"A last very characteristic group of cases the discussion of which must be included here, is formed by the patients with confusional speech." These are the Schizophasias of Bleuler.
It must be admitted that in view of Kraepelin's former contributions on this subject this classification must be looked upon as somewhat involved and confusing. It suggests an unnecessary complication of an already difficult subject to no great advantage. These varying conceptions are difficult to understand. Perhaps, as Meyer[307] expresses it, "the symptomatology in its first formulation in 1895, and later, emphasized too many things which prevail also in other conditions, so that altogether too many errors occurred. In four hundred and sixty-eight of Kraepelin's Munich diagnoses even between 1904 and 1906, 28.8 per cent were cases subsequently considered to be manic-depressive (Zendig)—altogether too broad a margin of uncertainty."
In summarizing the whole situation the conclusion reached by Buckley[308] would appear to be thoroughly established:—"Most authorities agree, however, that the term dementia praecox includes the psychoses which appear prior to mental maturity (early in some and much later in others), with a tendency to permanent mental defect in the long run, but which may follow a chronic course, may be divided into attacks, or may improve or stop at any stage, but never with restoration to absolute normal health."
Notwithstanding the elaborate investigations of Alzheimer, Sioli, Klippel, Lhermitte, Moriyasu, Goldstein, Nissl and many others, no definite pathological basis for dementia praecox has ever been established.
For purposes of statistical study in the collection of data relative to this disease entity, as in all other cases, the American Psychiatric Association has endeavored to adhere to fundamental conceptions generally accepted by the profession and has avoided as far as possible adherence to the tenets of any one school. For purposes of uniformity the following suggestions were made in the "statistical manual" as to the classification of psychoses to be reported under the designation of dementia praecox.
"This group cannot be satisfactorily defined at the present time as there are still too many points at issue as to what constitute the essential clinical features of dementia praecox. A large majority of the cases which should go into this group may, however, be recognized without special difficulty, although there is an important smaller group of doubtful, atypical, allied or transitional cases which from the standpoint of symptoms or prognosis occupy an uncertain clinical position.
"Cases formerly classed as allied to dementia praecox should be placed here rather than in the undiagnosed group. The term "schizophrenia" is now used by many writers instead of dementia praecox.
"The following mentioned features are sufficiently well established to be considered most characteristic of the dementia praecox type of reaction:
"A seclusive type of personality or one showing other evidences of abnormality in the development of the instincts and feelings.
"Appearance of defects of interest and discrepancies between thought on the one hand and the behavior-emotional reactions on the other.