DEMENTIA PRAECOX 
BY 
amos j. Givens, m. d. 
STAMFORD HALL 
STAMFORD, CONNECTICUT 
U. S. A. DEMENTIA PRAECOX 
What is known as Dementia Praecox is a disease of the 
entire organism, characterized by a state of feeble-mindedness 
that may or may not be permanent. It has been described as an 
organic process that has to do with the inner life of the individual 
and which accompanies his development. In its numerous mani- 
festations, this early weakening of mental power ranges from 
simple stupidity or dullness to profound stupor with marked 
muscular rigidity. There exists in all forms of the disease a 
complete paralysis of the will with a consequent loss of power 
for any kind of intellectual effort. The unnatural indifference 
that results may be varied by outbursts of anger and periods of 
excitement, though rarely by spontaneous activities that are use- 
ful. Violence or excitement seldom lasts more than a few days 
at the most, and is not a distinguishing feature of this form of 
mental trouble. Appearances are often against young men and 
young women suffering from Dementia Praecox, for they may 
seem dazed and altogether stupid even when retaining a fair 
degree of understanding and a very good memory. In many 
instances they know where they are, the day of the week, month, 
and year, and easily recall what happened in childhood, as well as 
events that take place from day to day, and later surprise their 
friends by minute accounts of various incidents that seemed at 
the time to make no impression upon their slow and dull powers 
of comprehension. 
Though weakness of mind is the essential feature of Demen- 
tia Praecox, it is not general and complete, but is confined in the 
beginning to certain qualities like judgment, imagination, con- 
centration, and tenacity of purpose. The power of attention is 
always lessened, with the result that the association of ideas is 
carried on so slowly that speech may become vague and discon- 
nected. 
External impressions have undue weight, owing to the effect 
of disease upon the force and activity of the will. A state of 
3 meaningless emotion is often an early symptom. Tears and 
laughter come without adequate cause, or for no cause at all. 
The patients do not know why they laugh. They find it equally 
impossible to give any reason for their characteristic habit of 
doing silly things in a fantastic manner, such as repeating over 
and over again the same peculiar movements, the same words 
or syllables regardless of sense, imitating the actions of those 
about them, remaining for a long time in the same attitude, grim- 
acing and keeping certain muscles of the face in a state of fixed 
contortion. Nor can they explain their sudden impulses to anger, 
their fierce retaliation toward others for some accidental irrita- 
tion, nor their desire to injure and destroy inanimate objects. 
Even stranger than the foregoing peculiarities, more incompre- 
hensible than the silly mannerisms and foolish laughter is the 
condition known as negativism, or psychic interference, a perverse 
frame of mind that prevents those suffering from Dementia 
Praecox from doing what they really want to do, from putting 
into execution some plan that they really wish to see carried out. 
Negativism has been described as the blocking off of some natural 
impulse by a contrary reaction of the mind, an involuntary im- 
pulse to do the exact opposite of what is demanded or required 
by others or even desired by the patients themselves. In the act 
of stretching out the hand, walking across the floor, making a 
want known, performing some little duty, such as dressing or 
eating, they seem suddenly fixed into a state of more or less 
rigidity and nothing is brought to pass. These contrary unnat- 
ural and antagonistic impulses account in great measure for 
apparent stupidity and for eccentric conduct. 
"An order given is not executed. Pricking, even when deep, 
produces no movement; not because it is not felt, but because 
voluntary action is annihilated. Interesting forms oi negativism 
are mutism and refusal of food." And it is this same negativism 
or psychic interference that brings about increased muscular ten- 
sion, a hypertonicity of the muscles that ranges from mere awk- 
wardness of movement to extreme rigidity of the body. In three- 
fifths of all the cases that come under medical observation, this 
form of mental enfeeblement appears before the age of twenty- 
five. Occasionally attacks resembling it in every particular come 
on for the first time during middle life and among the aged. 
Such mental disorders are regarded as states of delayed Dementia 
Praecox. Mild cases in early youth are often unrecognized, pass- 
4 ing for indolence, ill-humor, simple neglect of duty, or general 
disobedience. They are of far more frequent occurence than is 
generally supposed, recovery talcing place without apparent defect. 
For convenience, the diseases belonging to the Dementia Praecox 
group are separated into three divisions. The first includes con- 
ditions of hebephrenia, the second, those of what is known as 
catatonia, and the third comprises the paranoid forms of Dementia 
Praecox. Some authorities look upon catatonia as the classic type 
of the disease, the others being but modifications or deviations 
from this extreme form. Hebephrenia, which literally means 
"the mental abberation of madness of youth," is the mild type of 
Dementia Praecox that is associated with the onset of puberty 
and adolscence. It develops gradually, often with headaches, 
insomnia, loss of appetite and general weakness as its earliest 
symptoms, together with a change in character that is noticed by 
friends and a state of general apathy and indifference. Ordinary 
affection, the usual interests of youth, intelligence or even 
brilliancy of intellect are now replaced by listlessness and perhaps 
stupidity. Amusements are apparently as wearisome as work. 
