Until recently most psychiatrists placed dementia praecox among the so-called functional disorders. The newer studies have, however, revealed fairly constant, though not pathognomonic, anatomical changes. Alzheimer and others working by his methods have found products of nerve cell degeneration within nerve cells, in the clear spaces around them, and especially in the perivascular spaces.1 Southard, having selected 37 cases of dementia praecox showing at autopsy no coarse complicating features like brain atrophy, intracranial arteriosclerosis, etc., has found in 19 foci of gliosis distinctly palpable in the fresh brains.2 Rosanoff, making use of an improved method for measuring brain atrophy, consisting essentially in observing the relationship between cranial capacity and brain weight, has found very close and constant correlation between the degree of mental deterioration observed clinically and that of atrophy found at autopsy in cases of dementia praecox; from this he has drawn the conclusion that "dementia praecox is associated in some way with changes in the brain which lead to atrophy." 3

1 G. H. Kirby. Catatonic Syndrome and Its Relation to Manic-Depressive Insanity. Journ. of Nerv. and Mental Diseases, Nov., 1913. - T. W. Simon. The Occurrence of Convulsions in Dementia Precox, Manic-Depressive Insanity and the Allied Groups. N. Y. State Hosp. Bulletin, Nov., 1914.

2 Berze. Die hereditaren Beziehungen der Dementia Pracox. - A. J. Rosanoff. Dissimilar Heredity in Mental Disease. Amer. Journ. of Insanity, July, 1913. - A. S. Moore. Some Preliminary Observations Concerning the Types of Psychoses Occurring in the Individual Members of Families. N. Y. State Hosp. Bulletin, May, 1913. - A. Meyerson. Psychiatric Family Studies. Amer. Journ. of Insanity, Jan., 1917, and April, 1918.

3 Adolf Meyer. Seventeenth Annual Report, N. Y. State Commission in Lunacy, 1904-1905.

4 E. Bleuler. Dementia pracox oder Gruppe der Schizophrenien. Aschaffenburg's Handbuch der Psychiatrie, Vol. IV. Leipsic and Vienna, 1911.

Treatment

Excitement, refusal of food, dangerous tendencies are treated, as they arise, by the methods already described in the first part of this book. An effort should be made to combat stereotypy in all its forms by suggestion and by diversion and occupation. Employment at useful labor is desirable also from .the economic standpoint; precocious dements constitute a large proportion of institution workers and thus contribute toward their support.

1 Alzheimer. Beitrdge zur Kenntniss der pathologischen Neuroglia und ihrer Beziehungen zu den Abbauvorgdngen in nervosen Gewebe. Histologische und histopathologische Arbeiten iiber die Grosshirnrinde, 3, 1910. - Sioli. Histologische Befunde bei Dementia Pracox. Allg. Zeitschr. f. Psychiatrie, Vol. XLVI, p. 195, 1909. - Orton. A Study of the Brain in a Case of Catatonic Hirntod. Airier. Journ. of Insanity, Apr., 1913.

2 Southard. A Study of the Dementia Pmcox Group in the Light of Certain Cases Showing Anomalies or Scleroses in Particular Brain Regions. Amer. Journ. of Insanity, July, 1910.

3 Rosanoff. A Study of Brain Atrophy in Relation to Insanity. Amer. Journ. of Insanity, July, 1914.