258 PSYCHIATRY 



foresee a dementia praecox at eighteen, or an hysteria, or a mania 

 melancholia before adolescence, or a paranoia at maturity? 



Psychiatry, Pathology, and Physiologic Chemistry 



There is an increasing conviction among psychiatrists that some 

 inherited defect, often most subtle and difficult to recognize, is pre- 

 sent in all those who develop mental disorders without some 

 original weak spot in the psyche or soma, the man who is infected 

 will not get paresis or tabes; the man who has fevers, toxemias, 

 shocks, and emotional crises, will not get a delirium or insanity. 



But the weak point in a degenerate constitution may not be espe- 

 cially in the nervous system. It may be in a glandular defect or 

 insufficiency. One can imagine a person having congenitally defect- 

 ive adrenal glands; as a result, the blood-vessels are not kept at 

 their proper tonicity, and widespread defects in function follow. In 

 the same way, there may be defective or overactive thyroids, and the 

 tonus of the nervous system is disturbed. There is no doubt that the 

 large colon has important functions in selective absorption, and to 

 an extent in secretion. It is an organ that seems especially attuned 

 to cerebral states. It goes wrong at times with every one, but if it is 

 congenitally wrong, if it is born wrong, it is then one of the stigmata 

 of degeneracy. Thus a person may have a psychosis, because he has 

 congenital defect in the colon or other organs than his nervous sys- 

 tem; the brain may be a very good one, but these adrenal organs - 

 the thyroids, the blood-making organs, the enteric membrane, the 

 liver may be fundamentally defective or the circulatory organs 

 may be badly developed. 



Now it will be the part of the clinical pathologist and chemist as 

 well as of the anatomist to search out these factors, and in this way 

 help the psychiatrist to steer his way in the future. 



I do not believe that the results of this work can be very fruitful 

 as regards the severe dementing forms of mental disease ; here there 

 is always fundamentally a fault with the brain in structure or func- 

 tion. But in the functional and non-dementing psychoses, such as 

 mania and melancholia, and in the minor psychoses, such as hysteria, 

 many types of neurasthenic insanity, we may expect much help. 



Insanity, on the whole, is not a very curable affection. It is prob- 

 able that less than a fourth get permanently well, and its rate of 

 cure is therefore less even than that of pulmonary tuberculosis, 

 pneumonia, or the infective fevers. Nor is it likely that the percent- 

 age of cures will ever be a very high one. 



We may look to the sciences of pathology and chemistry, however, 

 for some help in this direction. It has been already shown that in 

 degenerative disease of the nervous tissue there is the perverted 



