fundamental science of nature, psychology that of mind, and from physics psychology has received invaluable aid and protection.

Again, physiological psychology has been a valuable aid in overcoming the dissatisfaction growing out of introspective psychology and as a result, the vigorous works like those of Maudsley, G. Stanley Hall and Mercier have brought about closer relations between academic psychology and pathology. Carpenter has in his mental physiology reinforced the work of Spencer, and later works have shown the physiology of the nervous system in its help in solving the problems of psychology.

Morat, in his recent and very valuable work on the "Physiology of the Nervous System,' bas this to say relative to the relationship of physiology and psychology-"The study of physiology gives rise to, or at any rate borders on, problems which are not in any way its special province; and, for the rest demands from psychology solutions which the latter seeks for with the aid of its own methods. A kind of mental area, common to both sciences, exists which the former endeavoring to appropriate by pushing farther back the boundaries separating it from the lat-. ter. With the combined methods of the study of psychology, it is evident that our area of observation has been greatly enlarged, and we can now include the conscious minds of others, and even in comparative psychology, the study of the minds of all animate beings from man downwards to where reason begins. Yet, in spite of all, the minds of others cannot be known directly and can only be inferred from their conduct, which is their outward expression and the criterion of mental soundness or unsoundness. Hence, the study of conduct becomes a very necessary integral part of the science of psychology.

The physiological unit, says Mercier, is a nervous process which when transmitted to muscles issues in a movement and is accompanied by a mental state. Raise this unit to the highest power and we find our subject falls into three natural divisions: the study of Nervous Processes; the study of Conduct and the study of Mind as regards its constitution, and these united studies give us clinical psychology, from which we draw conclusions in deciding upon the presence or absence of disease.

Nervous Processes.- The study of the nervous processes involves the study of the anatomy and physiology of the nervous system This opens up the study of the primal functions of the nervous system and their relationship to mental activity. We know that, as I have before said, the cell itself does not

act, but reacts to stimuli, and the absence of all stimuli would mean physiological death. In order for the body to act after receiving the necessary stimuli, there must be redistribution of force, and this is the prime function of the mechanism of the nervous system. Its perversions are noted in the varied palsies, the cerebro-spinal and peripheral neuronic degeneration; the special sense disorders, blindness, deafness, etc.; the varied sensory disorders, and in fact, disorders of the nervous system in general; all of which, according to their degree and combination, create a symptom complex, indicative clinically of the lesion, and when properly interpreted become a part of clinical diagnosis. It is by detailed study of these processes that we learn of their value in clinical psychology, for every lesion of the nervous system, directly or indirectly, has its effect on the mental activity of the individual; some mental accompaniment; its effect upon consciousness. Consciousness is composed not only of feelings and thoughts referring to the outside world, but beneath these there is a vast body of other feelings and other thoughts referring to what is going on in the interior of our organism. It is this knowledge which becomes of clinical value in studying the etiology and nature of hallucinations and the evolution of delusions.

Conduct.-Now as to conduct. "What we

know of the interior of other peoples consciousness, says Mercier, we know only by inferences, by judging from their actions what the condition of their consciousness is likely to be; supposing the actions are in them accompanied by states of consciousness similar to those which in us accompany our own." This is an uncertain inference, and we can best know and judge of conduct of an individual by comparing his condition at the time of our study with some period remote in our endeavor to determine the measure of conduct. Conduct is the criterion of mental unsoundness, but not all, for there is much beside disorder of mind in in. sanity as there are other nervous and bodily changes which are to be taken into account. "It is a fact, however, that when there is disorder of mind, there is disorder of the nervous processes and of those processes which have a mental accompaniment, that is to say, of those which are highest. But, the highest are those which regulate the movements of the body with respect to the circumstances in the outside world; in fact, those which actuate conduct. Hence, "when the highest nervous processes are disordered, not only must mind be disordered, but conduct must be disordered also." We could proceed to

