisposition and vulnerability, inherited
immunity, immunity as racial features ought to be most
attractive fields for the general student of evolution.
Furthermore, in man the opportunity is favorable for the
study of repetition phenomena or reversion phenomena as
possibly in the degenerative classes in idiocy, cretinism
and epilepsy. There ought also to be in man material for
attention to the dependence of ontogenetic repetition upon
repetition in the environment and life habit, in contrast to
the connection of ontogenetic variation with variation in
environment and life habit. Particularly valuable would
be the study of generations of delinquents in families, as
in the remarkable investigations of the Jukes family.

The prison often contains inmates fit to be patients in
the psychopathic hospital. Quite likely the psychopathic
processes and certain portions of the criminal classes may
reveal the initial stages of the process of neuron energy
liberation, only here the process is spread out through a
greater length of time. The ebb of neuron energy may
have occurred through generations, and the neurasthenic
phenomena concomitant with unloosening of the highest
constellations of neurons having to do with inhibition, and
the duties of morale and the guardianship of the finest and
noblest of human emotions may occur most insidiously.
The expenditure of neuron energy sinking in the course of
many generations by almost infinitesimal and unnoticeable
descents over the restitution-ascents of energy,* the higher
neuron constellations in some particular man in a series of
generations may utterly fail to develop the mechanism
for elaboration of energy. Hence their parallel powers

* See paper on ** Neuron Energy."

CORRELATION OP SCIENCES. 1 95

will be utterly lacking. Such a man may have no sense
of morality and discipline and his subconscious self may
tend to come out in all its nakedness.

I am not intimating here a transmission of acquired
characteristics, that is that the receding tide of neuron
energy in any individual influences the germ plasm to
any extent. The external causes that liberate neuron
energy in the individual affect the germ plasm simultane-
ously. These causes operating first in the highest and
most unstable neuron may, to. some slight extent, operate
on the germ plasm in a secondary way from the damage
to the neuron constellations. For these being progress-
ively impaired both in extent and degree by the continu-
ance of the external causes the general body forces
(circulation, general metabolism in cellular food supply)
may fall below par, and in this way exert a modifying
influence on the germ plasm. But I prefer to think that
the changes in the germ plasm passing on the continuance
or preparation for the neurasthenia of the next generation
are directly due to the same external causes such as toxic
agents, deficient food supply to neuron that will bring
about an undue liberation of neuron energy. The changes
in the germ plasm are less dependent on the pathological
expenditure of higher neuron energy than on the action
of the same causes that also affect the neuron.

It seems to me that there are points of similarity between
ordinary neurasthenia and the psychopathic conditions of
certain criminal classes. And I think we may take it for
granted that observation shows that some of the criminals
certainly show psychopathic and even neuropathic phe-
nomena. If we conceive that the ordinary type of the
neurasthenic phase of the psychopathic process be
stretched out through a greater space of time, so that it

196 CORRELATION OF SCIENCES.

is exceedingly chronic and insidious, we have a mental
picture of what may be taking place in the psychopathic
criminal and what leads him to do his acts. This is not
a mere speculation, for it is based on the general theory of
neuron energy alluded to previously, derived from a cer-
tain range of facts forming a supporting groundwork.
It is not at all difficult to conceive of the neurasthenic
manifestations and their concomitant phases of the
underlying pathological process as being more spread
out in space and time (through members of genera-
tions) than we ordinarily witness in the symptoms in
the concentrated phenomena in the ordinary form, occur-
ring as an attack in a part of the life-history of the
individual.

I am far, however, from making any sweeping applica-
tion of the psychopathic basis of criminal acts, for who is
to pronounce judgment upon right and wrong, or to give
a standard of goodness in mankind? We can only
look at the extremes, more or less, in delinquent actions.
It seems best to seek out the more outspoken psychopathic
cases in the prisons, and investigate them as comprehen-
sively as possible, under the guidance of the neuron
energy theory. The factor of environment is, of course,
included in the study of the criminal in speaking of the
guidance of the investigation from the standpoint of evo-
lution. Anthropological investigation of this kind of the
criminal, of the delinquent and defective classes may
possibly prove valuable and fruitful. ** Pathological an-
thropology," (by this I understand the study of human
variations from the basis of pathology) is especially de-
pendent for its success on a correlation of sciences after
some such plan as we have endeavored to outline for
psychiatric research. It is hard to see how anthropo-

CORRELATION OF SCIENCES. 1 97

logical investigations of this special kind can make any
headway.

In centres of psychiatric research, criminal anthropology
comes prominently to the surface in the direct and special-
ized investigation of the insane. For many systems of
caring for the insane have to take into consideration the
criminal insane and the insane criminal. In our own
system, for instance, there is one special hospital set
apart for the criminal insane. Here is a most valuable
opportunity for getting at the borderland between the
psychopathic criminal and the insane classes. Here is a
class where the descending process of neuron energy
liberation is outspoken and comes obtrusively to the
surface. From this pivotal point the investigation should
work in two directions : upward along the psychopathic
channel toward the initial stages where the process
approaches normal mental life, and downward in the
abnormal mental life into deeper and deeper levels of
insanity, both neuropathic and organic.

It seems to me that the hospital for the criminal insane
offers the most absorbing and fruitful field of work for the
anthropological psychiatrist. The differentiation between
the criminal insane and the insane criminal seems to hinge
upon a very insecure scientific basis. It is simply a
question as to when the insanity was detected ; if the indi-
vidual committed a crime and there is insanity detected he
is an insane criminal ; if his insanity is first detected and
then the crime is committed, he is a criminal insane. Both
are of the same order, and their difference simply depends
on the thoroughness of the examination. This distinction
is therefore an arbitrary one. Further researches are
greatly needed in the criminals exhibiting psychopathic
phenomena. The diseased or defective criminal should

igS CORRELATION OF SCIENCES.

be studied by the methods of psychology and psycho-
pathology.

In regard to the inter-relation of the abnormal mental
phenomena or mental variations with the physical varia-
tions, caution must be used lest one stumbles into
pitfalls of error, and allows the fallacies of the simple
method of enumeration to insinuate themselves into the
elaboration of the facts. If one starts out with the idea
that the mental departures in the criminal are in some
way linked with the physical variations, both operative
from a common cause or set of causes, it becomes easy to
support the idea by collecting the instances which support
the theory, and overlooking those which contradict it.

In statistical elaborations especially, this tendency to a
greater or less degree, is often prone to occur. Among
a large body of criminals the relation of physical varia-
tions to initial psychopathic phases might gain undue
weight, unless we ascertain how far possibly the same set
of variations may also occur in non-criminal classes, not
asHOciated with any psychopathic taint.

It might seem theorizing in advance of the facts that
errors in the molecular structure of the germ plasm would
first tell on the most supremely organized parts of the body
(the highest congeries of the neuron constellations in the
frontal lobes) without showing defects elsewhere in the
body. It would seem that defects in the highest parts
of the nervous system might occur without correspond-
ing defects in the body. Conversely morphological de-
fects in the body of any considerable degree would connote
defective brain development. Facts show, however, that
this may or may not be the case. F6t6* has shown
experimentally, that certain influences (noxious vapors,

* Bulletin de la Soci^t6 de Biologle, 1896, p. 790.

CORRELATION OF SCIENCES. 1 99

mechanical vibrations) harmful to development if applied
in a certain degree, may be favorable when applied in a
lesser degree. Thus it seems that agents capable of
exerting an influence resulting in an arrest of growth
in one part may in the total development produce
a superior individual. What is a drawback in one part
may be a gain to another. Thus, some individ-
uals with partial defects, have a remarkable general
constitution. Hence, one often sees great minds dwell-
ing in frail or ill-formed bodies. On the other hand, the
agencies which we may imagine of a kind similar to
those studied by F^r^ experimentally in the egg, may
be of such a degree of intensity (auto-intoxications of the
pregnant mother, other toxic and pathogenic agents and
disturbances in the cellular food supply brought to bear
from the mother to the foetus) as to cause retardation of
development without compensation in the nervous system
or elsewhere. In this way weak individuals would be
bom without any saving graces. According to these ex-
periments the matter hinges on the intensity of external
agents.

