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Thirty years ago, a senior in medical school, I failed to learn much about mental diseases either from textbooks or from lectures and demonstrations in a state hospital. The textbook we used was an imposing volume of nine hundred and sixteen pages, of which six hundred fifty were devoted to Nervous Diseases and two hundred sixty-six to Mental Diseases. A chapter of one hundred sixty-six pages among the former was headed 'Diseases of the Nervous System without known Anatomical Basis' and dealt with Trophoneuroses, Infection Neuroses, Motor Neuroses, Fatigue Neuroses (example, writer's cramp), Psychoneuroses (neurasthenia, psychasthenia, hysteria, epilepsy, migraine, tics), and Neuroses following Traumatism. The implication was that in time an anatomical explanation would be found for all the conditions named therein. Only the psychoses were included in the part devoted to Mental Diseases, in chapters on Mania, Melancholia, Circular Insanity, a very brief chapter on Manic-Depressive Insanity after Kraepelin, Epileptic Insanity, Dementia—primary and secondary—Dementia Præcox (four-and-a-half pages), General Paresis, Paranoia, Idiocy, Imbecility, and Feeblemindedness (fifty pages). From the standpoint of present psychiatric knowledge, the classification needs no comment. Looking through the pages and the index I fail to find any mention of Sigmund Freud (edition of 1909). I do find A Review of Recent Problems of Psychiatry, prepared by Adolf Meyer then Director of the Pathological Institute of the New York State Hospitals, dealing particularly with Kraepelin, Ziehen and Wernicke which provides a comprehensive résumé of the psychiatric thinking of the time.
Following graduation from medical school and internship in general hospital, I spent one year as interne in a state hospital. The development of American psychiatry has been intimately