analyze conduct, differentiate the adjustments of the individual as to orientation, purposive movements, intelligent conceptions in immediate adjustment, etc.; all showing the individual at variance with his environment when mental disorder exists, but time will not permit. I have said sufficient, however, to show that conduct in its disorder of adjustment is of clinical value in the psychological study of an individual. Further, conduct is the product of education of innate character; of environment; of experience; of fate; of fortune and of numerous other conditions, and must be studied in its relationship to all of these modifying influences, each of which has its clinical value. Mind in its Constitution.-We have reviewed many of the clinical essentials in our study of the mind, but there yet remains the very important, fundamentally so, study of mind in its constitution, which analysis contributes much valuable clinical information, and enables us to give the true value to the diseased personality, showing in what way the normal mental life is disturbed and forecasting its future, and suggesting its treatment. Paton aptly says, "we are awak ening to an appreciation of the fact that the same general methods of investigation that are applicable to the study of all biological sciences may be successfully adopted in attacking the problems connected with mental diseases." Further, he says, "instead of contenting himself (the clinician) with a native psychology founded upon theory and speculation, he has been taught to rely upon the basis of steady, painstaking observation, substantiating his results whenever possible by experiment. . . . The relation of body and mind is still an enticing theme for the philosopher, but to spend valuable time. in theorizing as to the manner in which the ultimate solution of this problem will be effected belongs only to those who live in a realm that is far afield from the path of the clinician."

The advancement in clinical psychology is especially noted today in the refinement of diagnosis in mental diseases, in the methods employed by Wernicke, Ziehen, Kraeplin, Meyer, Janet and others. Wernicke, recognizing the fertile field awaiting clinical investigation along psychological lines, has attempted to analyze accurately the individual symptoms in different diseases, in the hope that some additional clue may ultimately be obtained as to the etiology and genesis of a given disorder. This method is practical, and has the promise of being of great service in formulating the real scientific basis for the now illusive problems of mental disorders.

Paton says, "that no better exemplification of the good that may be accomplished by these refined methods of analysis can be brought forward than by a reference to the studies made in connection with the various paraonic states. In the light of recent investigation, we no longer speak of primary intellectual defects, as if the intellect were an isolated faculty, inasmuch as careful observation has shown that the majority can be traced to primary changes in organic sensations, anamolous, emotional states and disturbances in the complex of sensations designated collectively in the personality." He also speaks of Bonhoffer's study of alcoholic psychoses, whereby painstaking analytical inethods and the character of the reactions obtained, it is possible that a clue may be obtained showing how these poisons act. Kraeplin has advanced analytical methods of study by means of which certain groups, diseased entities, so to speak, are given full clinical consideration, and the disease as a whole is studied and not merely isolated conditions. Kraeplin's attitude, according to Paton, is that of an observer who says it is essential to success that every factor connected with the problem in question should be taken into consideration and given its due valuation. Kraeplin's synthetic methods are shown in his groupings as found in the symptoms portrayed in what he terms maniac-depressive insanity and dementia praecox. Other observers in following similiar methods of analytical study, all working along psychologi cal lines, are emphasizing the scientific value of exact and precise observation, showing the advantages of bedside, individual study of cases.

To perfect this method of study, observers must study the anomalies of sensation, of perception, of memory, of thought, of feeling (the emotions, the phobias, fears, the disturbances of consciousness, lucidity, confusion, incoherence, stupor), then disorders of the will, for it is clear, as Chaddock says, "that the fundamental elements of insanity are disorders of the emotions and the intellect, and that so-called disorders of the "will" are merely expressions of one or both of the former. The anomalies of volition (of will) and of conduct complete our analysis, but it must be remembered that in testing the mental state, the psychological tests may not yield the results anticipated because of the intellectual change in the patient, but the absence of these tests (the negative results) because of intellectual defect, will in itself aid in the diagnosis. It is also important to remember in analytical work, that we not only note positive results of our examination,

but the negative as well. In fact, we know in mental disease, this is of the utmost importance, because we can frequently determine what disease the patient has by finding out what he has not. A diagnosis is then made by exclusion, one of the most scientific and refined methods of diagnosis.

