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4th. To make our theories or ideals con. all minor details to be worked out by men form to truth and exemplify a scientific trained in sanitary science instead of by arch. proposition is to convert that theory or itects and other laymen. ideal into a faot.

16th. Endowinents for the working out 5th. To sacrifice on the altar of personal and proving surgical principles and honors to vanity or ambition one jot or tittle of truth the workers might be worthy serious considor science is to sacrifice the entire principle. eration.

6th. Empiricism has been the foundation 17th. The one great principle, that a sur. of quackery from the earliest days and to en- gical condition is always surgical should be courage, practice or teach any of our surgical constantly emphasized to the end that metbods empirically is to justify and father Dernier operations” may cease to be the quackery.

bane of our profession and the boon of the 7th. It is unreasonable, therefore, to expect undertaker. that any man can put into practice a scientifio principle if he knows not a thing about

The art of surgery is but the application of any of those sciences upon which surgery

the prinoiples taught by surgery as a science. rests, viz., philosophy, anatomy, physiology,

It is the meohanical use of knowledge for pathology, psychology,embryology and biol

the cure or relief of disease. The knowledge ogy, together with those collateral branches,

is either exact or empirical guess-work. This chemistry, histology, bacteriology and thera

makes the distinction between science and peutics.

theory or principle and theory. The art is a 8th. The human body must be viewed as a

true art only if it is the result of or the ap. machine. Its surgical or medical repair to

plication of true scientifio principles. The be based upon the idea of the province of a

operator may be skillful, be may be a good thorough mecbanism. There is no part of

anatomist, and yet be a poor surgeon, for the the body which is not constructed on a true

reason that he looks upon the operation as philosophy, and its repair requires a knowl.

the great part of his work, whereas the quara. edge of natural pbilosophy. All other olo.

tion is and ever must be to burgery only a gies and osophies are useful only in deter.

means to an end, the necessity for whiob aud mining the need of and obaracter of repair,

the plan of which must needs be the greater hence any surgical effort not pbilosopbic is

import than the operation itself. It is infin. unsurgical.

ite detail that makes real surgical success, de. 9th. Teaching of the principles upon

tail in consideration of each and every ele. wbich the treatment of a surgical case is

ment in the case, detail in anatomy, path. treated should be the most attractive, as well

ology, symptomatology, clinical bistory, and as the most important part of our efforts.

all palpable evidence, detail in the prepara10th. To accomplish this our methods of

tion for and performance of the operation, deteaching and our praotice must be consistent,

tail in the case of the patient after operation. and both can be revised with benefit.

The art subservient to the science. The 11tb. Traumatism should be given the con.

science free from all empiricism. A science sideration due its importance as a factor in

which at no time can or will tolerate the in. infection,

terjection of commercial methods or interests. 12th. Fads and fancies should not com.

A science without personal ends or motives. mand the respeot of the profession, and non

Surgical principles and not surgical fads or essentials should not be given prominence in

theories. An “altruism” in practice which our teachings.

brings from the grave its secrets to serve 13th. Surgery should be taugbt as an art

and save a living but suffering being. Which wbich rests upon exact or scientific princi.

touched by the fires of truth warms and ples, hence one in which pbilosophy is

illuminates the world, which delves into Naequally important with pathology, and anat.

ture's laws so deep and rising above the plane omy of greater import than the microscope,

of self-interest can view God's work with a although the latter is a necessary and satisfy

mind of understanding. Altruism which ing adjunct.

oreates an ideal for surgery whose pedestal is 14th. A man may be a good physician, but

Nature's interpreted law, whose body is art a poor surgeon, the converse, however, is not

clotbed with science's robe and whose crown true, for a man cannot be a surgeon who is

is illumined by the light of reason touched not a good physician, bence a special qualifi.

ial analiti. by a Hand Divine.

" oation might be advantageous.

15th. Hospital construction and hospital management should be consistent witb the The use of any considerable quantity of teachings of hygiene, segregation of patients, iodoformized gauze in the vagina involves isolation of infected cases, space per bed, and the risk of a severe dermatitis of the vulpa.

nto ind, abiat we kof mente de study bo moi.

