Amentia and dementia : a clinico-pathological study / by Joseph Shaw Bolton.

  • Bolton, Joseph Shaw, 1867-1946.
Date:
1905
Catalogue details

Licence: In copyright

Credit: Amentia and dementia : a clinico-pathological study / by Joseph Shaw Bolton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    hopes that recognition of the fact that mental disease consists in essence of a large group of cases with varying degrees and types of cerebral degeneracy and of another larger group with varying degrees and types of cerebral dissolution will be of value at a time when, with the object of elucidating the etiology of insanity with a view to its prevention, even a bacterial origin of mental alienation is being seriously dis- cussed. If the views expressed in the present paper deserve credence, future attempts to deal seriously with the incidence of mental disease will treat the subject, not as a branch of infectious disease or at least of toxaemia, but as the greatest of the degeneracies ; and an endeavour will be made on the one hand to discover and to minimise the causes which lead to cerebral degeneracy, and on the other to diminish the “ stress ” (in the widest sense) to which actual degenerates are subjected, with the object of decreasing the degree and the frequency of cerebral dissolution. In the experience of the writer cases of “ amentia ” possess “ stigmata of degeneracy,” eg, abnormalities of the skull, face, ears, palpebral fissures, teeth, palate, mammae, hair, etc., more frequently and in greater severity than do normal individuals or even other types of mental disease. They more frequently have an heredity of mental alienation and, not uncommonly, two or more members of the same family may be found in the same institution. They are also the cases about whom, apart from purely domestic reasons, the friends are never tired of instituting inquiries or expressing desires for their discharge ; and it is amongst the friends of these types that the major portion of “ borderland ” cases of mental disease are found. Finally many of the milder cases of amentia are in asylums because they are so unstable that they cannot be kept outside them for any lengthened period, rather than because they con- stantly exhibit abnormal psychic manifestations. In other words, apart from senile or pre-senile involution of the cortical neurones, or from neuronic degeneration due to primary and direct toxaemia of the cerebrum or to systemic diseases, eg., vascular lesions and emboli, carcinoma, the very rare cases of tuberculosis of the brain, etc., these cases remain in a stationary condition for an indefinite period and do not develop dementia. It may, perhaps, however, be worthy of note here that the lower grades of amentia, eg, many idiots and imbeciles, fre-