F^r^ notes in harmony with his line of thought that the
most civilized nations are distinguished by the number of
extremes and exceptional beings : men of exceptional men-
tal power, geniuses, and others intellectually and morally
pervert. These latter are so because of deficient energy
of the highest spheres of the brain unveiling in periods of
time spread through a single individual or throughout
generations the subconscious self which Sidis characterizes
as ** cowardly, brutal, credulous, suggestible, and devoid of
all morality and conscience. ** These variations discussed
by F6T6y however, are to be carefully distinguished from
the reversions or repetitions of variations. The inter-

loo

CORKEtATION OF SCIENCES,

^^t responde

^^1 pression!

^^^^^^ recent

relatioQs of the physical and mental variations are enor-
mously complex, but with what is known of the laws of
mental life, heredity, and variations, or with such
approaches as have been made toward these laws by psy-
chology and the study of evolution to guide the research,
we shall go less far astray by restricting the investiga-
tion to the criminal and endeavoring to find guiding
theories in the restricted sphere of criminal anthropology
alone.

It is somewhat customary in examining from time to
time the status of a science and regarding its future
progress, to look back into its past history and to go out
of one's way by quoting selected passages from older ob-
servers, to show that they had premonitions of the knowl-
edge of the present day. These retrospects are exceed-
ingly interesting, but in most cases they are hardly worth
the while, for in the past fifty years in many sciences the
knowledge is quite divergent, and indeed is often totally
different from that of the preceding periods. The reason J
is, the methods of investigation are now totally different;
they are more exact and of more extensive scope. The
past of criminal anthropology is interesting, however, for
it shows that the subject is worthy of a division of labor
in the community of sciences, and should be given the
attention of a distinct science of its own. There has
been a steady growth leading up to the formation of
the science of criminal anthropology and its pedigree is
quite old.

Plato and Aristotle made studies of physiognomy and
attempted to work out the physical and psychological cor-
respondence of the passions of men and their facia! ex-
iressions. From these early studies to comparatively
times there have been numerous attempts to estab-

CORRELATION OF SCIENCES. 20I

lish a relation between certain physical (anatomical) con-
ditions and abnormal psychical states. As a result, how-
ever, of the isolation of these investigators and their
dependence on speculations in lieu of adequate methods
of studying facts their studies present much repetition and
consequently useless work. Notwithstanding this it is
possible to trace in these and later works a gradual growth
and a steady advancement which forms the basis of our
present view of the unstable classes. Upon these works
criminal anthropology was founded.

The study of the criminal has not leaped into a sudden or
distrustful existence, but has behind it the momentum of
centuries of thought along the idea of the linking of man's
physical and mental variations. The study of physiog-
nomy was revived by the Jesuit Niquetius, by Cortes,
Candamus, De la Chambre, Delia Porta, etc., who were
the precursors of Gall, Spurzheim and Levator on the one
hand, and on the other of the modem scientific study of
the emotions with their expressions, in face and gesture,
conducted by Camper, Bell, Engle, Schaffhausen, Schack,
Heiment, and above all by Darwin. Gall's theories were
applied in the examinations of criminals by Lauvergne
(1841) and Attomyr (1842), but they carried the figments
of phrenology to the extreme. DeRolandes (Italy, 1835)
published observations on a deceased criminal; Sampson
(America, 1846) tried to trace the connection of criminal
phenomena and cerebral organization ; Camper (Germany,
1854) published a study on the physiognomy of murderers,
and Lallement (1858-1862) published a long work on crim-
inals from a psychological point of view. The science
of criminal anthropology, strictly speaking, only began
with Forbes Winslow (1854), Mayherr (i860), Thompson
(1870), Wilson (1870), Nicolson, Maudsley (1873) and the

202 CORRELATION OF SCIENCES.

notable observations of Despine (1868) and finally of
Lombroso.

Since 1876 a number of writers have published valuable
additional studies of the criminal, and have established
the fact that indications of psychopathic and neuropathic
processes frequently appear in individual members of
this class. Experience also demonstrates that quite a
share of crimes are committed by persons who are insane
in the ordinary acceptance of the word, or at least who may
be said to have the prodromata of insanity. In addition
to the prison we have in mind the extension of anthro-
pological work in the reformatories among the refractory
and delinquent juveniles, the epileptics, the deaf and
dumb, and the blind, or secure co-operation in work from
those having charge of these classes. Among the idiots
the work ought also to be very promising, and throw light
upon the modus operandi of this effect, and especially
upon their classification, unless this has been worked
out satisfactorily by such investigators as Sollier, Peter-
sen and Ireland. One quite certain indication of the
increasing momentum of the study of criminology and
allied subjects is the appearance of special journals on
the subject. Germany and Italy each have a journal for
the dissemination of the accumulating knowledge on this
subject.

The great difficulty encountered in this investigation is
the selection of a normal standard whereby to measure the
abnormal departure. In this country where the population
is so hetergeneous, we are immediately confronted by the
difficulty of finding a standard race type to measure by,
and in fact we can find no absolute standard. Only a
standard varying between certain small limits can be
used. We also hope by means of this department of

CORRELATION OF SCIENCES. 203

anthropology to study the phenomena of deterioration in
the criminal and in the epileptic.

Immediate results can hardly be expected from this de-
partment. The amount of work falling within the scope
of anthropologfical investigations of the early phases of
insanity is .stupendous. It can only be done little by little,
and must grow and develop in the course of years. Any
work along these lines such as previously indicated, to be
of any value whatsoever, must be most carefully planned.
It cannot be forced along with undue haste. One must,
therefore, ask patience in expectation of results from this
branch of investigation, the more so, since there is no
well defined and no established precedent to follow.
The work is of a pioneer character, and this as a rule
meets with failures, and often has to begin over again,
profiting by its mistakes, and has frequently to readjust
its plan and methods of work. From time to time
results may be published as to the progress of this
department, but they cannot be had all at once.

A very interesting piece of work now in progress in the
department of anthropology is a study of the correlation
of the mental and physical growth of some young boys
in a disciplinarian school. This has been undertaken in
conjunction with Doctor Downing, of Brooklyn, N. Y.
Fortunately we have an opportunity of studying these
boys for several years, in order that we may fully record
the relationship of psychical and physical growth, and
also identify those among them who tend to deflect into
the pathway of degeneracy. In short, the main object of
the department of anthropology is to identify and study
by means of scientific methods the degenerate, the
candidates for the prison, the reformatory and asylums.
It must be seen how important is some attempt at gaining

»04

CORRELATION OF SCIENCES.

a coherent knowledge of the insane before they make
their way into the hospitals. When this is known, it is
bound to be of practical benefit and yield economical
returns by instituting some form of control of insanity
before it reaches its more hopeless stages.

In brief, one prominent purpose of anthropology at the
Institute is to ascertain the proportion of cases of insanity
occurring in normal individuals, in individuals who have
no hereditary predisposition toward insanity — and to
compare this proportion with the other cases of insanity
complicated with or resulting from hereditary predisposi-
tion. For in the former class of cases insanity is more
or less of an accident, and in the great majority of
cases recover)' is to be expected; whereas in the latter
class with predisposition recovery is much less liable
to occur. The determination of tfiis question is most
important.

The instruments required for this department are com-
paratively simple and inexpensive. It has apparatus for
testing the acuteness of the senses and sundry instru-
ments for physical measurements of the human body;
two instruments to measure the diameter and contour
of the skull, one in duplicate for the use of the State
hospitals; measures for determining the cubic contents
of the skull; a stereograph for tracing contours and
profiles of the skull, and an anthroporaeter used for
taking general measurements of the body.

We hope in the course of time to make a collection of
skeletons of the insane, in order to study the stigmata of
degeneracy in the osseous system. These skeletons can
be exhumed without much expense, after the cadaver has
remained in suitable soil for two or three years.

The anthropological institute at Paris is very pnmd of

CORRELATION OF SCIENCES. 205

the collection of the complete skeletons of thirteen epilep-
tics, because their histories and behavior during life are
accurately known. Seeing that the histories of our
patients at the hospitals are scrupulously kept, we ought
to be able in the course of time to have one of the best
collections in the worid for studying the osseous systems
of epileptics, criminals and lunatics. The value of this
collection does not lie in the fact that it is a mere con-
glomeration of bones, but that it should be possible to
study each skeleton in connection with the life-history of
its possessor.
The department is in charge of Alois Hrdlicka, M. D.