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Another promising field for the psychological methods of study of the mind in disorder is that found in the borderline mental states, the hysteric, the neurasthenic and that classification, psychasthesia by Janet, which includes neurasthenia and that great mid class of cases between epilepsy on the one side and hysteria on the other. Janet in his clinical studies, according to Blumer, under the name of psychasthenia: (1) the simple neurasthenia with physical and moral depression, but without any accompanying sense of disease; (2) the patient who feels acutely and suffers from his state of depression, but shows a tendency to exaggerate and to generalize; (3) one who has crises of agitation and anguish; (4) one who exhibits tics, phobias or mental mania; (5) one who summarizes all preceding disorders in obsessional ideas of shame, crime, sacrilege, expressed continuously or by crises. He further classes psychasthesia under three divisions according to symptoms: (1) the motor; (2) the effective; (3) the intellectual fields. Janet again says, "the representations in consciousness in the psychasthenic are endogenous, and relate to persons or objects in the patient's environment, thus distingishing from hysteria the representations in consciousness are exogenous in origin, the result of suggestion or emotional disturbances."

The chief episodic syndromea of psychasthenia mentioned by Paton are hypochondrical obsessions, which tend to make the individual self-centered and abnormally sensitive in regard to physical ailments. Sometimes, their attention is centered upon certain organs, as in a case I have now under my care, a bright, intellectual, prosperous business man, whose whole attention is centered upon his liver, and in spite of assurances, physical demonstrations, etc., tenaciously adheres to his hypochondrical ideas regarding his liver. Innumerable complaints along this line could be cited, but they are familiar to you all; the man who is afraid of cancer; the woman with diseased ovaries; the man or woman with diseased heart; the youth with lost manhood; the anemic girl with fear of consumption, eto. All of these individuals have in common excessive shyness, anxiety, fears, embarrassments, and further, in their environment and social relations, have an ill at ease feeling with strangers for fear of doing or saying the

wrong thing; and consequently, prefer to live alone or in retirement from society.

Then, we have the patients with imperative ideas, with the mental, motor and emotional peculiarities. A large and interesting class because most of them are intellectual and are capable of reasoning and debating about their condition. The sleep vigils, the forced reveries, the insistent desire to write about themselves, the innumerable questions always ready, sometimes in writing, to be asked the a hundred other mental physician, and anomalies. Again, we meet them in the overzealous housewife, whose orderliness goes to the extreme; these good women who exhaust themselves and the family as well, in their You all know or emaculate housekeeping.

have heard of such individuals. "Rest is impossible if a book or any object is out of its proper place, and the mania for preservation of order is particularly noticeable in young mothers who cannot bear to see their children's clothing disarranged or their hands or face dirty." It would be a revelation, doubtless, to these good women to tell them they were considered as anomalous creatures; and yet, the imparting of such information would not be heeded. No! the exhaustion is apt to go on just the same and a semi-invalidism be their lot through life. I am sure we who deal with nervous patients meet them almost daily in our consulting-room.

We could go on and mention the tics, the anomalies of motion, as described by Charcot, the fears classified by Janet into four classes: (1) fears relating to the body and determined by anomalies of sense perception; (2) those relating to objects outside of the body; (3) those of situation which are not determined merely by the perceptions of single objects, but rather by a combination of circumstances; (4) the fears pertaining to various ideas. All of these fears, obsessions and impulses growing out of them are apt to move in cycles like all other phenomena dependent upon the nervous system, and as a result, we note crises accompanied with emotional storms, and frequently dominating the patient for days. Many, many of these patients find their way to the insane hospitals who really are more fit subjects for the psychopathic ward of a general hospital, and should by all means have their first detention at least in such institutions. These cases terminate in one of the following ways, depending upon the care and intelligence used in treatment: (1) They may get well, remain cured under proper environment and care; (2) the disorder may reach a certain mental level, the degree of which may be greater or less in each case, wherein the patient may live a comparative useful life and a life of

ease, and yet be a victim of its distresses; (3) the state may become chronic in a hypochondrical form and last always; (4) it may become chronic in a form of anxious anticipation with episodio outbreaks of variable duration.