CLINICAL PSYCHOLOGY.*

ence and signifying in the concrete proper.

ties wbich use physical. In further evidence FRANK PARSONS NORBURY, A. M., M. D.

of this changed position of psychology, an

evolutionary and practioal change, we know, JACKSONVILLE, ILL.

as Wundt bas said, that mental functions In all ages man has sought to solve the form a part of the phenomena o mysteries of his own ruling wind, but in into its cycle of production, preservation spite of the extraordinary development of all and destruction, and are governed by the of the physical sciences, the refinement in re. same inexorable law which falls to the lot search, he is still in quest of the solution of of all animate beings, whether they be mol. the problem. While it is true, physiological luso or man. Wundt, in the study of the psychology and psycho-physics have added organic evolution of mental function, re. their contributions, so that today the science minds us that we know the characteristics of mind has been translated from terms of of mind, which are subjective, only from the the metaphysician with its confusing verbi. contents of our own consciousness; hence, age; its almost unintelligible language, to we must not begin our search for mental words, that signify something by defining function among the lower types of organ. facts; yet, mind in all that the term im. ized nature, where its modes of expression

are least perfect, but we must by working our way downwards from man to animals find the point at which mental life begins.

It is not our purpose, however, to pursue this line of inquiry, but rather to accept unquestionably all that physiological psy. chology has proven, and with this as a foun. dation feel secure in our position in accept. ing the belief in the physical basis of mind. James, in bis masterly work on Psychology, supports this assumption in the general law wbich be lays down, viz., "that no mental modification ever occurs which is not accompanied or followed by a bodily change.” Example after example in all of the phenomena of mind verify this statement, and it is this fact upon wbich we are constrained to found the term, clinical psy. chology, by which we mean a study of phys. ical conditions, reactions following certain definite and well known reflexes, the reac. tions, the bodily change which follow mental

modification according to James' law. DR. FRANK PARSONS NORBURY.

We must remember that, as DuBois bas

pointed out so clearly, that the brain itself, plies still offers a vast field for research The King of our organs which imperiously and observation. It is, therefore, becoming commands, is a passive organ becauso its cells to us as medical men, to delve into this al. upon wbioh its activity depends, do not in most unexplored field so far as our profes- themselves act, but react. The cerebral cell sion in general is concerned, that we may has no more spontaneity than the muscular know mind in its growing, its maturing and fibre and it reacts only under stimuli of se. its decay; that we may have adequate ciet impulsions of organic sensations, or of knowledge of its clinical value to us in the stimuli which are received by our sense or. study of disease, whether it be in its iela- gans, those fine antennae wbich bring us tion to the body in general or to its own into relation with the outside world. The realms in particular.

peripheral stimulus must strike the extremity In entering upon this study, we become of the end organs of our sensory nerves, by practical clinicians, because we bring psy. means of which there are sucoessive transohology down from its abstract heights to an mission into the realm of mind and a reflex organio basis and interpret mental function is there created, either sensory or motor, or in terms of physical organization, bespeaking higher psychical cell. It is this study wbich a material basis imbued with sense experi. DuBois says is physiology in its essence, is

today when applied, one of the most promis. • Address in Medicine, delivered before the Mississippi

[graphic]

knowl of diseasd's in gol

Valley Medical Association, at Hot Springs, Ark., Nov. 6, 1906.

