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tively recent work gives one of the best classifications but it remained for Kraepelin of Munich to isolate dementia praecox, about 1896 and to give to the medical world a classification which has become quite generally accepied.

Heredity:- This term is applied to the fact of recurrence of traits in a number of blood relatives, due to their possession of a common germ plasm.

Heredity of a trait is direct, when the trait is found in parents and offsprngs; atavistic, when one or more generations are skipped; and collateral, when the trait is found prevailingly in collateral relatives and not necessarily in the direct line of ancestry.

It is similar when the condition present in the patient is the same as that in an ascendant or collateral relative; in the opposite case, it is dissimilar.

As to the causes of the various kinds of insanity they are legion and in dealing with the subject of "Inherited Insanities,” I shall confine my remarks to the importance of heredity to the more common types, namely dementia praecox, and manic-depressive insanity -although a bad heredity is frequently found in cases of psychoses with chorea, alcoholic and drug psychoses, involution melancholia, paranoia, epileptic psychoses, and psychoses with mental deficiency.

During the last biennial period there were admitted to the Independence State Hospital, 307 men and 232 women. Of this number there was a known bad heredity in 68 or 20 plus per cent of the men and in 79 or 30 plus per cent of the women. Of this number possessing bad heredity, 12 per cent of the men and 14 per cent of the women suffered with manic-depressive insanity; and, 43 per cent of the men and 47 per cent of the women suffered with dementia praecox. These figures, we feel, would be much higher had we found it possible to secure reliable family histories for the 67 men and 27 women whose heredity is given as unknown and unobtainable. It is not uncommon to find in our hospital from one to three relatives of a newly admitted case although the physician's return states that there has been no insanity in the family. Conjugal insanity is not common but it is a rather frequent occurence to find mother and daughter, father and son, and several brothers and sisters in the hospital while we recently received from Glenwood two sisters whose feebleminded brother died here only two years ago. The mother tells me her husband's father was insane and all of her eleven children were feebleminded.

A few years ago I became interested in Mrs. “X” recently received and nearly nine months pregnant. I found her paternal great-great-grandmother had been insane. Her paternal grandmother was insane and the third patient admitted to the Mount Pleasant State Hospital. Her father was admitted to the same hospital at the age of 13, and on four later occasions, while he was also admitted to the Clarinda State Hospital eight times. Her sister had been confined at Clarinda and while at home secured the release of

Mrs. “X” from Glenwood. I am unable to secure additional information concerning this family but am reliably informed that two uncles were in the Mount Pleasant State Hospital.

In etiology of dementia praecox, Jelliffe and White state that the question of heredity was carefuily analyzed at the asylum al Zurich. Of 2215 admissions there were 647 cases of dementia praecox of whom 90 per cent showed hereditary taint. They also state under etiology of manic-depressive psychoses that there are hereditary factors to deal with in this class of cases as there are in the praecox group. There are certain families which show a preponderance of the manic-depressive psychosis as there are families that show a preponderance of the praecox type of reaction.

Diefendorf states under etiology of dementia praecox that defective heredity is a very prominent factor, as it appeares in aboill 70 per cent of the cases reported by Kraepelin, but in not more than 52 per cent of his cases. Under etiology of manic-depressive insanity he states that defective heredity is the most important cause occurring in from 70 to 80 per cent of cases. The relatives have often suffered from the same form of disease. The defective constitutional basis is often apparent in individuals previous to the onset of the psychosis; some are peculiar; some are abnormally bright, others are of an excitable disposition and subject to frequent and apparently causeless changes of mood, and still others are excessively shy and reserved; while a few are imbecile from birth. Physical stigmata may also be present. The disease almost always appears independently of external causes. In a few cases the ap. pearance of the first attack is coincident with the first menstruation. The first and subsequent attacks may occur during succeeding periods of childbearing, but it is also a conspicious fac! that the attacks do not cease at the climacterium.

Kraepelin under hereditary disposition in his book “Dementia praecox” states there was found a hereditary taint in 52 per cent by Schott; in 53.8 per cent by Lukacs; in 54 per cent by Meyer; in 64 per cent by Karpas; in 70 per cent by Serieux; in 70 per cent by Wolfsohn; and in 70 per cent by himself at Heidelberg. He reports 28 pairs of brothers and sisters who succumbed to this disease. He notes that among the brothers and sisters of insane patients, there are found striking personalities, criminals, queer individuals, prostitutes, suicides, vagrants, wrecked and ruined human beings, all being forms in which more or less well-developed dementia praecox may appear. He notes also that manic-depressive parents not at all infrequently have children with dementia praecox, while the reverse case belongs to the rare exceptions unless there existed inherited predisposition to manic-depressive insanity from the other side. He views dementia praecox developing in prison as persons who had a long time previously changes of the personality in the sense of dementia praecox, which then made him it habitual criminal and vagrant. He mentions the frequency of the

catatonic type, developing in women cluring pregnancy and speaks of masturbation being a symptom rather than a cause.

Rosanoff states that heredity is the essential cause of dementia praecox, and that while the causes of manic-depressive insanity ire not fully known the essential feature in the etiology seems to be a constitutional predisposition which is believed to be hercditary.

Tredgold on “Mental Deficiency” states that the incident of amentia is directly proportionate to that of insanity for it has been found that where insanity is rife amentia is also prevalent, and conversely where there is little insanity there is little amenita. He does not think that environment has no influence, however he believes that mental defect is rarely caused by injurious external factors acting alone, and that in an overwhelming proportion of cases the cause lies in the condition of the germ plasm. He quotes Prof. Allbert as saying, “I regard feeblemindedness (if not accidental) as always hereditary.” Dr. Ashby as saying “In at least 75 per cent of the children with amentia it is probably hereditary.” and, Dr. Bevan Lewis as saying, “I look upon feeblemindness as a germinal variation." He concludes therefore that it is due to germinal causes and is transmissible.





Containing a Report of the Quarterly Conference of Chief Executive Officers of State Institutions and others with the Board of Control of State Institutions with papers and addresses

and discussions thereon.

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