This work is a collection of Carl Wenicke’s lectures on neuropsychiatry translated into English for the first time. Beginning with basic concepts about normal brain function, the book moves to clinical topics, dealing first with chronic mental disorders and 'paranoid states', and then to the more complex area of acute mental disorders. Many of the featured topics are still clinically relevant, and matters of contemporary debate. Carl Wernicke is one of the pioneers of neurology and psychiatry; clinicians, researchers and historians will find this of great interest.
Table of Contents
Dedication for this Translation
Preface to this Translation
PART 1: Psycho-physiological Introduction
Introduction to this Translation
Mental illnesses are brain diseases; nevertheless, they differ from them in practice. Projection system and central fields of projection. Association organ. Brain disorders to be defined as: diseases of the projection system; mental illnesses as: propagated illnesses of the association organ. Difference between primary and secondary identification in the case of speech.
To replace the Conceptualization Centre in the Speech schema by arbitrary, localized apperceptions. Registration and goal identification in the Speech schema. Generalization of the Speech schema. Types of movement: expressive, reactive, and initiative movements. Disturbance of Secondary Identification is induced by psychosensory, psychomotor, or intrapsychic means.
Nature of memory images. Retinal after-images and remembered visual images. The hypothesis of special sense cells and memory cells is insufficient as an explanation. Local signs in the retina. Visual representations.
The concrete concept of an ‘association of memory images’. Awareness of the outside world. Number of concepts. Requirement of causality.
The body is a part of the outside world. Awareness of physicality is a function of the central projection fields. Organ sensation and sensory content of sensations. Feeling tone of sensations. The large intestine represented in bodily-awareness.
Concept of spontaneous movement. Distinction from reflex movement. Position sense and position representation. Sensations of nervous activation of muscle, and their memory images. Sense of motion and movement imagery both derive from organ sensations. Also, tactile sensations and touch representations from the hand’s tactile organ are derived from organ sensations.
Consciousness of personhood, or individuality. Is its localization accessible? The mystery of self-awareness.
The activity of consciousness dependent on the content of consciousness. ‘Preformed’ organization of the connections of thought. Narrowness of consciousness. Level of consciousness. Attention and will. Ability to be attentive; Affect. Normal value of apperceptions.
PART 2: The Paranoid States
Overview of clinical results. Mental disturbance. Mental illness. Paranoid states. Unrecovered mental patients. Patient demonstrations.
Patient presentations (continued).
Inter-relationship of lapsed so-called ‘old’ cases to chronic psychoses. Explanatory delusional ideas of autopsychic, allopsychic and somatopsychic origin. Autochthonous ideas and hallucinations.
Sejunction hypothesis. An attempt to explain pathological symptoms of stimulation. Delusional explanatory ideas resulting from motility symptoms and from intrinsically-normal functions.
Sensory deception of speech sounds or phonemes. Delusions of relatedness and reference: of
autopsychic, allopsychic and somatopsychic origin.
Retrospective delusional explanation. Falsehoods of memory.
Retrospect of previous account of elementary symptoms. Overvalued ideas.
When has a mental illness ended?
Course of chronic psychoses. Aetiological classification. Griesinger’s primordial deliria.
PART 3: Acute Psychoses and Defect States
Definition of acute, as opposed to chronic, psychoses. Presentation of an almost-recovered case of acute psychosis. Features and special coloration of ideas of explanatory delusions. A few new sources of delusional elaboration: by analogy; by failure of attention; and by aberrant restructuring of associations.
The science of hallucinations. Hallucinations in various senses. Combined and dreamlike hallucinations. Historical section. Theory of hallucinations.
The science of hallucinations, continued. Cohesiveness of preformed associative organizations. Involvement of the projection fields in hallucinations. Special localization of memory images. Paraphasic speech compulsion of paralyzed patients. Compulsive repetition of phonemes. Different intensity of memory images. Hypermetamorphosis. Hyperaesthaesia. Modification of the schemata for disturbance of identification.
Disorientation: the fundamental symptom of every psychosis. ‘Disarray’ [Ed] linked with the condition of acute origin. Various types of disorientation and disarray. Treatments arising from this. Motor disorientation and disarray. Transitivism.
More about overvalued presentations. The science of illusions. Regular content of these. Regular content of deceptive appearances generally.
Presentation of a case of anxiety psychosis. Clinical picture, course, diagnosis, prognosis, treatment. Delimitation from the area of anxiety neuroses. An example of hypochondriacal anxiety psychosis.
Intestinal, worsening, and diffuse somatopsychoses. Hypochondriacal reflex psychoses. Severe hypochondriacal psychosis in a drunkard. Example of paralytic somatopsychosis. Clinical picture, Treatments of somatopsychic disarray. Outcomes. Overview of hypochondriacal symptoms.
Acute hallucinosis. Presentation of a typical case during the healing process. Aetiology. Danger of relapse.