physicians in general have been frightened ologioal and clinical methods, and in conse. by the term psychology, and have little con quence, mind now as investigated by modern ception of its usefulness when understood and methods is considered in correlated study intelligently applied. To me, this applied with the nervous system. As evidence of the psyobology is and can always be made useful value of these correlated studies we have the in clinical medicine and surgery. Every masterly work on the “Psychology of Ado. physician consciously or subconsciously is, lescence" by G. Stanley Hall. and may be more so, a living potential of its Mercier says there is a large amount of subtle usefulness, and it is just as important writing about the mind and about the conthat we discuss this feature as it is to discuss nection of the mind with the body, which the technique of some surgical operation or is, strictly speaking, nonsense, and in using some clinical problem in internal medicine; the word nonsense he does not use the word for it is true, "whether he wants to or not, as a term of vague abuse, but in its strictest the physician ought to be a psycbologist, logical meaning to denote language wbioh is and in practice he will often see tbat bis unintelligible and meaninglese, language knowledge of the human heart is more use. wbiob is neither true nor false, but is purely ful than his ability in questions of normal nonsense and is such because of the lack of or pathological physiology.".

recognition of the fact that a change of con. We have a right to use every means that, sciousness never takes place without a cbange when ethically and intelligently applied in the nervous system, in the brain, and the give peace, comfort, relief and cure to our change in the brain never takes place under patients, and we ought not only know how the same conditions without the change in and when to approach psychological prob. consciousness. This is in accordance with lems, but to know the real genuineness, the law laid down by James. Now, why the precision and effectiveness of the methods two occur together or what the link is which when applied.

connects them we do not know, and most au. We owe to Herbert Spencer the masterly thorities believe that we never sball and never and profound exposition of the origin and can know. nature of the normal mind; bis classical, syn. In view then of what has been said, let us thetical psychology has laid the foundation follow Mercier in bis practical statement of upon which has been built all of the practi. the facts we have to study in order to know cal work in psychology, both normal and of the nervous system in its relationship to morbid. To Drs. Hughlings Jackson, Char. the mind. We must first know of consciouscot, Richet, Charles Mercier, Pierre Janet, ness, and it is self-evident that there is only Wilhelm Wundt, Henry Maudsley, James J. one way of knowing of the facts of conscious. Putnam, Paul DuBois, Kraeplin, Bianchi andness, and that is by obserring the operations other physicians, we owe the adoption of the states and the sequences of one's own these principles of psychology to practical mind. This introspective method is a careolinical medicine.

ful and systematic study of facts that every. Unfortunately, medical men have not re- body notices in a more or less superficial and ceived in their college curriculum very much perfunctory manner. instruction regarding the normal mind as . Further, it is evident that this method can taught in psychology, and only within recent only be pursued by investigation upon one's years have they received very much infor- own consciousness. One cannot feel the emo. mation regarding the abnormal mental tions nor reflect the ideas of other peoples states, as a result, the mind in disease is mind; one knows and diaws by inference an unexplored wilderness to the average that other people have consciousness like physician. I personally feel no apology is one's self, but one can never directly observe necessary for occupying this time in discuss them. Psyobology takes all of this for ing what many physicians regard as a use- granted, and in further evidence of the cor. less waste of time and a pernicious imposi. reotness of this assumption it has adopted tion on good nature when one, speaks of methods of scientific observation to prove it. psychology. It is important that medical Speculative philosophy in investigating men know at least the principles of psychol. consciousness has no place in the modern, or ogy in order to formulate adequate knowledge what is called the "new psychology," of the abnormal states of mind. Obviously, wherein experimental methods have proven therefore, in order to know the abnormal in a source of valuable knowledge. Direct its fullest and most comprehensive delinea contributions to modern psychology in the tion, we must bave a working knowledge of study of consciousness have been made the normal mind in its relationship to the through physios, wbich, as Helmholtz bas body. This field in recent years has been shown, is theoretically at least the co-ordininvestigated thoroughly by laboratory, path- ate science of psychology. Physios is the

clinicalefed become ied study of bline

fundamental science of nature, psychology aot, but reacts to stimuli, and the absence of that of mind, and from physics psychology all stimuli would mean physiological death. has received invaluable aid and protection. In order for the body to act after receiving Again, physiological psychology has been

the necessary stimuli, there must be redis. a valuable aid in overcoming the dissatisfac.

tribution of force, and this is the prime tion growing out of introspective psychol.