Chapter XIII.

THE UNCLASSIFIED RESIDUUM.

In concluding these remarks on the correlation of
several branches of scientific research in the investigation
of the life- history of insanity,* a paragraph from one of
Professor James' essaysf is most appropriate.

**The great field for new discoveries,'* said a scientific
friend to me the other day, **is always the unclassified
residuum. Round about the accredited and orderly facts
of every science there ever floats a sort of dust cloud of
exceptional observations, of occurrences minute and irreg-

• It should not be considered that a centre of psychiatric study, such as the
Pathological Institute of the New York State Hospitals, has overreached itself
in bringing unnecessary or irrelevant departments of science to bear upon the
problems of psychopatholo^y and psychiatry, or that in taking a stand against
the restricted study of insanity it has gone to the opposite: extreme in too
greatly diversifying this research The fact that there is no assistant in psy-
chology and psychopathology, that there is but one associate for the whole
comprehensive department of pathological anatomy, and that there is no rep-
resentative for the department of normal histology of the nervous system nor
for experimental pathology and hsematology, shows that this projected plan of
the correlation of branches of scientific research in insanity at this Institute
is still not completely developed.

t **The Will to Believe and other Essays in Popular Philosophy," p. 299.

2o6 CORRELATION OF SCIENCES.

ular and seldom met with, which it always proves more
easy to ignore than to attend to. The ideal of every
science is that of a closed and completed system of truth.
The charm of most sciences to their more passive dis-
ciples consists in their appearing, in fact, to wear just this
ideal form. Each one of our various ologies seems to offer
a definite head of classification for every possible phenom-
enon which it professes to cover; and so far from free is
most men's fancy, that, when a consistent and organized
scheme of this sort has once been comprehended and
assimilated, a different scheme is unimaginable. No
alternative, whether to whole or parts, can any longer be
conceived as possible. Phenomena unclassifiable within
the system are therefore paradoxical absurdities, and must
be held untrue. When, moreover, as so often happens,
the reports of them are vague and indirect; whether they
come as mere marvels and oddities rather than things of
serious moment — one neglects or denies them with the
best of scientific consciences. Only the born geniuses let
themselves be worried and fascinated by these outstanding
exceptions and get no peace until they are brought within
the fold. Your Galileos, Galvanis, Fresnels, Purkinjes,
and Darwins are always getting confounded and troubled
by insignificant things. Any one will renovate his science
who will steadily look after the irregular phenomena.
And when science is renewed, its new formulas often have
more of the voice of the exceptions in them than that of
what were supposed to be the rules."

Surely from the scientific standpoint the disordered states
of consciousness in insanity form a very large *' unclassified
residuum." In correlating the branches of sciences we
have avoided the danger indicated by Professor James,
namely, the restriction of a branch of science to some

CORRELATION OF SCIENCES. 207

fixed and narrow limits of observation. If a branch of
science be thus restricted it soon becomes walled up within
itself. It travels in a rut, repeats its old observations over
and over again, trying to make them appear new by merely
setting them forth in new words, or what is still more de-
ceptive, marshalling and exhibiting them in diversely
colored plates of differently stained sections; it finally
becomes worn out and mummified. On the other hand, if
a branch of science seems to be nearing the limits of its
capacity to formulate new generalizations, when it seems
to have completed its possible activities in presenting the
ideal ** closed system" of truths to which there seems
nothing to add, such a science, when extended to the outly-
ing domain intervening between a sister science, may have
to begin its investigations all over again in a new and
broader light. Modern specialization among the branches
of science is creating gaps and clefts zuhich contain more
important fields for investigation than the individual de-
partments of science themselves. He who can bridge over
the rifts between the border lines of several of these
sciences will discover the richest domains of investigation
and gather in a good harvest of scientific truths. // is
the value of the domains between the various medical and
biological ^^ologies" when guided by psychology and psycho-
pathology that we have endeavored to bring into prominence
in the study of insanity.

Chapter XIV.

THE FUTURE OF PSYCHIATRY.

We have pointed out some of the natural shortcomings
of psychiatry, inevitable in the evolution of its progress;
we must now behold the greatness of its future. It would
be a carping and disrespectful form of scientific Use

2oS CORILKLATION OF SCIENCES.

majeste to point out the shortcomings of psychiatry as a
stigma on the name of the science^ for it is truly destined
to be the most majestic of all the biological and medical
sciencesw

The shortcomings of psychiatry only serve to show the
greatness^ comprehensiveness and difficulties of the science.
The other sciences in medicine and biology are elementary
beside psychiatry. They are but stepping-stones to psy-
chiatry and psychology. For the two are synonymous
in studying the abnormal phenomena of consciousness.
P5>ychiatr\- should never be so narrowly viewed as being
tied down only to insanity, it also deals with abnormal
phenomena of consciousness in general^ the domain of
psychopatbology. The study of abnormal manifestations
of conscioui>ness presupposes some knowledge of normal
psychology while at the same time it is the only key to
an understanding of normal mental phenomena.

It is not strange that psychiatr>\ the most difficult and
comprehensive ot all medical and biological sciences, has
been one of ibc last to begin its scientific progress. Psy-
chiatry has not lagged behind of its own accord: it has
been held back and had no choice but to wait until its
stepping-stones might be built. It has had to wait for
the growth of psychology in general and psychopatbol-
ogy in particular; it has had to wait for cellular biology,
pathological anatomy, neural anatomy, and their affiliated
branches of research to attadn sufficient development to
cope with the difficult problems of psychiatry. Psychiatry
for the short history of its existence has done its utmost
with the imperfect methods at its disposal, and is now
looking for new methods to fertilize its soil, highly fruitful,
but difficult to till. When it is perceived how far the
subsidiary sciences have had to develop before attaining

CORFELATION OF SCIENCES. 209

the capacity to be of service to psychiatry, we can gain
some idea of the eminence of psychiatr}' among the
medico-biological sciences.

Psychology, psychopathology and psychiatry are des-
tined to form the loftiest pinnacle of the temple of
science. The scientific story of the rocks holds one
spell-bound; the history of the egg or the mechanism
of a tiny organism have their fascination; mathematics
and the laws which command the courses of the stars are
awe-inspiring, but none of these sciences or their allies
have the grandeur or are so deeply and essentially human
as the three sciences — psychology, psychopathology and
psychiatry — for they unveil the greatest marvel of the
universe — ^the human mind. Well may we say with the
great Scotch philosopher: " In the world there is nothing
greater than man, and in man there is nothing greater
than mind." A knowledge of mind, both in its normal
and abnormal manifestations, is the science of sciences.

The common run of neurologists and pathologists, in
their mistaken nature of the true function of science, lose
more and more sight of what lies beyond their microscopic
field of vision. What is still sadder, they are absurdly proud
of their narrowness, making a virtue of their shortcomings;
their ignorance is as great as their conceit is infinite.
They highly value the process of groping aimlessly in the
dark for new details. All explanation, all rational inter-
pretation, is shunned as a pest, and under the stigma of
** theory" is kept in abhorrence; all comprehension of
phenomena, all generalization, is branded by the name of
•* metaphysics " and is sneered at, and ridiculed, and held
in contempt. The more meaningless, the more inexplica-
ble a detail is, the more is it treasured and valued as a
** good fact " purified of all extraneous dross, such as reason

and understaoding, which are branded as a vice, as
"theory and metaphysics." And yet these very neurol-
ogists, histoiogists and pathologists who suffer from intel-
lectual photophobia or phrenophobia are the worst type
of dogmatists, the least intelligent class of unconscious
metaphysicians, inasmuch as they revere only the chaotic,
the irrational and the incomprehensible. It is only the
best thinking men among them who begin to look for
light and for a broad horizon. The psychiatrist, on
the contrary, by the very nature of his studies, is forced
more and more to broaden out the basis of his science.
Nothing short of a co-operation of all the medico-biplogical
and psychological sciences is what psychiatry requires.
The enlightened psychiatrist looks for an organisation of
the dispersed and dismembered parts of medical science.
Medicine has usurped the psychological guidance of
psychiatry altogether too long.

