Nervous and mental diseases / by Archibald Church and Frederick Peterson.

  • Church, Archibald, 1861-1952.
Date:
1908
Catalogue details

Licence: Public Domain Mark

Credit: Nervous and mental diseases / by Archibald Church and Frederick Peterson. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    This is perhaps least obvious with Ziehen. With him, the system of available terminology is responsible for his divisions to a great extent. In his general path- ology the system of his association-psychology also furnishes the backbone for pathological psychology. Given the headings of the chapter in normal psychology, one can construct with ease the subheads of the chapter on pathology. This form is naturally dry, and does not quite do justice to the readability of the very good observations of fact which are classified in this very systematic man- ner. The student may be grateful for the beautiful order ; but the practitioner does not see the things as the teacher puts them down. What is to him an entity of great precision and value is torn apart here, and he naturally asks, To what advant- age ? The beautiful order does not dispel liis fear that over the details he might fail to see the otherwise familiar and practically useful entity. When we come to the division on special psychiatry, the description of the actual disease-types, the psychological order is again uppermost, as we shall see later in our analysis. Kraepelin is diametrically opposed to this in his latest editions. It is true that he, too, sought his salvation in psychology, and classifies the facts in his general pathology somewhat according to the headings of Wundt's psychology. In the former editions he had but few headings of special disease-types, mostly in harmony with the accepted terminology built on a few standard types of disorders which are supposed to be open to psychological classification. Of these, I mention the stand- ards : States of depression (simple melancholia and melancholia with delusions); states of mental obscuration (hypnotism, somnambulism, epileptic and hysterical states ; stupor and ecstasis, and acute dementia); states of excitement (melancholia activa, mania, delirium); periodic psychoses (mania, melancholia, circular forms); paranoia; paralytic dementia ; states of psychic defect. In the fifth edition Kraepelin breaks loose from the satisfaction with this symp- tomatic compromise and proclaims the need of broader nosological principles ; medi- cal interests, not a psychological system, shall decide the classification ; the medical questions of course, prognosis, and outcome demand the first place : and among these the prognosis is the most important. He divides most of the so-called acute disorders into recoverable forms and psychoses of deterioration, and makes this divi- sion an important principle of classification. Superficially very heterogeneous symp- tom-complexes are thus brought under one head, and broader, not necessarily psy- chological or etiological, facts are the new guides. Wernicke is very decided in his antagonism to Kraepelin's sweeping innovation. He considers such an undertaking premature. Probably this is an extreme view. But he has a great point in his favor, that of frank admission that a complete com- prehension of all the psychoses is not to be expected to-day, that certain groups of cases, however, can be sufficiently understood and harmonized with our knowledge of neurological and psychological facts. On the other hand, he condemns all at- tempts to obscure the line of distinction between what is clinically known and what is not known, even if this be done under the appearance of leading to broader con- cepts._ We shall see that he himself does not use the same reserve in his own theories of localization. _A very concise and clear statement of Wernicke's position is contained in his article on the classification of psychoses. ^ He makes due reference to his predecessor, H. Neumann, who recognized only one insanity, or as many mental disorders as there are diseased persons, in con- trast to the dogmatic Griesinger, who built a psychiatry on psychological ideas with observations borrowed from the literature. Neumann was one of the founders of a conscientious symptomatology. He made a deep impression on Kahlbaum, whose work Wernicke considers the most valuable to this day, ^ although it is evidently encumbered by haziness owing to his desire to do justice to Neumann (especially the idea that all typical insanity shows four stages : melancholia, mania, confusion, and dementia). Kahlbaum's great merit is the distinction between Habitualbild (or Zustandsbild), i. e., the temporary symptom-complex, and the actual underlying disease ; and the recognition that most of the so-called forms of insanity are merely pictures of symptom-complexes without sufficient analysis of their nosological bear- ings. Wernicke next mentions Meynert, who adheres to the current headings of ^ Psychiatrische Abhandlungen, Heft 12. Breslau, 1899. Schletter'sche Buch- handlung. ^ ''IJeber die Gruppirung von Geisteskrankheiten,'' Danzig, 1863,