function of the mechanism of the nervous ogy and as a result, the vigorous works like

system. Its perversions are noted in the those of Maudsley, G. Stanley Hall and

varied palsies, the cerebro.spinal and peri. Mercier have brought about oloser relations

pheral neuronic degeneration; the special between academio psychology and pathology.

sense disorders, blindness, deafness, etc.; Carpenter has in his mental physiology rein.

the varied sensory disorders, and in fact, disforoed the work of Spencer, and later works

orders of the nervous system in general; all have shown the physiology of the nervous

of which, according to their degree and com: system in its help in solving the problems of

bination, create a symptom complex, indicapsyobology.

tive clinically of the lesion, and when propMorat, in his recent and very valuable work

erly interpreted become a part of olinical on the “Physiology of the Nervous System,”

diagnosis. It is by detailed study of these bas tbis to say relative to the relationship of

processes that we learn of their value in clin. physiology and psychology—“The study of

ical psychology, for every lesion of the ner. pbysiology gives rise to, or at any rate bor.

vous system, directly or indirectly, has its ders on, problems which are not in any way

effect on the mental activity of the individ. its special province; and, for the rest de.

ual; some mental accompaniment; its effect mands from psychology solutions which the

upon consciousness. Consciousness is com. latter seeks for with the aid of its own

posed not only of feelings and thoughts remethods. A kind of mental area, common

ferring to the outside world, but beneath to both sciences, exists which the former

these there is a vast body of other feelings endeavoring to appropriate by pushing farther

and other thoughts referring to what is going back the boundaries separating it from the lat..

on in the interior of our organism. It is this ter. With the combined nethods of the study

; knowledge which becomes of clinical value of paychology, it is evident that our area

in studying the etiology and nature of hallu. of observation has been greatly enlarged, and

cinations and the evolution of delusions.

1 we can now inolude the conscious minds of others, and even in comparative psychology,

Conduct.-Now as to conduct. “What we the study of the minds of all animate beings

know of the interior of other peoples con. from man downwards to where reason begins.

° sciousness, says Mercier, we know only by Yet, in spite of all, the minds of others can.

inferences, by judging from their actions not be known directly and can only be in.

what the condition of their consciousness is ferred from their conduct, which is their out

likely to be; supposing the actions are in ward expression and the criterion of mental

them accompanied by states of consciousness soundness or unsoundness. Hence, the

similar to those which in us accompany our study of conduct becomes a very necessary in.

own." This is an uncertain inference, and tegral part of the science of psychology.

we can best know and judge of conduct of The physiological unit, says Mercier, is a

an individual by comparing bis condition at nervous process which when transmitted to

the time of our study with some period re. musoles issues in a movement and is accom.

mote in our endeavor to determine the panied by a mental state. Raise this unit to

measure of conduct. Conduct is the cri. the bigbest power and we find our subject

terion of mental unsoundness, but not all, for falls into tbree natural divisions: the study

there is much beside disorder of mind in in. of Nervous Processes; the study of Conduct

sanity as there are other nervous and bodily and the study of Mind as regards its consti.

changes which are to be taken into account.

Ch tution, and these united studies give us clin.

“It is a fact, bowever, that when there is dis. ical psychology, from which we draw conolu

order of mind, there is disorder of the nervous sions in deciding upon the presence or ab.

processes and of those processes which have sence of disease.

a mental accompaniment, that is to say, of

those which are highest. But, the highest Nervous Processes.— The study of the are those wbich regulate the movements of nervous processes involves the study of the the body with respect to the circumstances in anatomy and physiology of the nervous sys. the outside world; in faot, those which aotu. tom This opens up the study of the primal ate conduct. Hence, “when the highest functions of the nervous system and their re. nervous processes are disordered, not only lationsbip to mental activity. We know that must mind be disordered, but oonduct must as I have before said, the cell itself does not be disordered also." We could proceed to