Fortunately this enlightened spirit found a foothold in
the Commission and the representatives of the New York
State Hospitals, and for the first time in the history of
science was an Institute established on a broad scientific
basis, an Institute whose aim is to till the field of psy-
chiatry by means of instruments and methods obtained
through an organized federation of the most important
and most vital branches of biological and psychological
sciences. Such a federation is not only indispensable to
the growth of psychiatrj-, but is also most essential to the
development of biology, psychology and exact medical
knowledge in general. Men of science ought to be grate-
ful to the psychiatrist for the mere fact that he is the first
to call for a general unified activity of many branches of
science. For unification means generalisation, the dis-
covery of laws, the true aim of science.

CORRELATION OF SCIENCES. 211

PART III.

Chapter XV.

FACTS AND THEORIES IN MEDICAL SCIENCE.

When a scientist ventures into foreign fields, he can
return to his own particular territory with new and broader
ideas and recast his whole trend of observation; he
becomes possessed of the power of larger guiding princi-
ples; he has the great advantage of guiding his work with
discrimination and of seeing what is essential, passing by
what is accessory; he sees better through the relation and
interdependence of things instead of trying to hit upon
them by shuffling the facts about; he has a discontent
with the scope of his former work and seeks to look
further beyond the proximate into the remote. Such a
spirit of discontent is the watchword of progress in science.

Meanwhile the venturesome traveler must expect dis-
trust from those who are working in these other fields ; for
both they and he know that only the crust and the surface
are being inspected by the outsider who can have no
grasp of the depths and the details. On the other hand,
he must also expect to be openly or secretly discredited
by his colleagues who remain at home quietly working
out their results, and must also expect to be looked upon
as having fallen behind in the ranks, because he left the
work desk and the machinery idle for the sake of reflec-
tion. He is liable also to fall under the stigma of having
been affected by unsound ideas; and although this should
entail caution, it is not to be held in excessive appre-
hension. Altogether the task of broad generalization
and correlation is not inviting, and, besides, the great
labor, the distrust and opposition met with, make one

ZIS COKRELATIOK OF SCIENCES.

averse to ondenake such a work. If the journey be at all
extensive, it will indeed be strange, if one does not return
with a burdensome sense of oppression at the vaslness of
what lies before him in other strange pathways. The
pioneer in science may feel like Humboldt bewildered at
the fathomless depths of nature, not knowing where to
pick up the guiding threads for explanation.

In this cursor}' glimpse of a few departments one
cannot help feeling great dissatisfaction with the way
the subject of the importance and value of correlation
in psychiatry has been presented. Many points of im-
portance have been barely touched upon and others have
been entirety omitted. Yet no such vast plan was ever
entertained of attempting a comprehensive sweep of so
many sciences. The attitude has been to look at the
borderlands of the branches of research, to glance at tbeir
confines and at their points of coalescence, and from this
to gather ideas, guiding principles and methods whereby
psychiatrj- might open a new pathway. With some key,
some broad idea derived from a study of consciousness
and fortified by some psycho- physiological principle, we
work deductively and use the phenomena in psychiatrj-
for verification. In this deductive process these several
sciences would also be of use in the verification in their
several bearings on abnormal mental life and also reflect
light on the theor\- from an inductive standpoint.

A thing that has augmented the dissatisfaction with
this writing almost to the point of discouragement is
that certain matters have been accorded a prominence
[ and emphasis which in a little while will surely seem
I obvious. It may be, however, that what seems exceed-
ingly elementary in some places, as befits a discussion of
f this character, is somewhat balanced by being interwoven

CORRELATION OF SCIENCES. 213

in Other places with ide'ks that are not wholly superficial.
I think also that in a little while they who secretly and
openly discredit such an ideal, because it has not fallen
into the conventional and hopeless groove, will be the
very ones to take the whole plan of the correlation of
sciences in psychiatry for granted, as an indispensable
and obvious means of progress, as is usually the case with
all departures from the beaten track. Yet at this par-
ticular time one finds it necessary, elementary though
as it will appear a few years later, to defend the use of
the several branches of research in their correlation and
organization for the benefit of psychiatry.

One may get suggestions of deep application and
pivotal points to work out brilliant theories in disease
process by reflecting on the analogy of the human com-
monwealth of cells with the social organism. Take out the
factor of correlation and interdependence of the parts,
and progress stops — the organism, social, living or scien-
tific, falls to pieces. Restrict psychiatry to the microscope,
and it is impossible to gain the momentum and power of
the correlated sciences — aside from the fact that from the
very nature of microscopic research, it is not even on the
right road to solve the problems of abnormal mental life.

At one moment psychiatry is taken to task, because it
does not progress, at the next moment, because it does
attempt progress. The attitude is absurd, yet unfortu-
nately on the ground of expediency, it is also to be feared.
It is to be feared, because it measures the work of an
institution of this kind by the false standard of simple
mechanical fact-gathering mainly through pathological
anatomy. This is unfortunate, but it cannot stay the
progress of psychiatry. Progress in psychiatry is bound
to come, it is inevitable.

314 CUKKELATION OK bCtb^NUtS.

There is a great difEerence between "work in science"
and "scientific work." In "work in science" mechanical
work is at a maximum, and reasoning at a minimum;
in "scientific work" the reverse is the case. Shail work
in pathological anatomy and bacteriology remain the main
avenue of scientific psychiatric research ? Shall we have
men satisfied with the act of pouring forth into the already
swollen streams of literature desultory microscopical de-
tails, the real task, the true aim of science, being left
undone? Is there not already enough of such work, in
medicine, or is the work to create what might seem an
admirable spirit of emulation by detailed description of
minuteness outdoing the devils of whom it is said that
some twenty thousand can dunce on the point of a needle
without causing the least frictionf We do not get explana-
tion by miniaturing the problem. If the microscope could
get down to still smaller particles the same old question is
still on hand, as to why the particles dance and what
makes them dance.

What becomes of many of such descriptions after they
are discharged into medical or psychiatric literature?
After the first ephemeral notice is passed, they are shelved
with the rest of the lumber to be dusted off occasionally,
when someone else ou a like errand compares them with
his own results showing wherein he agrees and also
wherein he disagrees. The title of the work also adorns
its appropriate line in the bibliographical annex of other
papers.

When the collection of facts is to be made use of,
observe what is done by the man of ideas. He quietly
appropriates the work and puts a valne on it. Armed
with a play of the imagination, he makes a mental
elaboration of the facts; interweaves them with theory.

CORRELATION OF SCIENCES. 215

Meanwhile from the men of facts a storm of disapproval
comes. They are grieved, because they think they
have done the real hard work and a marauding theorist
has plundered them of it. What aggravates the matter
is that the man of ideas seems gifted with a strange and
vexatious ingenuity of eliciting what he can make use of,
what fits in and dovetails with his ideas.

Often, however, perhaps as a rule, the desultory ''new"
facts collected by the "workers" remain in their chaotic
and worthless state, — they cannot be utilized by the man
who works from the standpoint of ideas and theories.
This is because when facts are described and catalogued
by the workers, that which is frivolous, inconsequential,
and accessory, is given just as much weight as that which
is essential and of pivotal value to test a theory. The
worker cannot separate the indifferent from the essential.
How can he appreciate the essential without knowing
what he is striving after or not having any idea of what
he wants to prove and solve? In pathological anatomy,
for example, is there not amid the plenty of facts a
dearth of ideas? Do we gain, for instance, anything by
saying that in hyperplasia the tissue grows, because the
inhibition to growth is removed? This subterfuge does
not explain anything. And yet the phenomenon has a
deep significance when its explanation is realized in the
light of a broad range of thought.

The students of pathological anatomy make a mistake
in studying man by himself and as a species discontinuous
from other forms of life. The study of an animal is
not intelligible when the animal is taken by itself, away
from its environment, out of its place in the whole range
of animal life. If medical men have fallen into the
habit of believing that the microscope is the guide to

3l6

CORRELATION OF SCIENCES.

medical science and that pathological anatomy is the
great and main line of investigBtion, must psychiatry
also follow suit, or rather, remain in the same rut? If in
medicine the idea is prevalent that descriptions of the
facts of abnormal structure accomplish the main aim
of scientific research, must psychiatric study be dis-
couraged, because it would abandon this delusion? In
science the influence of the beaten track must not
arbitrarily repress that which departs from it.

