What Is Dementia

a selection from the beginning of the first chapter: FINAL STAGES OF DEMENTIA PRAECOX Gentlemen,—In general paralysis the inexorable results of the disease make it comparatively easy for us to recognise without post-mortem examination—at all events, at the end—that all the different forms of the malady are to be traced back to a uniform process of disease in the cortex of the brain. With other forms of imbecility it is a far more difficult question. In these the final conditions are in no way so similar that the homogeneity of the very manifold symptoms is made obvious by them alone. Not only do all possible gradations present themselves, from cases of the most favourable kind to those of the gravest imbecility, but also sometimes one and sometimes another relic from the earlier stage of the disease can give to the final condition its special colouring. In this way there arises, not only during the course, but also in the results of insanity, an absolutely confusing wealth of form. I can still only too well remember the perplexity with which I faced, throughout very many years, the vast number of states of mental weakness harboured by every large asylum. Their manifold manifestations were to a certain extent grouped together, but, in spite of all variety in outward form, definite characteristic features recurred with surprising uniformity. We are given the key to this confusion by the histories of individual patients. We learn from them that with the great majority of more or less imbecile patients those appearances which we have learnt to recognise in dementia praecox have existed previously, even if with varying degrees of distinctness. But they further teach us that where imbecility has been induced by different processes of disease, upon closer investigation the particular nature of the malady still remains recognisable, even in the final conditions. Therefore it is a fundamentally soluble problem, if at the same time a difficult one, not only to be able to predict, in the beginning of a mental derangement, the further course and result of the malady, but also inversely to form conclusions a posteriori upon the earlier stages of the disease from the final condition. It is not one particular form of imbecility with incidental variations which constitutes the result of the most varied kinds of uncured mental disorders, but every form of insanity, if not cured, leads to a final condition peculiarly its own. It is true that this peculiar condition invariably shows itself in the essential symptoms of the disease alone, whereas the incidental accompanying phenomena may greatly change. Our knowledge of what is essential is, unfortunately, at the present time very incomplete, so that often enough we must remain in doubt as to the meaning of a particular final condition, should we be without the preceding history. Still, even now, in a considerable number of cases, the careful observation of clinical symptoms makes it possible for us to trace out at least a rough outline of what has gone before from the final stage of the malady.