analyze conduot, differentiate the adjust- Paton says, “that no better exemplification ments of the individual as to orientation of the good that may be accomplished by purposive movements, intelligent conceptions these refined methods of analysis can be in immediate adjustment, etc.; all showing brought forward than by a reference to the the individual at variauce with his environ. studies made in connection with the various ment when mental disorder exists, but time paraonio states. In the light of recent in. will not permit. I have said sufficient, how. vestigation, we no longer speak of primary ever, to show that conduot in its disorder of intellectual defects, as if the intellect were an. adjustment is of olinical value in the psy. isolated faculty, inasmuch as careful observachological study of an individual. Furtber, tion has shown that tbe majority can be oonduct is the product of education of in- traced to primary ohanges in organic sensa. nate character; of environment; of experi. tions, anamolous, emotional states and dig. ence; of fate; of fortune and of numerous turbances in the complex of sensations desother conditions, and must be studied in its ignated collectively in the personality." He relationship to all of these modifying in. also speaks of Bonhoffer's study of aloobolic fluences, each of which has its clinical value. psychoses, whereby painstaking analytical

inethods and the character of the reactions Mind in its Constitution.-We hare re. obtained, it is possible that a clue may be ob. viewed many of the clinical essentials in our tained showing how these poisons aot. study of the mind, but there yet remains the Kraeplin has advanced analytical methods of very important, fundamentally so, study of study by means of which certain groups, dismind in its constitution, which analysis eased entities, so to speak, are given full clin. contributes much valuable olinical informa- ical consideration, and the disease as a whole tion, and enables us to give the true value is studied and not merely isolated conditions. to the diseased personality, showing in what Kraeplin's attitude, according to Paton, is way the normal mental life is disturbed and that of an observer wbo says it is essential forecasting its future, and suggesting its to suocess that every faotor connected with treatment. Paton aptly says, “we are awak. the problem in question should be taken ening to an appreciation of the fact that into consideration and given its due valua. the same general methods of investigation tion. Kraeplin's synthetio methods are shown that are applicable to the study of all biolog. in bis groupings as found in the symptoms ical sciences may be successfully adopted in portrayed in what he terms maniac-depressive attacking the problems connected with mental insanity and dementia praecox. Other obdiseases." Further, he says, instead of servers in following similiar methods of ana. contenting himself (the clinician) with 8 lytical study, all working along psychologi. native psychology founded upon theory and cal lines, are emphasizing the soientifio value speculation, be bas been taught to rely upon of exact and precise observation, showing the basis of steady, painstaking observation, the advantages of bedside, individual study substantiating his results whenever possible of cases. by experiment. . . . The relation of body and mind is still an enticing theme for To perfect this method of study, observ. the pbilosopher, but to spend valuable time ers must study the anomalies of sensation, in theorizing as to the manner in which the of perception, of memory of thought, of feel. ultimate solution of this problem will be ing (the emotious, the phobias, fears, the diseffected belongs only to those who live in a turbances of consciousness, lucidity, confu. realm that is far afield from the path of the sion, incoherence, stupor), then disorders of clinician.”

the will, for it is clear, as Cbaddock says, The advancement in clinical psychology is “that the fundamental elements of insanity especially noted today in the refinement of are disorders of the emotions and the intel. diagnosis in mental diseases, in the methods lect, and that so-called disorders of the "will" employed by Wernioke, Ziehen, Kraeplin, are merely expressions of one or both of tbe Meyer, Janet and others. Wernicke, recog. forcer. The anomalies of volition (of will) pizing the fertile field awaiting olinical in and of conduct complete our analysis, but it vestigation along psychological lines, has at. must be remembered that in testing the tempted to analyze acourately the individual mental state, the psychological tests may symptoms in different diseases, in the hope not yield the results anticipated because of that some additional clue may ultimately be the intellectual change in the patient, but the obtained as to the etiology and genesis of a absence of these tests (the negative results) given disorder. This method is practical, because of intellectual defect, will in itself aid and has the promise of being of great service in the diagnosis. It is also important to rein formulating the real scientifio basis for member in analytical work, that we not only the now illusive problems of mental disorders. note positive results of our examination,

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