Phrenology in American Medicine

Joseph B. LeRoy, M.D.
February 17, 1988


            My interest in phrenology began in 1986 as a result of a presentation on phrenology at the American Academy of Neurology by Dr. Frank Freemon.  My knowledge of this subject at the time was zero, as it is never mentioned in modern textbooks of neuroscience or neurology.  Dr. Freemon was particularly surprised that a professor of neurology at the University of Louisville knew so little about phrenology, especially since Charles Caldwell, M.D., was not only considered one of the founding fathers of the University of Louisville School of Medicine, but also the leading phrenologist of his time.  The subject was a particularly easy one to research at U of L’s medical library because its historical sections contain many books published or utilized by Dr. Caldwell as well as a phrenological bust.

            The basic phrenological assumptions are as follows:

1.            Mental phenomena have natural causes.

2.            Anatomical and physical of the brain influence behavior.

3.            The development of these faculties (organs) influence brain size.

4.            Faculties (organs) may be altered by blood flow and, if exercised, will grow.

In essence, they asserted that the mind is in the brain and that specific parts of the brain have specific functions.  Even with all of our knowledge in 1988, this question has not been settled to the satisfaction of all members of the scientific community, and the question is even debated at formal courses offered by the School of Medicine.

               Phrenology has left many legacies to American, although rarely, if ever, are those contributions recognized in modern literature.  These include the concept of cerebral localization, health awareness, prison reform, equality of women, quality of education, sexual satisfaction for both sexes, and monogamy.  Later in this lecture I shall return to these points and amplify them.

            By 1800 a few famous physicians advocated the fact that the mind was located in the brain; these included Magendy, Pinell, Willis, and Benjamin Rush.

            Gross anatomy at that time had been developed to a great art.  An example of just how great this art is seen in the textbook of John Lazarr’s “FRSE”.  This textbook, which undoubtedly was used by the leading phrenologists of the day, could be easily utilized in the neuroanatomy course this coming year in Louisville.  In addition to being struck by the beauty of the illustrations, I was particularly struck with its introduction, “The voice of antiquity, like the nature of disease, casualties of ordinary life, and the hazards of war, all conspire with the dictates of sound philosophy, in enforcing the claims of anatomy and physiology as the basis of a successful system of medicine and surgery.”  This particularly beautiful book which is now in the historical section of the Louisville School of Medicine library was discarded by the Louisville Free Public Library and fortunately rescued.

            The physiology lagged at least 100 years behind the anatomy.  At this time, there was no concept of the occipital lobes being related to vision, the frontal hemisphere to motor movement, the cerebellum to coordination, etc.  It was known that the spinal cord (at the time called the spinal marrow) had some localized function in that the posterior portion subserved sensation and that the anterior portion subserved motion.  Bell had described nerves as bundles of filaments and noted that their integrity depended upon adequate circulation.  He also put forth the thought that sensibility resulted from part of the brain as being affected by the nerve.  However, the prevailing opinion of the time was that the mind was a mysterious, non-material substance placed in the body by the Creator and taken back by the Creator when the body ceased to function.

            Franz Joseph Gall is considered the founder of phrenology.  He was born in 1758 and attended medical school in Vienna.  Medical school at that time was apparently as competitive as it is now, and Dr. Gall noted that those students who excelled in rote memory seemed to have more prominent foreheads.  From this simple observation, he devoted an enormous amount of time to studying individuals with outstanding mental characteristics including criminals, artists, statesmen, and great intellects and finally evolved his concept of 37 phrenological organs.  This doctrine included a particularly controversial assumption, that is, character and intellect were the sum of all the combined organs of the brain and that character was the brain.  It was obviously met with criticism, particularly from the church, and in 1802 he was dismissed from his post in Vienna on the grounds that he was subversive to religion and morals and forbidden to lecture anymore in Austria.

            He left to Germany with one particularly devoted pupil by the name of Johanne Gaspar Sprzheim and began a lecture tour of Germany and France.  Gail became internationally famous as a scientist and had a huge practice primarily of the aristocracy of the time.

            Before his death, three of the leading American physicians had by design or chance attended his lecture in Paris.  These included John Warren of Boston, Charles Caldwell of Louisville and John Bell of Philadelphia.  His pupil, Sprzheim, began, to popularize phrenology, and by making a few changes in its format, made the science particularly appealing to Americans.  Although Gall acknowledged the evil of the world by including an area of murder in the brain, Sprzheim deliberately eliminated all potentially evil areas from the brain localization and maintained that man was essentially good and that his bad attributes could be explained on a disharmony of the organs.

            When the Edinburgh Review published a particularly vitriolic review of phrenology, he traveled to Edinburgh to personally demonstrate brain dissection and to debate his detractors point by point.  As a result of this trip, two additional great names were added to the history of phrenology, these were the lawyer George Combe and his brother Andrew.  A phrenological society was immediately formed in Edinburgh in 1817 and the phrenological journal was founded which proved to be the most respected journal for the next 25 years.