It is very sad to find that some medical men, men who
ought to know better, are under the delusion, prevalent
only among the least educated classes o£ the profession,
that the main point of science in general consists in
recording facts in pathological anatomy and bacteriology.
The same thing is expected of psychiatry and all original
research work that does not follow the beaten track of
medical science is abused and decried. But how will the
advance of psychiatry be attained by recording facts in
pathological anatomy? To attempt to make the study of
pathological anatomy the guiding motive of research in
the phenomena of abnormal mental life is a snare and
delusion, sheer folly.

The demand to throw out on the would-be scientific
market a mass of incoherent facts, as if it were accomplish-
ing the real work of science, is unreasonable. Dumping
facts into so-called scientific medical literature would
have been an easy and simple matter. Indeed, a great
number of facts have been gathered at the Institute
by a great variety of methods. The brain has been
thrust into the crucible and its ashes determined, it has
been rended with acids and alkalies, it has been preserved
in many fluids and stained with many dyes, giving
rise to many plates with diversity of color; guinea pigs.

CORRELATION OF SCIENCES. 21 7

monkeys and rabbits have had their share of toxines
and bacteria; in fact it appears that the particular demon
presiding over a certain form of meningitis has been
caught, registered, put in the culture tube, and given
a proper place among his associates in the bacteriological
collection. Yet how does the mere statement of all these
facts in any way explain the phenomena of insanity?
Which is it best to do? Pour out these facts into the
literature just as they are found, or attempt to co-ordinate,
arrange them in harmony with theory, and endeavor
to see their relation to the problems of abnormal mental
life? We have endeavored to maintain a higher ideal
than to record facts blindly.

The aim of this Institute is not to collect blindly and
irrationally masses of incoherent facts and of confused
new details, the cherished ideal of the school or rather of
the crowd of the so-called scientific ** workers." The
Institute is a scientific centre and as such it aims to cul-
tivate science in a rational way making use of inductive
and deductive methods, guided by theor}% hypothesis and
speculation; it works at facts in order to solve a prob-
lem, in order to make use of the facts and not merely to
collect them without separating the chaff from the kernel.
The facts collected, whether of our finding or discovered
by others, arc as far as possible governed by guiding prin-
ciples, broad theories, theories consistent with the body of
knowledge gained in other directions. If the study of
facts is not guided in this way, it is hard to see, no matter
how fine the details and how close the observation, how
such blind recording of facts can possibly avoid confusion.
On the other "hand, one must fully understand the danger
of ill-founded speculation, of speculation wrought out of a
limited and specialized range of obser\'ation, of speculation
announced without sufficient verification.

2l8 CORRELATION OF SCIENCES.

Some medical men have queer notions of the mean-
ing of **work" in science. In all other walks of life
work must have a definite purpose — only in science work
should be done blindly, without any aim, work for the sake
of the work itself. If in life we require understanding of
the work and knowledge of its purpose, the purpose guiding
the work, why should ignorance of purpose be considered
a virtue in science? Are blindness and ignorance special
attributes of medical science? Most certainly not.

In this age of feverish activity hundreds and hundreds
of men are working in an almost delirious haste in labora-
tories scattered all over the civilized globe to obtain
priority of recognition in the discovery of new facts.
Great masses of desultory, fragmentary, inco-ordinated
descriptions of facts are recorded in scores of specialized
journals. Even in the same laboratory men are working
side by side and still independently isolating their fields
of inquiry. Their chief aim seems to be to find something
that no one else has worked upon, in order that it may be
neu'y however insignificant it may be otherwise. Most of
all, instead of suspecting where to find the new facts by
premeditation, they expect to hit on them by the doctrine
of chance, by straining everjrthing that comes along in
their nets in the hope of finding something new that may
be described. The chief ambition of these workers in
science is to dump into the literature four or five times a
year a mass of inco-ordinated facts. Surely it were better,
if the energy expended in this haste and hurry of announ-
cing and recording details were employed in co-ordinating
the facts before publication.

In the midst of all this, is it not well to pause and reflect
that in the feverish fact-collecting activity we run the
risk of losing sight of the true aim of science? Students

CORRELATION OF SCIENCES. 219

are too prone to take it for granted that the aim of science
is fnlfilled by the mechanical labor at the work desk and
dexterity with technical methods; they are often absolutely
innocent of the true aim of science, namely, generalization.
Science seems to be a race for new details, and when
these are found the inquiry is at an end. Bacteriology
has joined in the game with pathological anatomy,
and the prize is given to the man who can catch a
new devil, presiding in tutelary fashion over some dis-
ease entity, and bottle him up in the culture tube. To
identify the proximate causes of disease is of enormous
value from the standpoint of utility, but one must not
deceive himself in thinking that this explains the process,
the modus operandi of abnormal function.

Pathological anatomy has more need of neiu theories t/ian
of new facts. I hope this intimation that pathological anat-
omy is making the mistake of thinking that fact-gathering
fulfills the true aim of science does not seem hast>% or reck-
less. Among the several branches of science reviewed, I
feel less utterly confined to the surface of the inquiry of this
department, and, thanks to my master, I have also had the
opportunity of having some insight into its philosophy.
Hence reflection over its deficiencies does not warp
the vision of its strength, its scientific d:gn:t>-. and its
achievements. But these achievements must not blind
us to the fact that science does not make progress by stiidy-
ing proximate causes only: nor are we to fall into the habit
of believing that unreflective observation, no matter how
close, or voluminous, fulfills the true purpose of sdenoe.
There must also be the reflective formulation of the
observations. To find truth, to discover law, thought and
reflection must be used.

I do not mean to say that pathological anatomy has no

220 CORRELATION OF SCIENCES.

theories. It uses deduction in its own special line of in-
quiry; and this is iust the trouble. The theories seem
well grounded, if surveyed by the narrow extent of territory
from which they are drawn, but when tested by a wider
range of thought, they are inadequate and even absurd.
The theories are derived from causes which lie too adjacent
to the effects. Hence the pathological anatomist is con-
tinually turning out new facts which he cannot make use of.

Some of the pathological anatomists have not the first,
most elementary notion of the purpose of science, namely —
generalization of facts and deduction of laws. Many so-
called scientists are only concerned with getting the facts
catalogued. Pathological anatomy is in much the same
condition that biology was before Darwin's time; like
pre-Darwinian biology it consists of an appalling mass of
facts, piled up by hundreds of men working in many in-
dependent, highly specialized fields, all striving to get
hold of " something new." Instead of being properly co-
ordinated before being published, all this is thrown into
the literature just as it is fresh from the work desk.
What a great opportunity it is for some one with grasp
of mind to enter the field of pathological anatomy with
a great general co-ordinating principle to unite these scat-
tered facts and give them their appropriate theorectical
valuation. Such a man can spare himself the trouble of
delving out new facts. He may have to go, occasionally,
to the laborator>^ desk, but then it will be with the distinct
purpose of seeking some pivotal fact ; some crucial experi-
ment to test his theory.

The pathological anatomist has not only fallen into
the mistake of thinking that his science consists of mere
purposeless fact-gathering, but he is also leading general
medicine astray. Pathological anatomy and especially

CORRELATIOX OF SCIENCES. 221

icieriologv from their lack of broad theories, instead of
correcting^ the mistake, have only helped to confirm
z:edica! belief in the erroneous conception of the
of disease. Diseases are looked upon as entities,
fadrriCTialities, specific things, each with its specific cause
oc set of caoses. Contentment with this idea of the prox-
imate cause of disease simply wards off inquiry for wider
gerieralization of thought. The narrow views of patho-
logical anatomy and bacteriology dominate too much the
wboie trend of scientific medical thought.