The patient is inert, silly, disinclined to move, and finally does 
nothing. New ideas are not acquired, with the result that as time 
passes general ideas seem more and more limited in number and 
force. The word catatonia, used to designate the most striking 
form of Dementia Praecox, is Greek in origin and signifies "ten- 
sion." The mental and bodily condition to which the term 
applies when it develops regularly is first characterized by Mel- 
ancholia, then by mania, and later if not arrested through treat- 
ment and care, by dementia and physical decay. It is in cata- 
tonia that the counter impulses, preventing normal activities are 
most marked. The chief premonitory symptoms of catatonia are 
a change in disposition, inability to do any work and sleepless- 
ness. There may be mental depression, later associated with 
delusions and hallucinations that are not infrequently of a 
religious nature. In catatonia the general muscular tension is 
often so great that it results in some fixed position of the body 
or parts of it, positions that may be maintained for hours at a 
time or even for days, weeks, and sometimes for months. All 
sorts of positions may be assumed, those that in health would 
prove very uncomfortable or even impossible. Perhaps the most 
frequent of all is where the patient lies upon the back with limbs 
stretched out, either with the eyes closed, or always open and 
5 staring into distance, the face without expression and the slightly 
closed lips somewhat protruding. The hands are most often 
clenched, with the nails pressed into the palms. Other patients 
stand motionless in some constrained attitude, or sit doubled up 
on the floor, or lie in bed rolled up like a ball. They may turn 
away when spoken to, or hide the head under the bedclothes. 
When the muscular tension is less profound, the limbs may be 
put into any position chosen by the physician or nurse, and 
remain thus fixed regardless of what, in health, would cause 
great discomfort. In all cases muscular tension is not alike all 
over the body, but is greatest in the hands, arms and lower limbs. 
The gait is often influenced by this condition, some patients being 
unable to move at all, falling rigidly to the floor when raised 
to their feet; others walk stiffly on tip toe, or on the outer side 
of the foot, and with unbent knees, with the body bent forward 
or backward. The movements are slow and constrained. Some- 
times the counter impulses may be suddenly overcome and the 
movements become rapid. Every grade of stiffness and awk- 
wardness may be observed from the slightest to the most pro- 
nounced. When excitement comes on, it usually makes its ap- 
pearance suddenly. The inert patient may suddenly leap from 
the bed, tear clothing, rush about the room, overturn furniture 
and shout and sing. 
The paranoid forms of Dementia Praecox may develop and 
run their course in one or two different ways. In the first, some 
slight degree of bodily restlessness appears, together with many 
constantly changing and incoherent delusions and hallucinations. 
Consciousness is not impaired for a long time, but the general 
mental weakening takes place rapidly and without remission. 
Distinct signs of mental failure are apparent in a few months, 
and it said to be well marked in about two years. In the begin- 
ning there are no definite physical symptoms beyond loss of 
weight, insomnia and interference with general nutrition, and 
the usual mode of onset in this disease. The second group of the 
paranoid form of Dementia Praecox is characterized by hallucin- 
ations and extravagant delusions of grandeur and of persecution. 
These are present for a number of years, finally disappearing and 
leaving the patient in a state of moderate feebleness of mind. In 
this second group there is a slow gradual weakening of mental 
power. The first change, as in all forms of Dementia Praecox, 
is in the disposition. 
6 Then delusions of persecution appear, followed by delusions 
of grandeur. As these fade away, the mind shows much weak- 
ness. Though it is difficult for persons suffering from the par- 
anoid forms of early dementia to adapt themselves to external 
conditions, even when the acute stage is passed, it is still pos- 
sible for them to perform useful work under proper guidance. 
The early or premonitory symptoms of Dementia Praecox are in 
no way peculiar to the disease itself. They are, as earlier stated, 
for the most part common to all conditions of faulty metabolism 
and malnutrition. There is a feeling of weakness, disturbed sleep 
or actual insomnia, want of appetite, indigestion, flatulence, and 
sometimes vomiting. Later a tendency toward excessive eating 
may develop. The heart's action is often weak and irregular. It 
may be retarded, and it is sometimes more rapid than in 
health. The temperature may be sub-normal. There is a ten- 
dency to lose in weight during the early stages of the disease. 