            In the United States, the Center Phrenological Society was formed and included many of the leading physicians of the era.  These included Nathaniel Chapman, John Kersley Mitchell and Phillip Syng Physick.  The official statement of this organization was: (1) To improve education because phrenology maintained that through exercise various parts of the brain could grow.  A vigorous education could be expected to increase one’s intellectual faculties.  (2) To improve the diagnosis and treatment of brain disease.  Dysfunction of certain parts of the brain due to tumor or trauma should result in dysfunction of certain organs and as a result physicians should be able to understand and treat their patients better.

            Another supporter of phrenology at the time was John C. Warren, professor at the Massachusetts Medical College in Boston, which later became known as Harvard Medical School.  Dr. Warren began doing comparative research of the brain of different animals and noted that animals with especially well developed faculties such as smell also had particularly olfactory organs.  His interest began to wane in comparative phrenology when he dissected the brain of a lion expecting to find an enlarged organ of courage but found none.

            Of all the physicians who embraced the new science of phrenology, none was more prolific or avid than Charles Caldwell.  Biographers of Caldwell have suggested that his love of phrenology was related to his love of controversy, for throughout his life he left behind him a trail of enemies and controversy.  His first exposure to phrenology was in 1821 when he traveled to Paris with $17,000 to buy medical books for the newly established Transylvania University in Lexington.  By 1824, he had published a book, “Elements of Phrenology”, which was widely acclaimed.  It was the first book on phrenology produced by an American.  Perhaps because phrenology was considered anti-religious, perhaps because of his difficult personality, and perhaps because Louisville was developing much more rapidly than Lexington, in 1837 he moved to the medical institute of the city of Louisville which later became the University of Louisville School of Medicine.  After he accepted the position, the University instituted a rule for mandatory retirement at age 65.  In 1849 at the age of 78 he submitted a letter of his intention to retire in 1850, but this infuriated the Board and he was terminated immediately.

            While Dr. Caldwell was in Louisville, another Louisvillian by the name of Joseph Rhodes Buchannon began lecturing extensively on phrenology and the new phenomena of animal magnetism.  As part of these lectures, he began offering phrenomagnetic manipulation and without any research or thought at all added 91 new organs to the brain.  He is perhaps best remembered for coining the word “neurology” in Louisville, which he defined as some sort of mixture of phrenology, animal magnetism, and medicine.

            Up until the 1850’s medical reports and referred literature often attempted to utilize phrenological concepts in their attempts to explain neurological phenomena.  For example, Henry Dickenson of the Medical College of South Carolina in the “American Journal of Medical Science” described a 55 year old man with a sudden onset of a naming disorder which today we would call aphasia.  He had difficulty with repetition, could copy words but not write them spontaneously.  Dickenson hypothesized that “the perception of objects seems to irregularly defective, not from any disorder of the sense organs or nerves, but from some peculiar condition of the brain.”  Similarity of this patient and the patient reported by John Gratton in the phrenological journal was pointed out.

            Daniel Drake reported on a similar patient.  He first thought that the disorder of speech could have been related to dysfunction of the 7th cranial nerve, but Drake reasoned that the inability to write certain words meant to Drake a disorder of the brain he pointed out that the patient felt pain near that portion of the brain which the phrenologist regards as the organ of language.

            The most influential medical textbook of the time was published by Samuel Jackson in 1832.  He accepted phrenology as the most likely explanation of brain function but thought that phrenological maps were only a guide for further research; “the brain is the instrument or organ of the intellect and it is more than probable that the doctrine of Gall is correct, that assigns a particular organ of the brain to each faculty.  The seat of these faculties is difficult to assign with precision, but it can be affirmed beyond a doubt that the nobler and higher faculties are located in the anterior and superior parts of the brain.”

            The decline of phrenology came about when it could not withstand the rational scrutiny of rational thought.  The first opposition occurred at the University of Louisville as early as 1824 when John P. Garrison argued that an individual at any given instance can experience but a single stream of consciousness.  He also pointed out that current anatomy was not able to outline the borders of the various cerebral organs and if these borders could not be determined then the detailed measurements of the brain in correlation with psychological defects or abilities were also not possible.

            The most detailed critique of phrenology was by Thomas Sewell of Columbia College of Washington in 1839.  His arguments can be summarized as follows:

1.            Dissection of the brain reveals no organs.

2.            Brain mass and intelligence are not correlated.

3.            Skulls very in thickness.

4.            Frontal sinuses obscure frontal lobes.

5.            Focal lesions have not been observed to destroy specific faculties.

Although Sewell’s argument was reasonable and rational, Charles Caldwell characteristically reacted with emotional venomous personal attacks, accusing Sewell of falsehood, deception, malice, misrepresentation, fabrication, ignorance and stupidity.

