Extracts from Henderson and Gillespie's A Text-Book of Psychiatry

1927 edition p.36:

While psychopathic parents tend to have psychopathic children, and while the bulk of evidence is in favour of earlier onset of mental illness among descendants, the view previously held that familial "degeneracy" was inevitably progressive was unnecessarily gloomy; and there is evidence that Nature tends to mend, rather than to end, a psychotic strain. A familial tainting of psychoneuroses, of insanity, and of apoplexy, does not necessarily constitute a bad heredity

"A bad stock", as Mott says "is one where are found a large number of members exhibiting various forms of degeneracy besides insanity, e.g. feeble- mindedness, epilepsy, criminality, pauperism, inebriety; in fact a low standard, mental and physical, in stem and branches of the family tree, the further growth of which should be cut off"

1927 edition p.182:

Chapter nine

Schizophrenic reaction types

We believe that the term schizophrenia is more applicable than the term dementia praecox to the group of cases now to be described.

In 1896, after Kraepelin first made his important differentiation between the manic-depressive psychosis and dementia praecox, the latter term was more widely accepted. This term has, however, two principal drawbacks; first, many so-called "dementia praecox" patients do not show a permanent dementia; and second, many of them have developed outside the adolescent period. These objections are valid, but, in spite of them, the term "dementia praecox" has usually implied a rather hopeless prognosis. This is unfortunate, and in too many instances has led to an attitude of therapeutic nihilism.

1927 edition p.192:


Kraepelin differentiated three principal types, which he termed hebephrenic, katatonic and paranoid. Later he added a fourth variety, termed simplex. In the last edition of his text-book he added numerous other forms, e.g. simple depressive dementia praecox, delusional dementia praecox, circulaire dementia praecox, agitated dementia praecox, and so on. No useful purpose is served by forming so many subgroups. The main groups are fairly distinctive, but even those are not clean-cut, and if we wished, we could form almost as many groups as there are individuals. It seems preferable therefore to use the term schizophrenia instead of dementia praecox and to recognise four subdivisions - the simplex, hebephrenic, katatonic and paranoid forms.

1927 edition p.199:

Schizophrenia Simplex

In this type there is an absence of any definite trend. There is simply a general falling away of interest. Kraepelin describes it as consisting of an "impoverishment and devastation of the whole psychic life, which is accomplished quite imperceptibly"

1927 edition p.201:


... Hebephrenia ... is especially characterised by great incoherence in the train of thought, marked emotional disturbance, periods of wild excitement alternating with periods of tearfulness and depression, and frequently by illusions and hallucinations.

1927 edition pp 207-209:


Katatonia is usually described as an alternating state characterised by a stage of depression, a stage of excitement and a stage of stupor.

1927 edition pp 211-212:

Paranoid States

The delusions which are expressed are multiple, unsytematised, changeable, usually of the most fantastic and illogical nature; they may be persecutory, depressive or grandiose...

This type of schizophrenia runs very much the same course as the other varieties, and ends usually in a state of dementia, characterised by mannerisms, stereotypies, incoherence and a total lack of interest.

1927 edition p.397: Chapter 14: PSYCHONEUROSES

1927 edition p.398:

[Freud] sub-divides the psychoneuroses in this way: states of 'irritable weakness' (neurasthenia); anxiety states, including 'anxiety [p.399] neuroses' and anxiety hysteria; hysteria; and the obsessive-compulsive psychoneurosis.
Where constant preoccupation occurs with a single topic, itself usually of apparently minor importance (e.g. an anxious preoccupation with the idea of dirt) against the patient's better judgement and to his distress, 'obsessive-ruminative' state is a fair description. 'Obsessive-compulsive' state is applied to a similar condition in which the preoccupation issues in motor acts of an apparently trifling or meaningless kind. Both of these conditions are usually included under the 'Obsessive-compulsive psychoneurosis'

1927 edition p.405:

Neurasthenia This syndrome was at one time much more commonly mentioned in the literature than it is now. Beard first described it in 1880, and Beard's neurasthenia became such a popular diagnosis that by 1894 Muller was able to furnish a bibliography of fourteen pages. In modern days neurasthenia is rarely seen in pure form. This pure form consists in complaints of mental and physical fatigue, associated with sensations of pressure in the head, poor memory, inability to concentrate, irritability of temper, increased reflexes, poor sleep and various aches and pains (A. Meyer)

1927 edition p.416:

... few persons are more suggestible than those who are anxious from any cause... Too often we find that in the causation of a psychoneurotic illness there has entered a very large element of 'iatrogeny'. It is not very rare to a find a patient who has remained bedridden simply because a doctor sent him to bed and murmured words like 'neurasthenia' and 'toxaemia' over him."