Later the contrary condition may prevail, the patient becoming 
stout, and occasionally very fat or even unwieldy. While physi- 
cal disorders are very common in Dementia Praecox, they are 
seen most frequently in the form known as catatonia. No one of 
them appears with any marked degree of constancy, nor is there 
a single physical sign that is confined solely to this particular 
morbid process. An important characteristic of the disease is the 
variability of its symptoms. Whatever form it takes any case of 
Dementia Praecox that has recently developed may suggest 
hysteria, owing to its similar manifestations, such as mental 
depression, sudden outbursts of excitement, the oppression in 
the throat, the sensation of a nail driven into the head, fainting 
fits, epileptiform seizures and even convulsions similar to classic 
hysterical attacks. Difficulties of locomotion and disorders of 
movement are not uncommon, such as a transient paralysis of one 
side of the body or of an arm or leg. Other conditions that may 
be noted in some cases are a general enlargement of the glands, 
excessive perspiration, a bluish tint of the surface of the body, 
and a tendency for a mark drawn on the skin with the nail or 
pencil to remain as a white or red line. The sensibility of the 
skin may be disordered. Areas of tenderness or of anaesthesia 
are sometimes present. The pupils may be dilated, especially 
when stupor or excitement exists. They are occasionally unequal. 
In women, menstruation nearly always ceases or is absent for a 
time. Tension reflexes are usually increased, and there is also 
7 muscular irritability. There may be swelling of the hands and 
feet, and other manifestations of impaired circulation and defec- 
tive metabolism. Of all these varying physical symptoms, the 
most significant are the increased muscular tension, the dimin- 
ished sensibility to pain, and the various pupillary phenomena. 
As far as conduct goes, the chief characteristic signs of Dementia 
Praecox are foolish laughter and silly mannerisms. 
A word of warning recently uttered by an expert in regard 
to diagnosis deserves special emphasis and the highest commenda- 
tion. It calls attention to the fact that it is always most unwise 
and very unscientific to classify all forms of the mental diseases of 
youth that are characterized by apathy and foolishness as Demen- 
tia Praecox, and to imply that deterioration with the ultimate 
extinction of mind is the probable outcome of all such unfortun- 
ate conditions. Kraeplin himself states that in seventeen per 
cent. of the cases of true Dementia Praecox, the condition of 
dementia never sets in, and that in a large number of others there is 
a long interval during which time the patient enjoys perfect health 
and is a useful member of the home and of society Persons who 
are valuable to themselves, and others for many years, and perhaps 
during the whole of life following an early attack of mental 
trouble, from a practical point of view, cannot be considered to be 
suffering from chronic mental disease. Many forms of pubescent 
adolescent, masturbatic insanity, and the psychoses of exhaustion 
are entirely recovered from, and are quite distinct from Dementia 
Praecox, in the true sense of the form. In the main they have 
no place in this particular group. Experience and expert skill 
are essential to the complete differentiation of all these condi- 
tions. The diagnosis of Dementia Praecox is clearly recogniz- 
able at an early stage. In other words, Dementia Praecox should 
be an established fact before any definite diagnosis is made by 
the general practitioner, the consultant or any one to whose care 
the patient is confided. Among the young the necessity of sus- 
pending judgment is at once apparent when their astonishing 
reserve of vitality and recuperative power are taken into con- 
sideration. What might appear a serious mental handicap in 
middle life or during advanced age, is often merely an incident 
of youth that is destined to fade away and leave no traces. 
Diseases with which Dementia Praecox may be confounded at 
some of its stages are mania, simple melancholia, hysteria, cer- 
tain forms of confusional insanity, an early phase of manic- 
8 depressive insanity, and true paranoia. In none of the foregoing 
conditions is there the same muscular tension as in Dementia 
Praecox, nor the same tendency to a rather rapid weakening of 
the mind. Neither is there in any of the states just mentioned 
the same degree of "negativism" or psychic interference with 
normal thought. Pathological indifference or emotional deterior- 
ation also exists in manic-depressive diseases; but in manic- 
depressive insanity the patients are not up to little pranks and do 
not laugh at nothing. More than this, in their case the mind is 
not so definitely impaired. In Dementia Praecox, its weakening 
state is one of the most noticeable features of the disease, even 
in cases that make what are known as good recoveries later. 
The alleged causes for the development of Dementia Praecox 
are as varied as in other forms of mental disease. Among them 
are excessive study and too close confinement in the school-room 
infectious fevers, such as typhoid, scarlet-fever, and malaria, to- 
gether with sexual excesses of all kinds, indulgence in alcohol, 
poisoning by illuminating gas and carbonic oxide, together with 
fright, morbid emotions, shock, disappointment and grief. Lack 
of physical development of the skull, brain and other organs 
seem to favor the appearance of this disease. In persons already 
deficient, such as alcoholics, syphilities, idiots and imbeciles, 
Dementia Praecox may develop without other causes than exist- 
ing mental and physical inferiority. Whether Dementia Praecox 
is an accidendal or a constitutional process is as yet unknown. 
