Clinical manual of mental diseases : for practitioners and students / by A. Campbell Clark.

  • Clark, Archibald Campbell, 1851-1901.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual of mental diseases : for practitioners and students / by A. Campbell Clark. 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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    case; but though clear and distinct from each other, thev are probably the result of one fundamental obsession of persecution, and one is more predominant than the other. Indeed, the exalted idea often appears very early in the second stage, and in such a case there is no dividing-line between the second and the third stage at all. The fourth and last stage is that of dementia, with all the mental powers reduced, and a condition of fatuity as the result. Respecting this there is also some controversy, for the disease is said to last from twenty to forty years; and if we take the latter period, dementia in any case ought to be an inevitable result in many cases on the score of senility alone. Falret, while admitting a weakening of intellect towards the end of the grandiose period, and a more confused state of mind, refuses to acknowledge the existence of a period of dementia as an essential fourth stage of the disease. This, however, is a matter of small moment, for the tendency of all forms of chronic insanity is towards dementia, just as the tendency of life prolonged is towards senility. From chronic progressive delusional insanity we must differentiate melancholia, subacute or chronic alcoholic insanity, insanity of adolescence, epileptic insanity, general paralysis. It may appear a simple matter to do this ; but we must remember that we have here described the whole life- history of the disease, extending over thirty or forty years; and no such case will come to us with the whole life history —past, present, and future—opened out before us. The diagnosis therefore becomes more perplexing in proportion to the meagreness of the history presented to us. In melan- cholia the essential feature is distinct mental depression, an unmistakable grief; the melancholic is more disposed to accuse himself, not others ; his delusions are different, and persecution has no place in his thoughts. He is more likely to give evidence of bodily causes or accompaniments. Besides, the genesis and the manner of onset of the disease are different in both cases, and the mercurial variations of the melancholic are in contrast to the systematic sameness, the gradual pro- gressive development on the same line, of the mental history of chronic progressive insanity.