1927 edition p.485:

If, as a result of his examination, the doctor is convinced that mental hospital treatment is the best method of dealing with the patient, he can advise the relatives (and perhaps also the patient) that there are two methods of procedure:

  1. Voluntary application.
  2. Certification.

Voluntary Application

This method requires in Scotland that the patient himself shall sign two letters, one addressed to the Board of Control, the other to the medical superintendent of the institution to which he wishes to go, saying that he wants to place himself under care and treatment as a voluntary boarder. No other formality is necessary. In England only one form has to be signed, namely that addressed to the medical superintendent.

This is the method of choice, and every patient who is capable of appreciating the significance of such a letter should be given the opportunity to do so.

In England a voluntary patient can leave the hospital on giving twenty-four hours' notice of his desire to do so, whereas in Scotland three days' written application can be insisted on.

If a patient has been admitted on a voluntary basis, and insists on leaving even though he is obviously still ill, he should never be certified in the mental hospital. He [p.486] should be allowed to leave in the care of his friends, and, if necessary, his friends can have him certified and returned. If a patient comes voluntarily, and is then certified later in the institution, his trust in the institution and its officials is so shaken that treatment is a matter of the greatest difficulty.

In England the voluntary method applies only to private patients. In Scotland it applies not only to private patients, but to certain of the rate-aided institutions whose committees have been wise enough to see the humanity and usefulness of such a plan of treatment.

A voluntary patient retains his civic rights, can sign cheques and legal documents, and advise in the management of his affairs. This form of admission is being used more frequently, and in the Royal Asylums of Scotland 50 per cent of the admissions are now voluntary patients.


If the patient refuses to sign the voluntary application, some other way must be sought, and two main points must be considered carefully before certification is proceeded with:

  1. Is it advisable to certify ?
  2. Is it possible to certify ?

1. The medical man and relatives may believe that mental hospital treatment would be best, but the social and economic circumstances may be such that certification as a person of unsound mind may not be advisable. A compromise has to be effected either by employing specially trained nurses in the patient's own house or by removal to a nursing home.

The deliria associated with any toxic or infective-exhaustive process, mild affective states, psychoses associated with senility, and certain paranoid states are examples of groups of cases technically of unsound mind, yet able to be cared for satisfactorily under outside conditions.

Apart from the purely medical side, the social and economic circumstances are often deciding factors for and against certification. Certification is desirable where no adequate accommodation at home or in a special nursing home is available, or where money is a consideration. Certification is unnecessary where adequate arrangements for treatment can be made outside of mental hospitals, and undesirable where the patient occupies an important public position, e.g. director of company, partnership, etc.

2. It may be impossible to certify the patient owing to the [p.487] fact that he is thoroughly on his guard, and has sufficient understanding to enable him to rise to the occasion. In such instances, although the statements of the patient's relatives may be convincing in themselves, there may not be sufficient direct evidence to justify certification, e.g. in hypomanics, paranoiacs, alcoholics and epileptics.

It is not justifiable to certify a patient while in an epileptic fit, or while under the influence of alcohol, as these may be merely episodes.

When the doctor has satisfied himself fully regarding the good faith of those concerned, and when he feels that the patient has had every possible chance under the best circumstances, he is justified, without further delay, in recommending mental hospital treatment under certificates. The tendency is to delay such treatment far too long. The doctor must explain clearly to the relatives his reasons for advising it, and must inform them that his certificate is only one part of the formality, and that it is of no value unless the nearest relative is willing to sign the petition, which, along with the medical certificates, has to be placed before the legal authority for sanction. The law in England differs from that in Scotland. In England the law differs regarding the certification of private and parochial patients respectively, in that the private patient requires two medical certificates, the parochial patient only one. In Scotland no such distinction is made, every patient, private or parochial, requiring two medical certificates.

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Hanwell 1834

Mania 1844

Dementia 1844

Melancholia 1844

Monomania 1844

Moral Insanity 1844

Idiocy 1844

GPI 1844

Epilepsy 1844

Delirium Tremens 1844

Hanwell 1848

Sanity and insanity 1890

Broadmoor 1903



Model answers 1928