SENILE FORMS OF MENTAL FAILURE
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821 hill, such as that of Piccadilly or St. James’s-street, is iu very great. From a merely pecuniary point of view we d should have thought that it would have paid contractors - to fit their carts with the brake to which we have referred. Such an appliance would save the horses and so would I save the contractors’ money, to say nothing of obviating the chances of such an accident as that described above with its opportunities for destruction of life and property. But the average Briton is so-shall we say conservative- that he will not use anything new or to which he is unaccustomed. We think that the legislature should step in and should make the use of such a brake compulsory. It is true that some modification would have to be made to allow for the cart being tipped but surely this would not be beyond the powers of our mechanicians. 7 SENILE FORMS OF MENTAL FAILURE. THOUGH old age brings with it a decline in mental as in physical power and capacity the alteration is a gradual process and is on the whole unattended by serious mental disturbance. Senile dementia is that form of mental decay occurring after the fifth decade of life, in which various forms of mental disorder of a somewhat grave character Z manifest themselves. It is very rare before the age of 50 n years in men and it is found that at least two-thirds of all t patients over the age of 50 years admitted to public asylums v are cases of senile dementia. In the Journal of Nervous and o Mental Disease for February Dr. William Pickett, instructor v in neuro-pathology and insanity at Jefferson Medical College, n Philadelphia, publishes an article on the subject of the C mental decay and disorders of old age in which an attempt I is made to analyse and to classify the various forms and to furnish a practical basis for prognosis, the material studied comprising 200 cases-100 males and 100 females. Senile insanities other than dementia are rare; they comprise a delusional form and a melancholic form which are liable t to occur, strictly speaking, in the pre-senile period which ( corresponds with the climacteric period in women (from i 45 to 50 years of age) or with a slightly later period (from 50 to 55 years of age) in man. Analysis of the I clinical symptoms shows that the following are the general characteristics of oncoming senile dementia : en- feeblement of attention and slowness in the association of ideas, inexact perception of relations to surroundings and to time (disorientation), marked defects of memory (amnesia) for recent events, poverty of ideas, blunting of the feelings of affection, and irritability of disposition with exacting and tyrannical tendencies. The essence of senile dementia is quantitative but irregular reduction of the mental and moral capacities and the degenerative process is usually accompanied by attacks of temporary excitement, emotional depression, and delusion, so that the superficial symptoms of mania, melancholia, and paranoia are simulated, though these affections rarely occur in old age. ’’ Mental confusion of some degree is present in all types of senile dementia; it appears episodically in many (66 per cent. of) cases, being one cause of the familiar street wandering of such dements." The excited, depressed, and delusional types rank next in order of frequency. Physical wasting and weakness are greatest in the common or con- fusional type and are progressively less marked in the other types mentioned, a point which is of prognostic value. On the other hand, the depressed and paranoid types are of les s favourable prognosis as regards the mental life than are the other two types of dementia. The exaltation or ephemeral excitement of some cases is not true mania ; "probably, says Dr. Pickett, "true mania never arises in old age." " The following table gives a summary of the symptoms and the peculiarities of conduct of the 200 patients investigated. Some of the peculiarities of conduct have a medico-legal .uterest as the degree of responsioility may be hard to letermine. Ihe delusional cases are especially important from a medico-legal point of view, as these patients may become troublesome and even dangerous to their families, though when placed in asylums they soon subside into the category of ., uninteresting" senile dements. The chief delusions to which they are liable are those of persecution by unseen and malign agencies, poisoning, and marital infidelity, the last of which may cause much distress and trouble to the patient’s family. - THE METROPOLITAN STREET AMBULANCE ASSOCIATION. THE following is an abstract of suggestions approved by the committee of the Metropolitan Street Ambulance’Asso- ciation as the basis of a plan for providing London with an efficient street ambulance service.- 1. That there should be one controlling authority responsible for a uniform and well-organised ambulance service and that that body should be the London County Council. 2. That London should be divided into districts or "accident areas" and that a properly organised service should be arranged in each. This would necessitate the establishment of horse or motor as well as hand ambulances. 3. That the fire brigade and the ambulance services could be most advantageously carried out conjointly. 4. That where possible these ambulances under the control of the London County Council fire brigade should be stationed at, or in immediate connexion with, the principal London hospitals. 5. That the police should be kept efficient in "first-aid" training; should be available, as at present, for rendering first aid to the injured, summoning an ambulance by telephone, and taking charge of the patient until the ambulance and attendant arrive; but should not. as a rule, be expected to accompany patients to home or hospital. 6. That the 800 fire-alarm telephone posts now existing and all other telephones should, if possible, be made available for calling these ambulances and that the police should be instructed in their use. 7. That the experience gained in working such services for many years in such cities as New York, Paris, Liverpool, and many others is more than sufficient to justify the London County Council in under- taking the work in London on a scale large enough to provide adequately for the 13,000 to 15,000 street casualties requiring removal each year. 8. That there should be no charge for the use of the ambulance. The suggestions, it will be observed, are only set forth as a basis for a scheme and we are not quite clear as to whether the committee suggests that the whole of the work should be undertaken by the fire brigade or only that the ambulances, whether horse or motor, should be kept at the fire stations. But then we see that sug- gestion 4 proposes that the ambulances should be kept at, or in immediate connexion with, the hospitals. In that case where does the fire brigade come in? Everyone knows how admirably organised Is the fire brigade and no doubt the machinery of that body would do the ambu- lance work excellently but we have not yet heard the brigade’s opinion on the matter. If the fire alarm posts and the machinery of the brigade are utilised
Transcript of SENILE FORMS OF MENTAL FAILURE
821
hill, such as that of Piccadilly or St. James’s-street, is iu
very great. From a merely pecuniary point of view we d
should have thought that it would have paid contractors -to fit their carts with the brake to which we have referred.Such an appliance would save the horses and so would I
save the contractors’ money, to say nothing of obviatingthe chances of such an accident as that described abovewith its opportunities for destruction of life and property.But the average Briton is so-shall we say conservative-that he will not use anything new or to which he is
unaccustomed. We think that the legislature should stepin and should make the use of such a brake compulsory.It is true that some modification would have to be made toallow for the cart being tipped but surely this would not bebeyond the powers of our mechanicians. 7
SENILE FORMS OF MENTAL FAILURE.
