Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
Huntington's chorea is said to have been referred to first by C. O.
Waters of Franklin, N. Y., in Dunglison's "Practice of Medicine" in
1842. An article on the subject by Irving W. Lyon also appeared in
the _American Medical Times_ in 1863. The name by which the disease
is now generally known was the result of an elaborate description of
its symptomatology by George Huntington in the _Medical and Surgical
Reporter_ in 1872. He particularly called attention to the fact that
it is hereditary in origin, occurs in adult life, is associated
with suicidal tendencies and often exhibits mental symptoms. On
the important subject of heredity Huntington made the following
observation: "If one or both of the parents have shown manifestations
of the disease, and more especially when these manifestations have been
of a serious nature, one or more of the offspring almost invariably
suffer from the disease if they live to adult life; and if by any
chance these children get through life without it, the thread is broken
and the grandchildren or great grandchildren may rest assured that they
are free from the disease. Unstable and whimsical as the disease may
be in other respects, in this it is firm; it never skips a generation
to manifest itself in another; as soon as it has yielded its claims,
it never regains them." A well known monograph on the subject by Osler
appeared in 1894.
McCarthy[189] refers to the mental condition associated with this
disease as "a severe and gradually progressive deterioration,
ultimately ending in absolute dementia. In some cases the mental defect
is noted from the onset of the symptoms, in others the mentality may
remain unimpaired for years. Mental deterioration is the rule, and it
is associated with a loss of memory and a tendency to self-destruction
which gradually develops. When the mental degeneration is well marked,
outbreaks of violence are sometimes noted. In one of the writer's
patients, as the disease progressed, the clinical picture of paresis
was presented. The chronic delusional state is more often noted than
would be inferred from Huntington's description." Hamilton,[190] who
made a clinical study of a considerable series of cases in 1907,
expressed the opinion that mental deterioration occurs in the majority
of instances before the onset of choreiform symptoms. He found a
special tendency to deterioration in the cases appearing early in
life, while irritability and delusional ideas were more often observed
in those developing in later years. Delusions of persecution and
deterioration, however, were symptoms more or less common to both
groups. Diefendorf,[191] in a study of twenty-eight cases in 1908,
called attention particularly to the irritability with occasional
outbursts of violence as well as attacks of despondency. He emphasizes
emotional deterioration and indifference.
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