Then, again, we have a class of cases not so far advanced in their mental symptoms, as noted under psychoasthesia, a class, a large one too, which we are apt to call simply nervousness, which Zbinden has analyzed clinically in a paper entitled "A Psychological Conception of Nervousness" (Review of Neurology, May, 1906, Abstract). It is a condition characterized by primary symptoms of which fatigue, anxiety, emotionalism, irritability, and above all, auto-suggestibility is the chief; and, by secondary symptoms, such as insomnia, palpitation, dyspepsia, etc. The causes, he discusses under hereditary, predisposing (education) and determining fatigue, worry, disappointment. This is that large class of cases which are so prominent in the class which Du Bois and Dana calls the psycho-neuroses, and which are far-reaching and involve questions of family, social and political life and require almost superhuman effort to meet in all of their details. Zbinden believes, however, that their remedy is in education, as he says, men become nervous because they do not think rightly, and the neurotic does not know how to live. To preserve cur equilibrium, one must learn how to think and how to live, and if this were inculcated from early childhood, nervousness in time would disappear. It is evident right here that there are sociologic and economic questions involved in our clinical psychology, but of these we can only hint as we discuss in our treatment what are we going to do about it.

If time would permit, I would like to discuss genetic psychology with you, showing mind in its formation; the psychology of adolescence; of maturity; of decline or the senescence of life, but our subject is too broad, and time is too short to depart into these interesting, productive and valuable by-paths.

Before leaving this phase of our subject, though, let me mention another clinical class of cases, little understood by the average physician, and too frequently ignored, but which if taken early in hand studied by psychological methods and treated from the basis of a mental malady, will yield genuine results. I allude to hysteria. Charcot, we know, did more to bring about the true status of hysteria, defined its psycho-pathology, than any other clinician, but it remained for his pupil Janet, as Charcot himself has said, to unite the medical and philosophical studies of this disorder in the true effort to analyze clini

cally the mental state of a patient. Janet's classical studies have been published in his work, "The Mental State of Hystericals" and from which I select a few excerpts in presenting this very interesting subject.

Janet says: "The method of observation plays the principal part in his researches; it is the clinical method applied to diseases of the mind. In carrying out this method, he emphasizes the importance of knowing well the patient, his life, his education, his disposition, his ideas, and that we shoud be convinced that we can never know him enough. We must then place the patient in simple and well-determined circumstances and note exactly and on the spur of the moment what he will do and say. To examine his acts and words is as yet the best means of knowing men, and we find it neither useless nor wearisome to write down the wandering speeches of a lunatic. The words, the writing of patients, are instructive documents, the graphics of pathological psychology; of course they have to be interpreted, but we must never forget or transform them. Just here, let me say, that I would urge you to have your patients write you regarding themselves, also ask their friends to save their correspondence for your perusal, and never ignore a letter or any document that may come from a patient whom you are studying psychologically. Patients will write thoughts, detail their acts and otherwise express the workings of their mind.

The psychological analysis of a case requires says Janet: (1) The analysis of the stigmata; (2) examination of the mental accidents of hysteria. It is the psychological disturbance which accompanies the accidents that requires too careful analysis and study. The analysis of the moral phenomena will enable the differentiation to be made between all other mental maladies and hysteria. Mental maladies are not to be confounded with each other. If the hysterical patient presents in her various accidents, mental disturbances, it would not be characterizing her correctly to call her insane. She is not insane, at least, in the usual acception of the word. The diagnosis of her case would be difficult, no doubt, and would require a psychological analysis of the different forms of insanity. Janet in his clinical analysis is contributing to the solution of the problem as to what place hysteria should occupy in the classification of hysteria, and in his studies he has eliminated a class of cases which he designates psychasthenia, which by some were regarded as neurasthenic, others as hysterical, but which he shows are midway between epilepsy and hysteria. His work is classic and comparable to that of his distinguished master, Charcot.