Pathological anatomy, setting too much store on the
si32pk: task of obser\-ing and gathering facts and too
Hrile on ascertaining their significance, and general medi-
cdse^ looking too much to this branch as its guide, it
wouid be strange, if medicine did not come to be more
coofirmed than ever to look upon this '' collection " work
as the true standard of scientific research. So indeed it
has happened. In medicine it is taken for granted that
aH of its branches should conform to the same standard
tzA conduct its researches after the example set by
^Kttho'.ogical anatomy. For pathological anatomy and
bacteriology have done grand service for the art of medi-
cine. It wou:d also be strange, if under this medical
co^icjeption of science, theory and speculation were not
greatly distrusted. This is also the case. Attempts to
theorize ar^ not infrequently held up to ridicule and
•com and cons dercd prejudicial to the advance of science.
It is. certainly unfortunate that in medicine art is gliding
scsenoe.

We go on discouraging theory- and speculation, and yet

this is the s^/ul of science and the mainspring of its prog-

rett. We go on warning each other against philosophy

in iKrience, yet without philosophy there is no science.

22 2 CORRELATION OF SCIENCES.

Johannes Miiller says of physiology that without philos-
ophy it is no science at all. We must, however, remem-
ber that men naturally fall into two classes. By far the
greater number have minds that can only concern them-
selves with the adjacent and the proximate. The syn-
thetic mind that looks above and beyond the immediate
and the surface of things is unfortunately a rarity, a form
of genius. We should encourage this form of genius and
provide suitable environment that it may thrive. We go
on discrediting those who come from foreign fields of re-
search to work in our own particular territory, yet I think
we ought to welcome these outsiders who come to look
over our facts and take a comprehensive glance, per-
haps, not a profound view of our work, as they are often
better equipped to theorize over our facts than we who are
deeply immersed in some fragmentary, dismembered part
of our science.

Chapter XVI.

THE PATHO-ANATOMIST AND THE CLINICIAN.

The great science in medicine is general physiology and
pathological physiology in particular. It is in biology, gen-
eral physiology and psychopathology that the philosophy of
medicine is to be sought. Function presupposes structure.
If we would understand disease, we must naturally study
the living phenomena. This the clinician does, and the
scientific clinician is in fact a physiologist and psycho-
pathologist, for he studies function. And he is in a far
better position to perceive the great gliding principle — in
the study of abnormal manifestations — the energy basis of
function, than the observer with the microscope. The
pathological physiologist, or, if you please, the clinician,
perceives the actual manifestations and activities of the
disease process, whereas the man with the microscope only

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224 CORRELATION OF SCIENCES.

clinician's technical methods with the microscope (which,
of course, is not to be commended), is inclined to think
that the clinician's conclusions are erroneous, his views
unsound, and are to be avoided. Yet the clinician en-
deavors to find the meaning of the lesion and of the dis-
ease process, and is in fact far more scientific than his
friend the patho-anatomist.

Chapter XVII.

THE PATHOLOGICAL INSTITUTE AND PSYCHIATRY.

Pathological anatomy and bacteriology have an undue
influence in moulding medical scientific thought and
activity. This being the case medicine expects that scien-
tific research in psychiatry should pursue the same channel,
an absolutely profitless task. There is no use of deluding
ourselves in the hope that we can make progress in the
investigation of abnormal mental life under the guidance
of pathological anatomy and bacteriology.

The finding of proximate causes does not explain in-
sanity. I might as well say at once that this Institute
was not built up on the plan of simply assembling these
several branches of research and plunging into them
blindly, describing facts without stopping to reflect on the
general aim of the institution itself. Nor was it founded
on the plan of using the mainstays of medical research,
such as physiological chemistry, and particularly patho-
logical anatomy, as the principal and guiding branches
of research in psychiatry. Nor was it based on the plan
of simply delving out any facts that research in these
branches might unearth and expecting to hit, by happy
chance, on some discovery of the modus operandi of abnor-
mal mental life. No such plan was ever entertained.

The guidance of psychiatric research by the medical

CORRELATION OF SCIENCES. 225

conception of using anatomy, chemistry and bacteri-
olog^, would have been simple. We should merely
have to follow the precedent of the pathological labora-
tory in medicine and extend it by adding chemistry
and bacteriology. By focussing these sciences on autopsy
material from the asylum or from hospitals of nervous
diseases, recording the observations and then publishing
them, side by side with the superficial clinical history,
the task would have been finished and much **work"
could have been put forth with that degree of celerity
which the pressure for results demands from an institu-
tion of this kind before it can even become organized.

The medical conception of guiding psychiatric research
by branches of investigation that do not in the least
take account of the phenomena of mental life is utterly
wrong. Had we, however, followed out this simple and
fallacious plan of psychiatric investigation and poured
forth observations of this character, it would have ful-
filled the expectation of the medical conception of the
research, met with approval, and the ordeal of trying
to maintain a higher ideal could have been avoided.
Meanwhile the psychiatrist, unless also infiuenced by the
medical conception of the research, on observing this work
might well remark: *' This is the same old stuff only on a
larger scale. The granules in the neuron are exceedingly
fine and quite new. The chemical analyses of the excre-
tions are more searching than formerly. The toxic factor
in some forms of mental disease is more thoroughly veri-
fied. But through no stretch of sophistry am I able to
find any approach to the explanation of the living phe-
nomena — insanity itself. I still have no key to the
solution of the general problem of abnormal mental life."
On the other hand, if we adhere to the ideal of endeavoring

226 CORRELATION OF SCIENCES.

to furnish explanations of abnormal mental life and aban-
don the medical conception of psychiatric research, we run
the risk of losing favor with the medical **ologists," such
as the neurologist, pathologist, histologist, bacteriologist,
etc., and perhaps with some psychiatrists, who under the
influence of their medical training take the same narrow
and fallacious view of psychiatric research.

In the midst of these difficulties, however, the choice
is definite and clear. We are to follow out the true
aim of science and to work out explanations, theories
and generalizations of the abnormal phenomena of con-
sciousness. To do this we cannot use the medical
branches of pathological anatomy, physiological chem-
istry and bacteriology as the guiding sciences in our
ideal of psychiatric investigation. These branches must
be made entirely secondary and auxiliary to general physi-
ology^ psychopathology and psychology. I sincerely hope
that we shall not be misjudged, if we have not brought
forth various inco-ordinate observations on the dead
tissues of the insane along purely medical lines of investi-
gation, as though this could furnish any key to the under-
standing of living phenomena of abnormal mental life.
We have desired to avoid this kind of work, unless it could
subserve some purpose in the explanation of insanity,

I think it must be quite plain that, if we would ever find
any key to the explanation of insanity, we had best first
and foremost investigate the living phenomena of insanity
and not by sciences which have to do with the third and
fourth degree concomitants of abnormal phenomena of
consciousness, such as anatomy and chemistry. If we
wish to understand the modtis operandi of insanity, let us
by all means go directly to the fountain-head and give up
the hopeless task of inductive ascent from the far distant

CORRELATION OF SCIENCES. 227

by-waters and remote side-channels of medical research.
We must study insanity itself^ — we must examine^ investi-
gate and experiment on tlu living patient.

Hitherto and even at the present time two obstacles
have stood in the way of a direct psychopathological study
of insanity. In the first place, a purely medical education
does not only prepare one for the study of the abnormal
phenomena of consciousness, but actually leads him astray.
Medical training leaves out psychology^ the only science
which can guide investigation of abnormal mental life^ and
it is useless to try to substitute other sciences. In the
second place, the difficulty of finding any well-grounded
working hypothesis of insanity is further augmented by
the fact that asylum cases are too advanced and far
too greatly complicated to yield the key. What holds
the science of psychiatry back is the fact of its being
glided by medicine; it is a case of the blind leading the
blind.

The plan of this Institute has been to fnake psyc/ia-
logical groups of sciences the guide of psychiatric research.
From the very beginning all our efforts were directed
towards one aim, — the discovery of some general principle
of abnormal mental life. The idea was to study the
living phenomena of abnormal consciousness and find a
working theory of the modus operandi of these phe-
nomena. I think, if we wish to accomplish scientific
work, the first thing to do is to survey the field by in-
dependent thought, and not be governed by too excess-
ive a veneration for tradition, dogma and the formalism
of the schools.

The first thing is to state the problem, to find out
what is to be done. The second step is to find out how
to solve the problem. The problem is the explanation

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C0RR£LAT30X OF S-ZJEXCES. 22^^

begin at the living phenon:ena, end some l:ej i:j their
nii::re. and then on'v test and verifv this theo^rr br
az^itG-cnT. chemistrv and other sciences.