Phrenological research was generally flawed.  An example might be the report of Dr. William B. Fahnestock who made detailed measurements of the bones.  No measurements of the brain itself were actually made, but the brain was removed and a candle was placed inside of the skull to determine which parts were thinnest, the hypothesis being that the larger organs would cause the skull to be thinner.  Of course, the largest organ in this criminal’s brain was the organ of destructiveness.

As a measure of phrenology’s loss of credibility in the reputable medical world, Charles Caldwell barely mentioned phrenology in his autobiography written in 1853.  Benjamin Coates, who had been an officer of the Central Phrenological Society in 1823, wrote Caldwell’s memorial for the American Philosophical Society and listed Caldwell’s many accomplishments and failings but made no mention whatsoever that either he or the deceased had any acquaintance with phrenology.  As is true with so many scientific theories which ultimately prove to have no merit, the decline of phrenology in the mind of the lay public was not nearly so rapid.  This was primarily due to Orson Fowler who was an evangelist and salesman par excellence but who knew virtually nothing of medicine.  His endeavors were added by his brother Lorenzo and Lorenzo’s wife Lydia.  They offered phrenological examination to the lay public.  This examination included a chart of the brain organs along with a 60-page handout.  The examinees name, that of the examiner and the date were written of the flyleaf.  These examinations cost anywhere from $1-3.  They even offered to do phrenological examinations from photographs.  They also operated the famous Phrenological Cabinet which had thousands of skulls, casts, skeletons, exotic artifacts and paintings.  At one time in the 1850’s it was considered one of the musts for all sight-seers in New York City.  They established a school for accrediting phrenologists.  The student was sold a set of 40 choice plaster casts for $25 which included casts of the skulls of such famous men as John Quincy Adams, Voltaire, Sir Walter Scott, and Arron Burr.  For a much higher price, real animal skulls and skulls imported from ancient battlefields could be obtained.  They also published an endless stream of books which included such titles as “Love, Percentage and Amadivaness”, “Matrimony, Hereditary Descent and Matrimony,” “Self Culture and Perfection of Character,” “Religion, Natural and Revealed”, “Education Self-Improvement,” “Temperaments and Tight Lacings,” “Physiology, Animal and Mental,” “Memory and Intellectual Improvement,” and a 900 page book provided to the buyer in a brown wrapper entitled “Sexual Science.”

            As an example of how the Fowler’s worked, one of the more famous of Lorenzo’s phrenological examinations was that of Clara Barton at the age of 15.  Years later she wrote in her memoirs, “Two courses of lecture by L. Fowler were arranged for our town.  He very naturally became the guest of my father and mother.  These two courses covered nearly a month of time.  How the value of the results of that month extending through a lifetime be put into words?  How measure the worth of the ideas and knowledge of oneself and of others growing out of it? Aside from this was his aid and comfort to my mother in her perplexity concerning her incomprehensible child.  I recall the long earnest talks which was evidence that I was the prime subject.  Although not clearly realizing it at the time, my mother remarked that none of her children had ever been so difficult to manage.  Was I disobedient, exacting, or wayward asked Mr. Fowler.  Oh now, she wished I were.  She would then know what to do for I would make my wants known and they could be supplied but I was so timid and afraid of making trouble that they were in constant fear of neglecting me.  I would do without the needed article rather than ask for it and my bashfulness increased rather than diminished as I grew older.  Mr. Fowler replied that certain characteristics were indicated, however much her friends might suffer from them, she would always suffer more.  They may be apparently outgrown but the sensitive nature will always remain.  She will assert herself for herself.  She will suffer wrong first for others.  She will be perfectly fearless.  To my mother’s anxious question, what should I do, he replied her responsibility upon her, she has all the qualities of a teacher.  As soon as her age will permit, give her a school to teach.

            From this account, one can readily see that the Fowler’s carried the phrenological concepts well beyond the anatomical configuration of the skull; rather, he and his family used phrenology as a springboard towards popularizing self-help psychology.

            Even though by the 1850’s phrenology had been largely discarded by the reputable medical profession, it continued for at least the next 50 years to have enormous popular support.  As evidence of this, phrenology can be found in the works of Melville, Thoreau, Harriet Beecher Stowe, Edgar Allan Poe and Walt Whitman.  Avid followers of phrenology at the time included Clara Barton, Bernard Baruch, Ulysses S. Grant, Karl Marx, Baudelaire, Balzac, George Elliot and Horace Greeley.