THOUGH old age brings with it a decline in mental as inphysical power and capacity the alteration is a gradualprocess and is on the whole unattended by serious mentaldisturbance. Senile dementia is that form of mental decayoccurring after the fifth decade of life, in which variousforms of mental disorder of a somewhat grave character
Z
manifest themselves. It is very rare before the age of 50 n
years in men and it is found that at least two-thirds of all t
patients over the age of 50 years admitted to public asylums vare cases of senile dementia. In the Journal of Nervous and o
Mental Disease for February Dr. William Pickett, instructor v
in neuro-pathology and insanity at Jefferson Medical College, n
Philadelphia, publishes an article on the subject of the C
mental decay and disorders of old age in which an attempt I
is made to analyse and to classify the various forms and tofurnish a practical basis for prognosis, the material studiedcomprising 200 cases-100 males and 100 females. Senileinsanities other than dementia are rare; they comprise adelusional form and a melancholic form which are liable tto occur, strictly speaking, in the pre-senile period which (corresponds with the climacteric period in women (from i
45 to 50 years of age) or with a slightly later period(from 50 to 55 years of age) in man. Analysis of the I
clinical symptoms shows that the following are the
general characteristics of oncoming senile dementia : en-
feeblement of attention and slowness in the association of
ideas, inexact perception of relations to surroundingsand to time (disorientation), marked defects of memory(amnesia) for recent events, poverty of ideas, blunting ofthe feelings of affection, and irritability of disposition withexacting and tyrannical tendencies. The essence of seniledementia is quantitative but irregular reduction of themental and moral capacities and the degenerative process isusually accompanied by attacks of temporary excitement,emotional depression, and delusion, so that the superficialsymptoms of mania, melancholia, and paranoia are
simulated, though these affections rarely occur in old age.’’ Mental confusion of some degree is present in all typesof senile dementia; it appears episodically in many (66 percent. of) cases, being one cause of the familiar street
wandering of such dements." The excited, depressed, anddelusional types rank next in order of frequency. Physicalwasting and weakness are greatest in the common or con-fusional type and are progressively less marked in the othertypes mentioned, a point which is of prognostic value. Onthe other hand, the depressed and paranoid types are of les sfavourable prognosis as regards the mental life than are theother two types of dementia. The exaltation or ephemeralexcitement of some cases is not true mania ; "probably,says Dr. Pickett, "true mania never arises in old age." " The
following table gives a summary of the symptoms and thepeculiarities of conduct of the 200 patients investigated.Some of the peculiarities of conduct have a medico-legal
.uterest as the degree of responsioility may be hard to
letermine.
Ihe delusional cases are especially important from a
medico-legal point of view, as these patients may becometroublesome and even dangerous to their families, thoughwhen placed in asylums they soon subside into the categoryof ., uninteresting" senile dements. The chief delusions towhich they are liable are those of persecution by unseen andmalign agencies, poisoning, and marital infidelity, the last
of which may cause much distress and trouble to the
patient’s family. -
THE METROPOLITAN STREET AMBULANCEASSOCIATION.
THE following is an abstract of suggestions approved bythe committee of the Metropolitan Street Ambulance’Asso-ciation as the basis of a plan for providing London with anefficient street ambulance service.-
1. That there should be one controlling authority responsible for auniform and well-organised ambulance service and that that bodyshould be the London County Council.
2. That London should be divided into districts or "accident areas"and that a properly organised service should be arranged in each. Thiswould necessitate the establishment of horse or motor as well as handambulances.
3. That the fire brigade and the ambulance services could be mostadvantageously carried out conjointly.
4. That where possible these ambulances under the control of theLondon County Council fire brigade should be stationed at, or inimmediate connexion with, the principal London hospitals.
5. That the police should be kept efficient in "first-aid" training;should be available, as at present, for rendering first aid to the injured,summoning an ambulance by telephone, and taking charge of thepatient until the ambulance and attendant arrive; but should not. asa rule, be expected to accompany patients to home or hospital.
6. That the 800 fire-alarm telephone posts now existing and all othertelephones should, if possible, be made available for calling theseambulances and that the police should be instructed in their use.
7. That the experience gained in working such services for manyyears in such cities as New York, Paris, Liverpool, and many others ismore than sufficient to justify the London County Council in under-taking the work in London on a scale large enough to provideadequately for the 13,000 to 15,000 street casualties requiring removaleach year.
8. That there should be no charge for the use of the ambulance.
The suggestions, it will be observed, are only set forth asa basis for a scheme and we are not quite clear as to
whether the committee suggests that the whole of thework should be undertaken by the fire brigade or onlythat the ambulances, whether horse or motor, should be
kept at the fire stations. But then we see that sug-gestion 4 proposes that the ambulances should be keptat, or in immediate connexion with, the hospitals. In
that case where does the fire brigade come in? Everyoneknows how admirably organised Is the fire brigade and nodoubt the machinery of that body would do the ambu-
lance work excellently but we have not yet heard the
brigade’s opinion on the matter. If the fire alarm
posts and the machinery of the brigade are utilised