There is a general trend of opinion among some authorities that 
it is primarily an infectious process, due to abnormally altered 
secretions along the genital tract. Those who hold to this idea 
give as possible proofs, the fact that it appears during the evolu- 
tion of complete individual sexual life, and that it often follows 
child-birth. Though denying that it is in any sense a degenera- 
tive process, others affirm the chief factor in its production is 
some form of defective heredity. 
How far preventive measures can mitigate the process ot 
the disease or secure immunity from it is as yet unknown. When 
a tendencjr to early dementia is noticed, when there are periods 
of exhaustion and a change in character and disposition, a new 
environment that favors a healthy normal life, together with 
judicious training, avoidance of all strain, and proper care of the 
physical health, gives the best chance of warding off this abnor- 
mal and destructive condition. Headache, insomnia, loss of 
9 appetite, irritability, suspicion, and a change in character in any 
young person are all danger signals well worth regarding with 
the utmost attention if catastrophes are to be averted. They may 
not always be the forerunners of early mental enfeeblement, but 
they do denote an unstable nervous system and a strong possibil- 
ity of some form of future nervous disease unless the most nat- 
ural conditions of living are secured. An environment that 
makes exercise in the open air possible with companions of .suit- 
able age, together with judicious tasks and training, long hours 
of sleep and an abundance of good plain fare, is the one to seek 
for dispirited and easily exhausted boys and girls. When Demen- 
tia Praecox has definitely declared itself, the best possible plan 
is to place the person thus handicapped in some institution where 
constant medical supervision is possible. The general condition 
and special symptoms can be carefully studied in a well ordered 
institution and the degree of liberty compatable with the patient's 
highest good in this way can be decided upon. Light work of 
any kind, when the patients are capable of doing it is an excellent 
antidote for many of their morbid impulses. Well directed 
efforts that accomplish a definite object are in this way actual 
curative agents. Getting the patient to read aloud, when it can 
be done, will aid in breaking up the habit of indefinitely repeat- 
ing the same phrases or verses, perhaps do away for a time with 
the tiresome string of syllables that merely sound alike and have 
no meaning. Sustained physical exercises seem to lessen the ten- 
dency to impulsive acts, to negativism and fixed attitudes. 
Dementia Praecox, like many other forms of mental and nervous 
diseases in the young, is in the main a disease of lowered 
vitality. 
The proper nourishment of the body is a matter requiring 
the attention of an experienced physician. Appetizing food of the 
best quality that is carefully prepared and properly served is an 
important element of cure. Usually a full nutritious diet varied 
each day is of greatest value. Exceptionally, some special form 
of feeding may be required for a time, as an exclusive milk diet, 
or one in which flesh foods have no part. Exceptionally beef 
peptonoids, extract of beef, defibrinated meats, fresh meat juice, 
entire wheat flour, gruel, and prepared patent foods may prove 
valuable adjuncts when ordinary diet fails to accomplish its usual 
purpose. Vegetables, fruit, milk, butter and eggs, without des- 
sert or made dishes, give the best results in certain instances. 
10 Sometimes fruit fails to agree with the patient, and has to be tem- 
porarily discarded. Here, as in all conditions in which the entire 
organism is at fault, the peculiarities of the individual must be 
considered. Not alone what the patient eats, but what he has the 
power to assimilate and transform into good blood, is the correct 
diet for him, one that will aid in overcoming special abnormal 
tendencies and is carrying on the good work of building up new 
cells of greater resistive power. 
The treatment of all forms of Dementia Praecox is of neces- 
sity both general and symptomatic, as in other states where the 
entire organism suffers from any marked and abnormal disease 
process. Special attention must be given to nutrition and elimin- 
ation, to the complete activity of all the functions of the body. 
While the disease may or may not be due to auto-intoxication, 
treatment is most successful when the patient is placed under 
conditions best adapted to overcome the influence of constantly 
active morbid products, that act as poisons to the entire organism. 
Plenty of fresh air, peace of mind, and the absence of fatigue, 
and of all bodily strain, offer the most hopeful chances of over- 
coming unfavorable tendencies 
In the selection of remedies, whether' the state of mental 
aberration is characterized by excitement or depression or neg- 
ativism, the careful study of the individual case and use of the 
indicated remedy gives the best results. 
11 T)R. GIVENS' SANITARIUM; 
STAMFORD, CONNECTICUT 
u. S. A. 
* 
50 MINUTES FROM NEW YORK CITY 
44 TRAINS EACH WAY DAILY