Commentaries on the Causes, Forms, Symptoms, and Treatment, Moral and Medical, of Insanity

COMMENTARY X.

DEMENCY OR FATUITY.

THE Condition of the mental faculties designated moria or morosis by the Greeks, and amentia and dementia by later authorities, is recognised by nosologists as a distinct genus; but, like mania or melancholia, it is only a variety it is liable to the same alternations, and is met with both in an active and chronic form.

It is defined to be a defect or hebetude of the understanding, general or partial, confined to individual faculties of the mind, particularly those concerned in associating and comparing ideas; whence proceeds great confusion and incapacity of arranging the thoughts, though they are sometimes very vivid, a partial or total loss of memory, a relish for childish pursuits, with garrulous babble or drawling speech, impotency, and diminution or loss of the powers of volition, and premature senility.

The countenance and eye are dull and stupid, the gait feeble or lounging, appetites depraved, unconsciousness of the calls of nature, abdomen frequently tumid, and little disturbance of general health.

The faculties in demency are not, however, always abolished; they are often in abeyance only, and may revert on the cessation of the morbid action inducing this condition, or on the improvement of the corporeal powers, when they have been impaired by disease or any extenuating cause.

Esquirol draws a faithful picture of demency.* Per

Dict. des Scien. Médic. art. Démence.

sons are in this state, he says, because exterior objects. make too weak an impression upon them, which is owing either to the sensitive organs becoming weakened, or the organs which transmit the sensations having lost their energy; or, finally, because the brain itself has not sufficient power to receive and retain the impression which is transmitted to it; whence it necessarily results that the sensations are feeble, obscure, and incomplete. Therefore the patient can neither form a correct idea of objects, nor compare, associate, or abstract ideas; he is not susceptible of sufficient attention, the organ of thought being deprived of that tone which is necessary to the integrity. of its functions.

There is a marked difference between demency and imbecility or idiocy. The connate imbecile never had his mental faculties fully developed, and therefore never attains the ordinary standard of adult intelligence. True demency implies a previous possession and exercise of the mental faculties; but one or more of those faculties may, by accident, disease, or age, have become simply deteriorated. The conversation and manners of the latter preserve some traits of the character of the original man; those of the former always retain the impress of childhood. The connate idiot never possessed any intellectual endowment; there is neither sensation, memory, nor judgment. He displays mere animal instincts, and his internal and external conformation indicate the vices of cerebral organisation.

The depravity of the mental faculties which characterises demency is very apt to be confounded with permanent mental alienation, imbecility, or absolute idiocy; in consequence of which many cases have been pronounced irremediable, which might, by judicious treatment, have been restored to reason.

Demency may alternate with mania or melancholia, or it may, which is more usual, be the sequel of either.

It may continue several weeks or months, and suddenly cease; and instances have been known of its preserving its pristine form for years, and at length the understanding be restored; or it may degenerate into chronic fatuity or perfect idiocy.

When this condition of the mental faculties succeeds mechanical injuries of the head, violent evacuations, venery, masturbation, paralysis, epilepsy, or old age, it assumes the chronic form, and is generally a permanent affection.

Demency is often a mere concomitant of other forms of insanity; and then is usually quite temporary. This fact is particularly worthy of remark, because the appearance of fatuity frequently leads to the hasty prognostic, that a patient is sinking into an irremediable chronic state, or that it is the result of excessive depletory practice. It is advisable, when such symptoms appear, to wait; for a few days, perhaps, prove, by the remission of the symptoms, the fallacy of either of these conclusions.

This mental condition may be the effect of general debility, or of long-continued maniacal action itself, producing atony of the organ of intelligence (the brain); and this is the common termination of all cases of insanity when really incurable, provided that the patient live long enough for this organic change to take place.

When it succeeds insanity, it may come on suddenly or slowly patients sometimes appear to be improving, or convalescence even to be advanced, and suddenly, or in a very short time, lose their intellectual powers. This state is often preceded by an attack of acute paralysis, and generally the muscular powers are partially impaired. All who, after a marked amendment, or an equivocal cure, fall into this state of mental alienation, even without paralysis, remain incurable: no excitant can then renew the energy of the brain.

When demency comes on slowly, it is almost impossible to fix the exact date of its origin; but the signs which characterise it soon leave no doubt of its existence: if the patient becomes suddenly furious or agitated, fatuity disappears, and afterwards he will cease his noisy babble, be tranquil, and sleep profoundly.

When reduced to this hopeless state, ideas the most opposite and extravagant succeed, without connexion or motive, and his conversation then becomes quite incoherent. He utters words or sentiments without attaching any precise meaning to them; and talks without the consciousness of what he says. Memory is often sufficiently retentive to remember some stories of past-gone days; but they are repeated, as it were, from an involuntary or automatic impulse, or recollection is revived by fortuitous accordance with objects which actually strike his obtuse senses.

Before insanity thus degenerates, the delirium either remains the same a long while, or varies in character or intensity. In this state it is often very difficult to decide if there still exist a hope of cure, or if the disease be incurable. Should it continue above two years, the ordinary limitation, it is very rarely cured.

This state too of the intellectual faculties is often the consequence of paralysis or epilepsy. It is then a hope

less case.

As authors have commonly neglected to treat this as a distinct and active form of mental derangement, I shall refer to, and quote more particularly, the information conveyed by Esquirol and Georget relative to it. I feel besides a conviction of the general fidelity of their descriptions. Perhaps, as is usual with the French, there is too much refinement and fondness for system in their division into species, &c. But it is desirable to incite, if possible, by their example, a more minute attention to a condition of the mind frequently met with in all public

institutions for lunatics, and which, I verily believe, is neglected because it is not well understood.

Esquirol divides demency into two species, simple and complicated, and each species into four varieties. The proportions of poor women so affected in La Salpetrière, and of those in his private establishment, who are persons in good circumstances, and of both sexes, he has thus arranged:

TABLE OF THE SPECIES OF DEMENCY.

Simple Species. In La Salpetrière.

In Esquirol's Establish.

1. Acute demency.

......

2. Chronic demency

3. Senile demency.