We cannot take time to recite his methods of psychological analysis, but will quote from his resume some of the leading deductions he makes from his study of the mental state of hystericals. After speaking of the provocative agents, which weaken the organism and increase the depression of the nervous system, he speaks of the critical age in which hysteria is apt to appear, that of puberty. He says not the age of physical puberty which, however, has a great influence, but of a state which comes a little later, and which might gently be called moral puberty. It is an age when all of the greater problems of life present themselves simultaneously; the choice of a career and the anxiety about making a living; all of the problems of love and for some religious problems. These are preoccupations which invade the minds of young people and completely absorb their power of thought. These thousand influences manifest a psychological insufficiency which remains latent during the less difficult periods. At this time, it is sufficient to develop symptoms which we call hysteria. Janet gives a very thorough and exhaustive definition of hysteria, the result of his psychological analysis, in the following words: "Hysteria is a mental disease belonging to the large group of diseases due to weakness, to cerebral exhaustion; it has only rather vague physical symptoms consisting especially in a general diminution of nutrition; it is above all characterized by moral symp. toms, the principal one being a weakening of the faculty of psychological synthesis, an abulia, a contraction of the field of consciousness manifesting itself in a particular way; a certain number of elementary phenomena, sensations and images, cease to be perceived and appear suppressed by the personal perception; the result is a tendency to complete and permanent division of the personality, to the formation of several groups independent of each other; these systems of psychological factors alternate some in the wake of others or co-exist, this lack of synthesis favors the formation of certain parestic ideas which develop completely and in isolation under the shelter of the control, the personal consciousness, and which manifest themselves by the most varied disturbances, apparently only physical. He gives a brief definition of hysteria by saying, it is a form of mental disintegration, characterized by a tendency toward the permanent and complete undoubling of the personality.

I could go farther in the psychological studies of epilepsy and disease, the disorders of the sub-conscious self, all of which is of clinical importance, indeed, of great import ance, for it enters upon the study of human

personality. Time will not permit this excursion, however, and I have doubtless lead you far enough into the field of abnormal mind, the distempers, as Shakespeare would call them, it seems well in closing to intimate some way out of this labyrinth. In discussing the ways and means, we must unavoidably touch upon some of the most vital, social factors in race, family and individual, disorganization so far as the mind is concerned. Factors which show the need and urge the importance of rules of wisdom and virtue to be formulated and observed to strengthen the health, to heighten the intellect, to refine the morals of mankind.

It is of first importance to note that clinical psychology in its analytical study does not consider heredity with the same degree of insistence as that advocated by Morel, but has, according to Adolf Meyer, in his "Review of the Recent Problems of Psychiatry," shows how its influence largely pointing to the necessity of a future study of constitution and caution, in questions of etiology, generally inasmuch as they show the need of considering a special predisposition besides the exacting cause. The views of heredity are becoming better understood, and as time goes on the work of DeVries of Copenhagen, and other observers will be merged into our psycho-pathology and we will learn of the coefficients, intrinsic and extrinsic value. now only know and must content ourselves with that knowledge "that no matter what the anomaly or deviation from the anthropathological and functional type of the individual or family with respect to the historical moment of existence of a society, a race, it may be the first link of a chain to which others and still others may be added in the descendants, with various changes up to the gravest forms of nervous and mental affections, and to the extinction of the family."

We

Environment and education afford the greatest value in our consideration of therapeutic problems, for inasmuch as they are factors in etiology, they may and will when properly controlled, become our best means in the solution of our psychological problems. Zbinden insists that the treatment of nervousness is an educational problem, and we know that the treatment of a neurasthenic is an educational problem, including proper instruction in personal hygiene as a remedial measure for future protection as well as for immediate necessities. In my very varied experience covering almost every phase of mental anomaly, from the mild to the profound, I am sure that I am right when I say that every case is a problem in nutrition, somewhere along the line, and it is only by proper environment, good nutrition and education