            In the latter part of the 1800’s, phrenology began to assume decidedly racist overtones.  Note that the diagram placed on Caucasian as the highest type of human being, followed by “enlightened, civilized, improved, uncivilized, and the Negro bushman.”  At the time, Americans were almost constantly at war with the American Indians and the greatest venom was reserved for them.  The Negro received only slightly better treatment.  However inflammatory the description of the Negro was, it made phrenology even more controversial, because the Civil War was rapidly approaching and at least the Negro was acknowledged as being part of the human species.

            Popularized phrenology withstood the financial panics of the 19th century, civil war, and even the First World War.  In 1925, the Phrenological Institute still existed in New York City at 135 West 119th Street where for a fee of $50 the doors of the mind could be unlocked by lectures on hereditary and character analysis with the descendants of the original Fowlers.  The final demise of phrenology came about through a combination of the Great Depression and the rising popularity of Freud who had the enormous advantage of being accepted by organized American medicine.

            As stated at the beginning of the lecture, phrenology had many positive lasting effects.  Amongst the greatest of these were the treatment of the psychiatrically disturbed.  Prior to the advent of phrenology, when a person lost his mind he was considered possessed of evil spirits, had retrogressed to the animal level, and deserved to be treated no better than an animal.  Part of the treatment consisted of frightening the evil spirit out of the person by immersion in ice water, incarceration in pits filled with snakes, beatings, and immobilization with chains.  Phrenology asserted that the brain was the organ of the mind and that insanity was a diseased condition of the mind, not a visitation from the devil.  Although 150 years passed before scientific evidence could be brought to bear the truth of this assumption, its immediate result was more humane treatment of the insane.  The treatment of each patient was individualized, and if a particular organ of their brain was thought to be over-developed, leeches, mustard plasters and hot packs were applied to reduce the blood flow from one organ or to increase it to another.  The basis of all the regimens were fresh air, physical exercise, a bland diet with no liquor, tobacco, plenty of rest and sleep, intellectual stimulation and a moral uplift.  The American Journal of Insanity was established by Dr. Amariah Brigham.  The Journal’s articles were a mixture of cerebral pathology and phrenology, and in its time was one of the major psychiatric journals of the world.

            The impact of phrenology on penal institutions was not as dramatic as that on the insane asylums but certainly had some effect.  The phrenologists wanted to establish a doctrine of rehabilitation as opposed to a doctrine of retribution.  The attempt to regard social misbehavior as an organic disease (as it must be if the brain is a mind of the organ) met with a storm of protest.  An article in Harper’s magazine in 1852 is as follows: “Phrenology’s aim is wholly to unspiritualize what hitherto has been called sin or crime.  Thus its features lose much of their intolerable hideousness.  This undoubtedly is the great secret of the ready reception of phrenology and phrenologic works in penitentiaries and state prisons.  Prison reformers maintain that Combe and Spurzheim produced repentance and reformation more than the Bible and direct preaching of the gospel.  Phrenology locates crime in the brain, a phrenological malady, cured by dietetic regimen, treated in hospitals and asylums, soothed into repentance with music, flowers and fetes instead of what they rightly deserve, whips, prisons, and the gallows.”  It is of note that even as of 1988 at least 8 prisoners in the United States on death row have Huntington’s chorea and many many more have mental retardation with IQ’s less than 70. 

            Localizations of the functions of the various parts of the brain began being discovered in the late 1800’a.  Great names in this development include Hulings Jackson in 1864, the papers of Fritz, of Hitzig in 1870, of Horsley in 1886, and reaching its zenith with Walter Penfield in 1928.  For the last 50 years in American neurosciences it has been axiomatic that various parts of the brain serve specific functions: the occipital lobes of vision, the temporal lobes hearing and speech, the dominant hemispheres subserving speech and the nondominant hemispheres subserving special localization, the cerebellum subserving coordination of the motor movement and the basal ganglia is the repository of automatic and motor movement.  However, the basic question posed by the phrenologists, that is ‘where’s the mind’, that the ‘mind’ is located in the brain, even today has scant scientific evidence supporting its view.  We all know that in patients with Alzheimer’s disease, acetel choline and the neurons of the substantia innominata are disturbed and that in this condition the patients have a massive intellectual decline.  However, no one asserts that the ‘mind’ is in fact located in the substantia nominate. New imaging techniques are even challenging our long-established dogmas of the cerebral localization.  For example, patients with lesions of the motor cortex do not invariably suffer hemiparesis.  PET scans are able to detect metabolically active areas of the brain, and in hydrocephalics with no intellectual, motor or perceptive deficit, may have an area of the brain no larger than a quarter that is actually functioning.  Amongst the many lessons we can learn from the phrenologists of the 1800’s are that careful clinical and pathological correlations must always be made in order to test the validity of any theory.  One must also approach any scientific project without any preconceived notions of the outcome, and we must be particularly careful to isolate our medical science from politics, prejudice, and personal financial concerns.