One can perceive that /i^j^* mainsSaj cf this Iwszic^sU is
sid f.'ili cf :k€ pSjchiatris: himsrlf; onjj tc feel
that at f rst we mnst beg^ln in the inTest-i^^cSsjC kk a
aormal mental phenomena ontside of the hosprral wh-erc
thej are less complicated. After some general ker 5s
fcrind to explain these phenomena, the invescigacf tn
be extended little oj littHe into the hospitals.

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4* ^ m

tki m^::r,t iks firing 7 hi institutiK^n did Kct jimT'j i-:'%siit
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tki insane. Most assiiredlT noc This dies zyx. -ZL-tanz
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expliinin;^' the s-ccessrc^ns rri the phenocnena -rri ahoirmaZ
mental life. The simple es^abli5hment of these depacrt-
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aa8 CORRELATION OF SCIENCES.

of abnormal phenomena of consciousness, the discovery
of their laws. The way to solve the problem is very
obviously by means of the sciences of consciousness,
namely, psychology and psych ©pathology — and by this
means alone. Start with this idea and you will be able
to estimate the proper value of the medical branches of
research in relation to psychiatry, and know how to use
them. In psychiatric research, especially when a working
hypothesis is absolutely indispensable, medical sciences are
to take second and not first place.

The plan guiding the building of this Institute was to
regard psychiatry as the keystone of the whole arch of
sciences. Now psychology alone and by itself is inade-
quate ; it needs the support and auxiliary work of other
sciences. The psychological group of sciences is to fur-
nish the guiding principle of abnormal mental life-history,
a principle that should control and at the same time be
verified by the researches of the medico-biological group
of sciences. Given some key to the general modus oper-
andi by psychological investigation of some very carefully
selected psychopathological case, a case furnishing crucial
tests, the work of the medico- biological group of the
sciences becomes subject to control. We know where to
direct it. We are then under the guidance of a general
hypothesis of the phenomena of insanity, know what facts
to select from the work of the medico-biological group and
how to use them. It is only under such conditions that
we are enabled to make pathological anatomy of great
value, because we can interpret its results in relation to the
living phenomena, and it is only under such conditions that
pathological anatomy will cease to be a dead science and
will become a really living science. Most assuredly, then,
to find some foundation for psychiatric research, we must

CORRELATION OF SCIENCES. 229

begin at the living phenomena, find some key to their
nature, and then only test and verify this theory by
anatomy, chemistry and other sciences.

One can perceive that the mainstay of this Institute is
the field of the psychiatrist himself; only we feel sure
that at first we must begin in the investigation of ab-
normal mental phenomena outside of the hospital where
they are less complicated. After some general key is
found to explain these phenomena, the investigation may
be extended little by little into the hospitals.

One point should be made quite distinct. The plan and
the motive inspiring the instittition did not simply consist
in assembling the various scientific departments under a
common roof and bidding them work at the dead bodies of
the insane. Most assuredly not. This does not mean
mutual co-operation of these sciences for the purpose of
explaining the successions of the phenomena in abnormal
mental life. The simple establishment of these depart-
ments in a common home does not mean correlation of the
work toward a definite aim. All these departments might
be established and although doing **work," giving forth
"results," and industriously stimulating the same kind of
activity in the hospitals, might leave us in the end not
one whit nearer the laws and principles of abnormal phe-
nomena of consciousness.

One might even add psychology to this group of
sciences, and if one chooses the kind of scholastic ** labor-
atory psychology" which is limited to the collection of
statistical data of normal mental phenomena, such as
reaction-time and the like, without in the least making a
single step in advance. For the psychologist like other
scientists falls into the notion that one is to be satisfied
with collecting and cataloguing facts and data. Thus we

230 CORRELATION OF SCIENCES.

find that some psychologists while piling up many^data
concerning the psychophysics of sensation and perception,
forget to make use of the facts or to work out theories to
correlate the facts. Their work bears an analogous re-
lation to the true aim of psychology as that of the histolo-
gist or patho-anatomist to the science of function. The
pathological anatomist piles up facts of abnormal structure
as though they were explanations of abnormal function,
whereas only through the study of the latter can he expect
to gain an explanation of his facts, and a guide to discrim-
inate the non-essential from the essential in his particular
study.

Normal psychology must speculate as well as observe,
and to speculate safely it must study the abnormal. If a
department along the lines of simple *' laboratory" psy-
chology be added to the previous medico-biological group,
the plan for psychiatric research would seem quite per-
fect. The delusion would indeed be quite strong. Psy-
chology would then be working with the medico-biological
group. The only trouble is that a psychology of numbers
and incoherent ** facts" by merely recording data and
measurements can hardly give us a clew to the explana-
tion of abnormal mental life. Collections of reaction-times
among the insane and voluminous records of psychophysi-
cal measurements do not explain the abnormal phenomena
of consciousness. Such a plan, even with the experimental
type of psychological research included, might remain a
collection but not an organised correlation of sciences in
psychiatric research. Such a type of psychological re-
search cannot possibly guide the work of the other sciences
and the whole institution would fall short of its avowed
purpose — the formulation of laws and principles of the
phenomena of insanity.

CORRELATION OF SCIENCES. 23I

In the amount of *' work" related to insanity, however,
that might be brought out of such an institution, its ulti-
mate aim of explaining the living phenomena in insanity
might be lost track of for some time. The example of
such an institution would be pernicious. It would encour-
age others to fall into routinework and strongly discourage
and delay the attempt to lead psychiatric research from
the dominance of fact -collecting into the channel of the
higher aim of elaborating the laws of mental life. The
key to the finding of these laws lies in the domain of abnor-
mal consciousness, not that the phenomena are at all differ-
ent from the normal, but they better exhibit the phenomena
of progressive dissociation. This furnishes the key.

I have desired to avoid turning psychiatric research into
a cataloguing of facts in this institution, either under the
guidance of pathological anatomy or of ** laboratory psy-
chology." On the grounds of expediency, however, it often
seemed almost compulsory, from the pressure of bringing
forth immediate results under the dominance of the mis-
taken medical idea of psychiatric research, to postpone the
fulfillment of the ideal of this Institute and give over its
energies to pathological anatomy and describe ganglion
cell lesions wherever they could be found in the asylum
mortuary and report it in the journals. The clinical his-
tories could be written side by side with the morphological
account, the interrelation of the two, the vital problem
could be left for someone else to work out. I think,
though, to relinquish the chosen aim of the research, even
temporarily, for the sake of satisfying this mistaken notion
for results, would have been dangerous. Had we started
in this fashion, even holding in mind the ultimate aim of
finding some working hypothesis of insanity to guide
observation, it is quite likely that this aim would have

232 CORRELATION OF SCIENC^.

been indefinitely postponed, and that we could have hardly
paused long enough to work out the true aim of our
endeavor. For the research is not isolated in this
Institute; it extends out into twelve great hospitals
with some twenty thousand patients and among one
hundred to one hundred and twenty of our colleagues
forming the staffs of these hospitals. It may be seen that
the extent of the work of this Institute is rather extensive.
I think it would be wrong to start right oflE simultaneously
throughout these hospitals and deflect the work blindly
into the channel of pathological anatomy and stop at the
recording of the facts or with deductions so narrow as to
be useless. It would be an unworthy response to so great
an opportunity.

All over the civilized globe laboratory workers seem
most actively engaged in recording observations gained
by the Nissl method, although a good part of this activity
seems to be conducted at the expense of reflections on the
meaning of the observations. Such work by no means
constitutes the central inspiration and motive of an
institution for psychiatric research. We have to find
a guide for this work and make it subserve some
purpose in explaining the phenomena of insanity, or
to show how these changes are eflEects of the morbid
process concomitant with abnormal mental life. Work
of this kind, and everything else, must not interfere with
the proper aim' of such an institution.

