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PART I

Psychiatry is the stepchild of medicine. All the other branches of medicine have one great advantage over it—the scientific methods can be applied; there are things to be seen, and felt, physical and chemical methods of investigation to be followed: the microscope shows the dreaded bacillus, the surgeon's knife halts at no difficulty and gives us glimpses of most inaccessible organs of vital importance. Psychiatry, which engages in the exploration of the mind, stands ever at the door seeking in vain to weigh and measure as in the other departments of science. We have long known that we have to do with a definite organ, the brain; but only beyond the brain, beyond the morphological basis do we reach what is important for us—the mind; as indefinable as it ever was, still eluding any explanation, no matter how ingenious. Former ages, endowing the mind with substance, and personifying every incomprehensible occurrence in nature, regarded mental disorder as the work of evil spirits; the patient was looked upon as one possessed, and the methods of treatment were such as fitted this conception. This mediaeval conception occasionally gains credence and expression even to-day. A classical example is the driving out of the devil which the elder Pastor Blumhardt carried out successfully in the famous case of Gottlieb in Diltus. To the honour of the Middle

Ages let it also be said that there are to be found early evidences of a sound rationalism. In the sixteenth century at the Julius Hospital in Wurzburg mental patients were already treated side by side with others physically ill, and the treatment seems to have been really humane. With the opening of the modern era, and with the dawn of the first scientific ideas, the original barbaric personification of the unknown Great Power gradually disappeared. A change arose in the conception of mental disease in favour of a more philosophic moral attitude. The old view that every misfortune was the revenge of the offended gods returned new-clothed to fit the times. Just as physical diseases can, in many cases, be regarded as self-inflicted on account of negligence, mental diseases were likewise considered to be due to some moral injury, or sin. Behind this conception the angry godhead also stood. Such views played a great role, right up to the beginning of last century, especially in Germany. In France, however, about the same time a new idea was appearing, destined to sway psychiatry for a hundred years. Pinel, whose statue fittingly stands. at the gateway of the Salpetrière in Paris, took away the chains from the insane and thus freed them from the symbol of the criminal. In a very real way he formulated for the world the humane and scientific conception of modern times. A little later Esquirol and Bayle discovered that certain forms of insanity ended in death, after a relatively short time, and that certain constant changes in the brain could be demonstrated -post mortem. Esquirol had described as an entity general paralysis of the insane, or as it was popularly called " softening of the brain," a disease which is always bound up with chronic inflammatory degeneration of the cerebral matter. Thus was laid the foundation of the dogma which you will find repeated in every text-book of psychiatry, viz. "diseases of the mind are diseases of the brain." Confirmation of this conception was added about the same time by Gall's discoveries which traced partial or complete loss of the power of speech—a psychical capacity—to a lesion in the region of the left lower frontal convolution. Somewhat later this view proved to be of general applicability. Innumerable cases of extreme idiocy or other intense mental disorders were found to be caused by tumours of the brain. Towards the end of the nineteenth century Wernicke (recently deceased) localised the speech centre in the left temporal lobe. This epoch-making discovery raised hopes to the highest pitch. It was expected that at no distant day every characteristic and every psychical activity would be assigned a place in the cortical grey matter. Gradually, increased attempts were made to trace the primary mental changes in the psychoses back to certain parallel changes in the brain. Meynert, the famous Viennese psychiatrist, described a formal scheme in which the alteration in blood-supply in certain regions was to play the chief part in the origin of the psychoses. Wernicke made a similar but far more ingenious attempt at a morphological explanation of psychical disorders. The visible result of this tendency is seen in the fact that even the smallest and least renowned asylum has, to-day, its anatomical laboratory where cerebral sections are cut, stained, and microscoped....

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