Presentation of a patient with alcoholic delirium. Clinical picture. Aetiology. Diagnosis. Treatment. Post mortem findings.
Chronic and protracted alcoholic delirium. Polyneuritic psychosis. Presbyophrenia. A case of acute asymbolic allopsychosis.
A case of acute autopsychosis based on hysteria. Description of autopsychic disarray. Examples of alternating consciousness, the ‘second state’ of French authors. Episodic drinker. Cure of one such by bromide treatment. Acquired moral insanity, a special form of autopsychosis. Example of one such case of recurrent behaviour.
Acute expansive autopsychosis due to autochthonous ideas. Disappearance of thoughts as an elementary symptom. Obsessive neurosis. Obsessive psychosis. Audible thoughts as the basis of an ascending form of acute autopsychosis.
Presentation of two opposite types of illness. Digression on volition. Clinical picture of Affective melancholia. Risk of suicide due to this. Fantastic delusions of belittlement. Phonemes and visions. Course, frequency of the illness. Diagnosis. Treatment. Prognosis.
Clinical picture of pure mania. Levelling of ideas. Course, interruption through clear intervals. Tendency to recurrence. Diagnosis. Paralytic mania. Paralytic grandiose delusions without mania. Kahlbaum’s Progressiva divergens. Combinations with melancholia. Circular mental illness. Chronic mania.
Clinical presentations of a puerperally-induced and a menstrually-induced hyperkinetic motility psychosis. Pseudospontaneous movements. Idiosyncrasy of the movement. Absence of compulsive speech in this. Psychomotor compulsive speech. Description of a case of jacktatoid compulsive movement. Verbigeration in compulsive speech. Choreatic compulsive movement. Impulsive actions. Disarrayed restless movement. Hypermetamorphotic compulsive movement. Periodic recurrent course of the illness. Prognosis and treatment.
Confused mania or agitated confusion. Escalation of intrapsychic hyperfunction to confusion. Different grades of flight of ideas. Admixture of sensory and motor excitatory symptoms. Clinical picture. Meynert’s Amentia. Asthenic confusion as a phase of confused mania and as a stand-alone illness.
Examples of akinetic motility psychosis. General impassivity. Negativism. Flexibilitas cerea. Muscular rigidity. Persistence in positions. Parakinetic behaviour in standing and walking. Verbigeration. Pseudo-flexibilitas. Behaviour of the sensorium. Catalepsy. Melancholia attonita or cum stupore. Kahlbaum’s catatonia. Course of the illness. Outcomes.
Akinetic phases of hyperkinetic motility psychosis. Cyclic and complete motility psychosis. Significance of the paranoid phase. Excursion into intrapsychic akinesia. Indicators of psychomotor akinesia. Theoretical considerations for understanding motility psychoses.
Simple or basic forms of acute psychoses. Mixed and compound psychoses. Examples.
Progressive paralysis, an aetiological group of diseases. Prodromal symptoms. Spinal and cortical symptoms. Various forms of paralytic psychoses. Course as a compound psychosis. Paralytic dementia. Remission and paralytic attacks. Atypical paralysis. Worsening paralysis. Diagnosis. Treatment. Anatomical findings.
Notes on the aetiology of acute psychoses. Aetiological groupings of the psychoses. Alcoholic psychosis. Alcoholic jealousy mania. Alcoholic stupor. Pseudoparalysis. Cocainism. Polyneuritic psychoses through lead poisoning and arsenic poisoning, in tuberculosis and syphilis. Hereditary psychoses. Epileptic psychoses. Perseveration.
Continuation of aetiological grouping of the psychoses. Hysterical absences. Hysterical delirium. Pubertal psychoses or hebephrenic psychoses. Kahlbaum’s Heboid. Senile psychoses. Menopausal psychoses. Menstrual psychoses. Puerperal psychoses. General and special aetiology. Inanition delirium. Symptomatic psychoses.
Course of disease. Body-mass curve. Intensive and extensive disease curve. Accumulating and substituting course. Outcome in death, mental invalidity, or paranoid states. Material confusion. Dementia or idiocy and imbecility. Congenital and acquired dementia. Principal signs of acquired dementia. Causes of the same. Paralytic dementia, post-apoplectic, epileptic, alcoholic, hebephrenic dementia.
Dissimulation and simulation of mental disturbance. Functions of institutional treatment. Final remarks on the prospect of a pathological-anatomical rationale of the psychoses.
Robert Miller, ONZM, B.A., B.Sc. (Oxon), PhD. (Glasgow)
Freelance Researcher, and Honorary Fellow, Otago University
Department of Psychological Medicine, University of Otago School of Medicine
Wellington, New Zealand
K. John Dennison, J.P., M.Sc., B.A.
Department of Anatomy, Otago Medical School
Dunedin, New Zealand