Insanity : its classification, diagnosis, and treatment; a manual for students and practitioners of medicine / by E. C. Spitzka.

  • Spitzka, E. C. (Edward Charles), 1852-1914.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Insanity : its classification, diagnosis, and treatment; a manual for students and practitioners of medicine / by E. C. Spitzka. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    in order to fully characterize their varieties, to state what primary form preceded the dementia. Thus we say: de- mentia follows mania, melancholia, or stuporous insanity. Sometimes we are enabled to determine from the demented patient's symptoms what the primary form of his insanity was; in one case we may find residua of the delusions of marital infidelity with physical symptoms indicating the previous existence of alcoholic mania, in another the delu- sions of persecution, and incoherent ideas growing out of such, which point to the previous existence of melancholia. Dementia must not be confounded with imbecility; while both dementia and imbecility imply a profound general de- fect in the mental sphere, the former term should be always limited to acquired enfeeblement, the latter to the original feeblemindedness due to foetal or infantile arrest of develop- ment. Much confusion has also arisen from the unfortunate use of the terms acute and primary dementia. Acute dementia is applied to a primary insanity more properly d esignated as acute stupor, while primary dementia is in- differently applied to stupor, insanity of pubescence, and primary deterioration. The designation dementia should be limited to permanent mental deteriorations, and a dis- crimination should be made between the dementia from gross organic disease of the brain, the paretic dementia to be considered in a later chapter, and that senile dementia which is a natural manifestation of brain-involution on the one hand, and the trouble we are here considering, which implies the previous existence of some well-marked primary form or the other. The course of the development of this secondary insanity is twofold: either the primary disorder passes directly into dementia, or it does so indirectly, through an intermediate stage of chronic secondary mania, with confusion of ideas and mental enfeeblement as prominent features. When dementia follows the latter affection it is tertiary. But, as it does not in this case materially differ from the demen- tia which is a more direct sequence of and secondary to the primary forms of mental disturbance, it is best to de- vise some common term for both. The framing of such a term may be based on the fact that, whether secondary or tertiary, these varieties of dementia, in contradistinction to the primary dementia from coarse brain disease and senes- cence, are the terminal epochs in the history of prior psycho- sis. They may hence be termed terminal dementias,