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This work is well placed among the classics of the 'Nervous and Mental Disease Monograph Series', of which it is No. 35. It embodies the results of an extensive research into the morbid anatomy of Dementia Praecox, excluding Dementia Paranoides for reasons which the author will explain in future publications.
From a study of 631 autopsies on cases of Dementia Praecox, selected from a total of 4800 mental cases, the author shows that the heart and circulatory system are undeveloped in this disease. For example, in 75.5% of the cases of Dementia Praecox the heart was below average weight, the nearest approach to this proportion in other insanities being 59.1% in General Paralysis; but it would appear that the heart is below average weight in all the insanities. In Dementia Praecox, however, even the lumen of the aorta is strikingly small and its walls are revealed by the microscope to be thinner than normal.
The author naturally sought an explanation of his discovery by examining the endocrine glands. This he did thoroughly in 22 of his cases and he found histopathological changes (aplasies, atrophies, scleroses and patchy hyperplasias), not only in the gonads as Sir Frederick Mott has described, but also in the thyroid, adrenals and (in 6 of the cases) the pituitary. These change 'are as universally present as are the characteristic mental symptoms in the clinical picture of a case'. They 'do not depend on age, duration of psychosis or the association of physical disease'. Dr. Lewis's considered conclusion is that the function of the glands has suffered during the development of the personality. From this and other passages in the book we gather that the author is willing to accept the view that Dementia Praecox is of purely psychical origin and that the morbid anatomical features he has discovered are not primary, but secondary to mental factors.