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Living with Dementia

Dementia during the nineteenth century

  • - Dementia: general aspects
  • Jun 20, 2011
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Tags: | amentia | bucknill | calmeil | cause of dementia |

Because in the past the mentally ill: ‘had been categorized only in terms of a [putative] impairment of their mental faculties ...’ (p. 2), Morel (1860) endeavoured to develop a taxonomy that distinguished between occasional and determinant causes of mental disorder (p. 251) and suggested six clinical groups: hereditary, toxic, associated with the neuroses, idiopathic, sympathetic and dementia In regards to the latter, Morel (1860) believed that:

... if we examine dementia (amentia, progressive weakening of
the faculties) we must accept that it constitutes a terminal state.
There will, of course, be exceptional insane individuals who,
until the end, preserve their intellectual faculties; the major-
ity, however, are subject to the law of decline. This results from
a loss of vitality in the brain ... Comparison of brain weights in
the various forms of insanity shows that the heavier weights
are found in cases of recent onset. Chronic cases show more
often a general impairment of intelligence (dementia). Loss in
brain weight - a constant feature of dementia - is also pre-
sent in ageing, and is an expression of decadence in the human
species. [There are] natural dementia and that dementia result-
ing from a pathological state of the brain ... some forms of
insanity are more prone to end up in dementia (idiopathic)
than others ... it could be argued that because dementia is a ter-
minal state it should not be classified as a sixth form of men-
tal illness ... I must confess I sympathize with this view, and it is
one of the reasons why I have not described the dementias in any
detail ... on the other hand from the legal and pathological view-
points, dementia warrants separate treatment ... (pp. 837-838).

Morel’s view is in keeping with his ‘degenerationist’ hypothesis, which he himself had developed three years earlier (Morel, 1857; Pick, 1989). One consequence of this view was that there were no specific brain alterations in dementia.

In spite of his early death, L. F. Marce published a series of important articles on the neuropathology of senile dementia which challenged Morel’s non-specificity hypothesis.

There is no space in this section to analyse with the same level of detail the evolution of the concept of dementia in other European countries, although it can be said that it followed similar lines. Views in England,  for example,  were mainly derivative from French ones. In a popular textbook, and following Pinel, Esquirol and Calmeil, Prichard included a category which he called ‘incoherence or dementia’:

[it] is a very peculiar and well-marked form of mental disorder.
The mind in this state is occupied, without ceasing, by uncon-
nected thoughts and evanescent emotions; it is incapable of
continued attention and reflection, and at length loses the fac-
ulty of distinct perception or apprehension. Numerous examples
of this disease, or decay of the mental powers are to be met
within every receptacle containing a considerable assemblage
of deranged persons ... incoherence is either a primary disease,
arising immediately from the agency of exciting causes on a
constitution previously health, or it is a secondary affection,
the result of other disorders of the brain and nervous system
which, by their long duration or severity, give rise to disease
in the structure of those organs ... secondary incoherence or
dementia follows long-protracted mania, attacks of apoplexy,
epilepsy or paralysis, or fevers attended with severe delirium.
This decay of the faculties has been termed fatuity or imbecil-
ity, and it has been confounded with idiotism, which in all its
degrees and modifications is a very different state ... (pp. 83-85)
(Prichard, 1835).

The same can be said of the views expressed by Bucknill and Tuke in their popular textbook:

Dementia may be either primary or consecutive;  acute or
chronic. It may also be simple or complicated; it is occasion-
ally remittent but rarely intermittent. It is primary when it is
the first stage of the mental disease of the patient; and when
this occurs, it is, perhaps, one of the most painful forms of insan-
ity; the patient often being acutely sensible of a gradual loss
of memory, power of attention, and executive ability. At this
period, the distinction is often well marked between the strictly
intellectual and affective disorder ... dementia is much more
frequently consecutive, that is the consequence of other dis-
eases of the mind. Thus during 44 years, while 277 cases of
mania and 215 of melancholia were admitted at the Retreat,
only 48 of dementia were admitted during the same period;
yet, at the end of that term, there were remaining in the insti-
tution, 20 patients in a state of dementia out of 91 inmates.
Mania very often degenerates into dementia; as also do melan-
cholia and monomania ... it should be observed, that the term
dementia may be,  and sometimes is,  too indiscriminately
employed. All writers of authority agree in representing impair-
ment of the memory as one of the earliest symptoms of demen-
tia; but we believe cases are occasionally classed under incipient
dementia,  in which close observation would show that the
memory is unimpaired ... It is often rather a torpid condition of
the mind, falling under the division ‘apathetic insanity, which
ought not to be confounded with dementia ...’ (pp. 117-119)
(Bucknill and Tuke, 1858).

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