PSYCHIATRY IN THE FUNCTIONAL PSYCHOSES 267 



Halliburton, which, however, relate distinctly to changes in struc- 

 tural disease. In America, the trend toward functional concep- 

 tions of mental pathology became embodied, with a special motive 

 inspiration from general medicine, in the work of the McLean 

 Hospital more than two decades ago. Early in this period, under 

 the added influence of the new teachings of physiological chemis- 

 try, the purpose was developed which has led, in the last half dec- 

 ade, to Folin's chemical investigations of disordered metabolism 

 in immediate connection with the clinical study of the physical 

 conditions and treatment of the insane; the parallel development, 

 on both physical and mental lines, of the original purpose there is 

 also finding its prime expression in the recent establishment of 

 another clinical laboratory in which Franz is applying the physio- 

 logical and experimental methods of the trained physiologist and 

 psychologist. This particular development of the tendency to 

 studies of the physiological aspects of psychiatry has been char- 

 acterized throughout by its essential purpose of seeking guides 

 for treatment of the physical conditions associated with functional 

 mental disorders. 



It appears that the turning-away from the barrenness of his- 

 tological provings is becoming general; the improvements of the 

 clinical method and psychological experiment are inevitably draw- 

 ing attention to the closer observation of the individual patient, and 

 to the better study of the minor causes of his mental variations; 

 this means a trend toward physiology. It is a safe prediction that 

 pathological physiology is to be called to render such aid to psych- 

 iatry as it is giving in general medicine; and that the extraor- 

 dinary advances in pathological chemistry will become available 

 in mental diseases. 



Such are some of the considerations suggested by a survey of 

 the present aspects of the field of psychiatry. The changing atti- 

 tude of psychiatry toward psychology is of great significance. These 

 circumstances guide the inquiry into the conditions and causes of 

 the present position of psychiatry. 



The Relation of Psychiatry to General Medicine 



Psychiatry belongs to general medicine. 1 This view has been 

 presented in the annual reports of the McLean Hospital since 

 1882 ; 2 my first statement of it, in the report of that year, was to 



1 Cowles, E., Advanced Professional Work in Hospitals for the Insane, Am. 

 Jour, of Insanity, vol. LX, 1898; The Mechanism of Insanity, ibid., vols. XLVI, 

 XLVII, XLVIII, 1889-91 ; also The Shattuck Lecture, Neurasthenia and its Mental 

 Symptoms, 1891, Bost. Med. and Surg. Jour.; Mental Symptoms of Fatigue, 

 Transactions, N. Y. State Med. Assoc., 1893. 



2 Cf. Annual Report, 1882, 1889, et seq. 



