466 ANNALS NEW YORK ACADEMY OF SCIENCES 



of scientific mythology serves its purpose if it stimulates, but it ought not 

 to be accepted as solution. It seems infinitely wiser to reduce events not 

 to static principles, but to simpler events, and to study the laws of modi- 

 fiability of the active factors and of the results. The notion of the "lesion" 

 is helpful where facts are accessible; otherwise, it plays the role of a noume- 

 non. Events are defined by the situation, the reaction and the final ad- 

 justment, and the role played by parts of the event or part of the mechanism. 

 Abnormal events may be best accounted for by modification either of in- 

 frapsychical (simple physiological) or of mental (physiological-psychological) 

 factors. Since the mental events constitute adjustive actions with a scale of 

 efficiency or lack of efficiency, we can distinguish the well-planned act, 

 poorly supported by faulty physiological mechanisms, from inadequately 

 planned, inferior reactions; and the latter we designate as substitutive 

 activities, to denote that the fault lies more in the deficiency of the mental 

 adaptation itself than that of the tool of the same. The advantage lies in 

 the fact that we do not telescope the facts into a schematic artifact devoid 

 of a time component, with a craving for uncontrollable nerve-cell notions, 

 but our attention remains faithful to the field in which things happen. The 

 tendency of an overbelief in the value of noumena is further illustrated in 

 the notion of a "disease," as soon as it figures as more than an empirical 

 unit, satisfying the identification of certain combinations of manifestations, 

 or of some issues of treatment, or not infrequently of a desire for protection 

 against demands of responsibihty concerning the outcome. The "disease" 

 notion is hardly conspicuous in the plainest events of pathology, in injuries, 

 intoxications and even infection, but the nearer we get to the ill-defined, 

 the more the term "disease entity" gets a noumenal overimportance. Con- 

 sumption used to be a protective term covering up the inefficiency of man- 

 agement of tubercular infection; dementia prcecox is to-day such a term 

 covering up medical inefficiency in dealing with the so-called deterioration 

 processes. Within their proper field and plainly realized limitations, the 

 maintenance of these noumena has a great advantage for orderly thinking, 

 but, like the neo-vitalistic modes of presentation of biological facts, they 

 would be most detrimental if considered as more than formulas or starting- 

 points of more fundamental work. For didactic and practical work the 

 differentiation of unfavorable developments from harmless or from consti- 

 tutional recurrent, but non-deteriorating, disorders is equally important for 

 the physician and for the families. Hence the importance of a distinction of 

 dementia prcecox and manic-depressive insanity. But for progress in the 

 understanding, a constructive knowledge of events has to supersede the 

 purely formal method of what can only be a preliminary grouping, until 

 the pertinent cases can be said to present experiments of nature with clearly 



