THE STUDY OF NEUROLOGY 229 



We can hardly treat a patient, no matter with what he may be 

 suffering, without having to reckon on the vast and complex part 

 which his mental attitude will play in controlling the result. In 

 many instances, indeed, the physician's success depends upon the 

 skill with which he makes this estimate. Yet how rarely is it sys- 

 tematically and consciously made, under the guidance of any de- 

 finite principle, and how gladly would most physicians crowd out 

 of sight the necessity for making it at all. A man meets with an 

 injury attended with great nervous shock, and the neurologist is 

 ready enough to spend infinite pains on the study of the necrotic 

 areas in his spinal cord, but is apt to overlook the fact that this 

 localized process does not explain why he has at the same time 

 lost flesh and strength and color, and has become the football of 

 his delusions and his fears. The data gathered by psychologists 

 and physiologists, and the principles based thereon, count for but 

 little in most assemblages of neurologists. The reason usually 

 given for this disregard of psychological and physiological data is 

 the insufficiency of our means for the verification and interpreta- 

 tion of them. But this fear should not hold us back from making 

 the attempt to utilize these facts, for the same uncertainties attend 

 anatomic research the moment we endeavor to use it for probing 

 the essential problems of disease and life. The confusion attend- 

 ing the recent discussions over the neuron theory and the real seat 

 of neural energy bot'h justify and illustrate this statement. 



This attitude toward the problem of disease, which claims path- 

 ology as a special department of physiology, is essentially the atti- 

 tude of Wolkow, to whose stimulating essay I have alluded already, 

 and it is also the attitude of Dr. Hughlings Jackson, of London, 

 whose brilliant studies, stretching back for nearly half a century, 

 mark him as foremost among the advocates of the physiological 

 method in neurological research. Professor Welch, 1 of Johns Hop- 

 kins University, has recently made substantially the same claim 

 in his address upon "Adaptation in Pathologic Processes," draw- 

 ing his illustrations from the department of general pathology. 

 Verworn 2 takes the same position when he speaks of diseases as 

 stimuli (Reize), which alter the conditions under which life is car- 

 ried on, thereby adopting Virchow's designation: "Die Krank- 

 heit ist das Leben unter veranderten Zustdnden." 



The physical changes which the organism undergoes in this 

 process of adaptation may be few and slight, and mainly local, or 

 they may be so broad and numerous as wholly to overshadow the 

 lesions by which they were set in motion. In illustration of this 

 overshadowing of the direct effects of a lesion by the processes of 



1 Transactions of the Congress of American Physicians and Surgeons, 1897. 



2 Berl. kl. Woch, 1901, no. 5, and other papers. 



