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very high, the proportion of these returned to the community as self-supporting individuals is small. Here, again, prophylaxis is difficult, and treatment is largely ameliorative.
INVOLUTION GROUP. The next group, a comparatively small one, includes the cases of depression coming first at the involution period of life, usually chronic, and leading to dementia, though not necessarily so. Dreyfus' has tried to show that they are really cases of manicdepressive depression, but his demonstration, though able, is not clearly convincing. Its pathology is unknown. The diagnoses included in this group are involution psychosis, melancholia, and chronic melancholia. Some of the cases here figured doubtless belong in the manic-depressive group, a few in the dementia præcox group, and possibly some in the organic brain-disease group. But since there are probably a few cases in each of those groups that would, if carefully diagnosticated, fall in this one, I assume that errors approximately balance each other, not only here but among the other groups as well. Of this group there were 539 cases, 3.6 per cent, admitted, and 414, 3.4 per cent, discharged. Of the discharges, 41, or 9.9 per cent, recovered; 53, or 12.8 per cent, became capable of self-support, and 174, or 42 per cent, died. The proportion of those able to support themselves, is rather small, the mortality is high. As in the case of the dementia præcox group, we are at a loss to know at what to direct our efforts at prevention and treatment.
PARANOIA GROUP. This small group consists of those cases of delusional insanity which begin fairly early in life, and is characterized by the gradual evolution of a system of delusions which grows more and more extensive, until almost everything and everybody in the universe is involved in it; it is chronic in its course, and, progressively, more and more trivial things and events come to have significance as confirming the patient in his delusions. There is no loss of initiative, or of interest in the daily affairs of life, or of memory. The
Georges L. Dreyfus. Die Melancholie: ein Zustandsbild des Manischdepressives Irreseins. Monograph. Jena, 1907.
pathology is unknown. It is a comparatively infrequent form of insanity, much fewer cases arising than the figures here indicate. The diagnosis is often made in cases of manic-depressive insanity or dementia præcox or toxic insanity because of the elaborateness of the delusions that sometimes occur in these diseases. The numbers here given are large because one hospital reports twice as many cases of paranoia as all the other hospitals put together. There should be about 105 cases admitted, 0.7 per cent of admissions. But as the figures stand, of this group, 251 cases, or 1.7 per cent of the admissions, were admitted, and 252 cases, or 2.1 per cent of the discharges, were discharged. Of the latter, 1, or 0.4 per cent, was considered recovered; 39, or 15.4 per cent, were capable of self-support, and 86, or 34.1 per cent, died.
UNDIAGNOSTICATED GROUP. Owing to the difficulties of diagnosis, this is a fairly large group, comprising 512 cases, or 3-4 per cent of admissions, and 191 cases, or 1.6 per cent of discharges. The difficulties of diagnosis lie chiefly between dementia præcox and manic-depressive cases, or between these and involution psychoses. As would be expected, the number of undiagnosticated discharges is much less than of admissions, prolonged observation serving to clear up some doubts.
SUMMARY AND CONCLUSIONS. From the foregoing figures it is apparent that nearly half the admissions (48.6 per cent) are of the organic brain disease and dementia præcox groups, and that these yield very few recoveries. Nearly one-third (32.4 per cent) of admissions belong to the manic-depressive and toxic groups, of which nearly half (47.8 per cent) recover. The remaining sixth of admissions is divided among the defective, involution, epileptic, paranoia, and undiagnosticated groups, in proportions varying between 5.9 per cent and 3-4 per cent of admissions, except in the case of the paranoia group. They furnish but few recoveries, of which a third are in the undiagnosticated group.
If we regard syphilis as the sole cause of general paralysis, more than a third of the cases of organic brain disease are preventable. Abuse of alcohol is the cause of 86 per cent of the cases of the toxic group. These two preventable diseases constitute one-fifth (20.8 per cent) of all admissions. Prophylactic efforts may well be directed to the control and suppression of these two causes of insanity. Such suppression would indirectly diminish by an undetermined, but probably large, per cent the number of defectives and epileptics. Next in importance, so far as numbers are concerned, would be the prevention of unnecessary overwork, in the hope of diminishing the number of manic-depressive cases.
Until we have learned more by continued study of the causation and pathology of dementia præcox, curative measures will be most fruitfully employed in the manic-depressive and toxic cases, to increase the percentage of recoveries and diminish the number of deaths.
By W. H. HATTIE, M. D., Medical Superintendent Nova Scotia Hospital, Halifax, N. S. The offering I bring to you to-day is merely an addition to the large number of family trees which have been prepared to illustrate the importance of inheritance in the condition known as Huntington's chorea.
The charts indicate the incidence of this disease in the families and descendants of George M-1 and his sister Mary M—1, in so far as I have been able to ascertain it by the rather unsatisfactory method of correspondence. I had planned to viisting the districts in which the disease is most prevalent in the hope of gaining more information than the charts show, but was unable to carry out this intention. As far as they go, I think that the charts are accurate, but they are not complete. Several of the patients indicated have come under my observation, and at least two others, who undoubtedly belong to this group, have been under my care, although I cannot, as yet, find the proper places for them in the charts.
The M—Is belonged to a party of Huguenots who left the town of Montbeliard, or its neighborhood (near the boundary between France and Switzerland), because of the religious persecution which followed the revocation of the Edict of Nantes. While several of the party chose to follow the lead of many of their compatriots and found their way to South Carolina, a number were attracted to Nova Scotia, where they established themselves in the county of Lunenburg, and there experienced the hardships and dangers of first settlers.
Following the peace of 1763, one Colonel Des Barres, a fellow countryman of theirs, who had served in the British army (and
* Read at the sixty-fifth annual meeting of the American Medico-Psychological Association, Atlantic City, N. J., June 1-4, 1909.
into whose arms, it is said, Wolfe fell at Quebec), was granted a large tract of land at Tatamagouche, in Colchester County, on the northern coast of Nova Scotia, and in 1771 he induced some of those who had settled in Lunenburg to relocate in his domain. Eleven families responded to his request, and among them were the M-ls, with whose descendants we have now to deal, and also the forebears of the Tes, L-es, and Pns, whose names appear in the charts. The families descendant from these original settlers have largely remained in the county of Colchester, and the restriction of the disorder, so common amongst them, to this locality was at one time attributed, by the laity, to some peculiar local condition.
Both George and Mary M-1 suffered from Huntington's chorea, but of their forebears I have no knowledge.
Of George's immediate family the available information is scanty, and my record deals with but one daughter, who married a Te. The issue from this marriage consisted of two sons and two daughters. Both sons and at least one daughter were choreic. The choreic daughter married a P-n, and four of her eleven children were choreic. Of these four, two at least married, one begetting three and the other one choreic children. Of T- e's sons, we do not know that more than one married. He had five children, of which at least one was choreic. As far as this record goes, therefore-and it is very incomplete—it is seen that 13 of the descendants of George M-1, distributed through four generations, suffered from the disease of which George M-was himself a victim.
The chart of Mary M-1 and her descendants is more complete, although it also is by no means free from omissions. Four of her six children, twelve of her twenty-one grandchildren, fifteen of her twenty-nine great grandchildren, and one of her fourteen great great grandchildren, or in other words, thirty-two out of her seventy descendants, of whom we have knowledge, were (or are) choreic. But few of the great great grandchildren have reached the age at which the disorder commonly becomes manifest, and it is reasonable to assume that further research will discover other cases among less recent generations, so it is quite likely that fully more than half of the descendants of this