Although two years is an exceedingly short space of
time, a wide range of C3rtological investigation of the
neuron has been conducted more or less successfully.
This morphological work embraces studies in the histo-
genesis of the neuron, in its comparative cytology
through quite a number of invertebrates and lower

CORRELATION OF SCIENCES. 233

vertebrates, and in many and varied pathological
conditions in man, also experimentally induced in ani-
mals. All this work was not rushed into print as a mass
of facts under the delusion that it explains the phe-
nomena of insanity. These observations have, in the
first place, been used for the formation of a general theory
of the phenomena of insanity, and, secondly, they have
been used to lend support to the theory of neuron energy ^ and,
finally, the facts have been used to explain, as it seems to
us, the mechanism of certain phases of mental and nervous
disease process. Thus an explanation was found of peri-
pheral neuritis, tabes, general paresis, and of a large part
of the system diseases of the spinal cord and brain, such as
combined sclerosis, amyotrophic lateral sclerosis, Landry's
paralysis, pernicious anaemia, sclerosis, and of a large part
of the whole problem of fibre death in the nervous system.
This has been accomplished by working out the significance
of the migration of the neuron nucleus and the excretion of
the metaplasm particles. *

Chapter XVIII.

MEDICINE AND PSYCHIATRY.

I have spoken somewhat freely of the pressure for
results and its bad influence on the growth of a young in-
stitution, with the risk of having it fall amiss all around,
both to the physician and the psychiatrist. If it con-
cerned this Institute only it would certainly not be said,
it would be a most unhappy return for the magnificent
opportunity granted us by the directors of the hospitals
and our Commission in Lunacy. If, however, this press-
ure for premature results is liable to depress and pervert

* An account of this work will appear in a future number of the Archives
OF Neurology and Psychopathology.

334 CORRELATION OF SCIENCES.

the progress of the science of psychiatry in general, it be-
comes a very serious matter and demands consideration.

In medicine there are an enormous number of eager,
active "workers" in hundreds of laboratories vying with
each other in the accomplishment of mechanical desk work
on dead tissues. Every university has them — their name
is legion. A new dye, a new technical method is a boon
to them, it opens a new field for more "work." The
cause of the phenomena is neglected, the process of tran-
sition of cause into effect dwindles out of sight. By its
very volume and momentum, by the force of example,
the influence of all this laboratory " work " widens and
deepens the stress to conform to it.

The principal cause of this unintelligent vain labor and
travail is our unfortunate manner of medical education.
It is the fault of those who teach medicine. We fail to
give our students so much as an inkling into the philoso-
phy of medicine; we lead them to beheve that the great
goal of good work is the noting down of details. Observa-
tion of details is indeed necessary, but reflection and the
use of the methods of seeking after causes are as much
requisite, and possibly far more indispensable. The
result is that too many men leave the medical university
without knowing what science really means. They are
possessed of the idea that science consists solely in
observation of desultory facts and in aimless experimen-
tation, and they consequently avoid the philosophy of
science Uke a pest. They become ingrained with that
false and mischievous notion that success is best achieved
by sticking to one thing, one highly particularized line of
observation.

The natural result of this training is that when men
I leave college and wish to enter the science of medicine,

CORRELATION OF SCIENCES. 235

they go where desultory observation of new things has
the greatest opportunity — pathological anatomy and bac-
teriology. They become skilful with technical methods
and labor with the sense organs at laboratory desks
despising all mental activity. The banishment of reflec-
tion is with them the sine qua no?t of good scientific work.
To make an attempt to understand the phenomena and
form a hypothesis, then verify it and arrive at a theory
is a sacrilege. Reflection is theorizing, metaphysics, or
as some of the profession like to express themselves
strongly in popular parlance, mere rot. Their conception
of the 3Lixn of science would have been pitiable, had it not
been so ludicrous; science, according to them, is a kind of
dime museum where all sorts of odd things and new
curiosities are to be collected for exhibition.

It would be absurd to think for a moment that facts are
of no value in science — science must have facts, but they
are relatively useless until we can give them a valuation
by the methods of reasoning. Without training in the
general principles of biology, general physiology and psy-
chology, we can hardly expect the medical student to find
the basis for any broad elaboration of facts. Many brill-
iant minds in this field do not lead their energies toward
the higher motives of science, because of their training in
medicine and the lack of correlation with other sciences.
Thus, year by year, the army of '* workers " grows and the
influence of joining it becomes stronger by mere force of
social suggestion and imitation. Let a man leave the
work desk in the laboratory to reflect on a purpose for his
work, to subordinate the aimless observation, mechanical
experimentation to an idea, to formulate a problem, and
straightway he is a deserter from the ranks and is branded
as an '^ ideal " idler, as a metaphysician. So great is the

236 CORRELATION OP SCIENCES.

conceit of these " workers," so narrow is their mental hori-
zon that outside their field of occupation ever)rthing is
regarded with an air of superiority and utter contempt.
Thus to one of this type of ** workers" a book was shown
in manuscript form. He looked at it with great arro-
gance and asked: Anything about the Nissl stain? No.
Then it must be metaphysics. When Egypt was con-
quered by the barbaric Arabs the problem was what to do
with the great Alexandrian library. Is the Koran in it?
the barbarian asked. No. Is it in the Koran? No.
Then it is useless stuflE ; bum it ! I do not know whether
the laboratory patho-anatomists are direct descendants of
those barbarians, but they are certainly their successors
in spirit.

Another spur to the haste to record desultory scrappy
descriptions of facts is the great number of journals
in medicine. In medical science there must be at least
six or seven hundred journals. This is about five times
as many as any other science uses, and about five times
as many as necessarj' for well considered, deliberate
and valuable scientific contributions. The rest are too
much in the nature of catalogues, and to search through
them to find the occasional papers of value is indeed a
task. The evil is happily overcome by the year books;
although one often hears the exceedingly valuable work
of those who cast out the chaff in the year books pitied by
the *' workers " as compilers. I think the service rendered
to science by those who assemble these disjointed frag-
mentary descriptions in some succession and order, is as
valuable, if not more so, than many of the contributions
from the * * workers. "

Such unnecessary journals play no inconsiderable share
in urging medical men to forget the true aim of science

CORRELATION OF SCIENCES. 237

in the blind, feverish race for '* facts." Every centre
of research, every laboratory, seems to desire to individ-
ualize its work in a new journal. Before long it is quite
liable to happen that the work has to be made to order
to keep the journal going. The work has to be ground
out on time. This is simply ruinous to the higher motive
of science. One should think twice before starting a
new medical journal, that is, if it purports to advance the
science of medicine. If a journal is inaugurated, it is
well to show its purpose, as Roux has done in the fine
introduction to his journal.

It is unnecessary to allude to the similar baleful in-
fluence exerted by superfluous medical societies in spur-
ring medical men along hasty mechanical lines of work.
The effect of it all, however, whether from one direction
or another, is to drive medical research into a beaten
track. Medicine, headed by pathological anatomy and
bacteriology, is becoming too much a school of desultory
facts. In America, we are trying to drive science along
with the same baste that is characteristic of activity in
other walks of life. No sooner is a scientific institution
inaugurated than results are immediately demanded.
The task of conforming to this demand has been par-
ticularly hard in this Institute, for it had no precedent to
follow ; it had to plan out all of the work on an entirely
new basis. Haste is the bane of scientific research.

In the pressure to bring out work, problems whereby
work can be guided intelligently, problems anticipating
the rc7iaissance of psychiatry as a science have to be
ruthlessly cast aside. An institute devoted to the science
of psychiatry is like an organism, it must grow and
develop, it cannot become great by the irrational demand
of the ** workers " in medicine to make hasty "work."

238 CORRELATION OF SCIENCES.

Medical training thwarts all endeavors to find a path-
way for the progress of the science of psychiatry. Inves-
tigations in psychiatry are to follow the pattern of medical
laboratory work, and that unless indulged in it all research
is deemed a failure. If we have come to such a pass, it is
indeed time to declare openly that medicine is no guide
for the student of psychiatry.

Neurologists, pathologists, histologists and all those high
sounding '*ologists** think that they can afford to disdain,
deride and even to slander and defame the psychiatrist
and his science. As a matter of fact the investigator of
abnormal consciousness, with his broad view of life and
science, has certainly a larger horizon and wider scope for
scientific thought. It is high time that the psychiatrist
should free himself from the incubi and succubi, the
medical •* ologists," that have weighed on him for so long
a time. In the art of psychiatry medicine has been and
still is a great mentor; in the science of psychiatry
medicine can only lead astray.

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