I recently found records for a man who was committed to the Essex County Hospital for the Insane in Newark, NJ in 1889. He was 25 at the time, and his father signed the committal papers. The young man remained in the institution until his death in 1933 at age 68. When his father died in 1899, court papers were filed to transfer the patient's guardianship to his older brother, in lieu of his mother or other siblings. I have found the court file for the guardianship change, but not for his original institutionalization.
The 1899 file contained two certifications from a physicians at  the hospital. One reads that the patient "suffers from a chronic disease of the brain known as Terminal Dementia." The second physician termed it "suffering from a form of chronic mental disease known as Terminal Dementia," essentially the same as the first.

Two questions:

1) I have researched the diagnosis "Terminal Dementia" and found nothing more helpful than the explanation that it was a form of demential that was not curable and would last for life -- not very helpful. Because the patient was so young at the time of institutionalization I have more or less ruled out early onset Alzheimer's Disease. The more probable conditions for a person of that age I think would be a form of Bi-Polar Disease or Schizophrenia. This is my own non-professional guess. I wonder if someone with more psychiatric experience could shed some light on this archaic term and it's usual meaning at that time (1899).

2) The Essex County Hospital for the Insane has moved and changed it's name several times, and today is part of a larger medical complex in NJ. Can anyone shed some light on if and where copies of the records from the 1889 committal be obtained? I found the second Guardianship file on Ancestry under "New Jersey, U.S., Wills and Probate Records, Essex, Unrecorded estate papers", but nothing for the first committal.

Thanks in advance for any assistance.
Judith Lipmanson
Smyrna, Delaware USA

I think you are asking an unanswerable question. In 1889 (and for many decades after that) people might have ended up in institutions because they had untreated hypothyroidism, or a brain bleed, or hydrocephalus or a host of other things. There would have been no way to distinguish the cause most of the time (albeit not all of the time). Some where institutionalized because they were awkward women, had different sexual preferences. Perhaps if you can get medical records with detailed descriptions  those could be reinterpreted with the insights of 2020 (which are often also wrong -- Bi-Polar disease, or Schizophrenia are not easily categorised diagnoses especially at the margins where they might not be diagnoses at all). "Terminal Dementia" would have meant nothing essentially apart from a lack of normal mental abilities which might be associated with a shortening of life. 

Dr Aubrey Blumsohn

Sheffield, UK

Aubrey and Paul,

Both of you have supported what I thought -- that at the time Terminal Dementia was a catch-all categorization for a spectrum of psychiatric symptoms.
The man in question could have had brain damage at birth and just become too difficult to manage at home as an adolescent. He could have developed symptoms later. There's no way of knowing as none his family who would have known is living. In addition, when Essex County Hospital for the Insane moved to Cedar Grove, NJ and became Overbrook in the early 20th century, his records probably went with him. Overbrook is now razed, and pictures from its abandonment show that patient records were left in the basement to rot. There may be court records of his original committal as the family had to post a "bond" for his care at the institution.
Thanks for replying.

Judith Lipmanson

Smyrna, DE USA

Sherri,
In 1880 the family lived in Alachua County, FL. In the U.S. Census of the same year, the young man in question was 15 yrs old and listed as attending school with his siblings, strongly suggesting he was not intellectually or physically challenged at that time (when there was no Special Ed). The father died in July 1899 in NJ. Between 1880 and 1899, they had moved to NJ. I don't know exactly when, but the 1885 NJ State Census does not show the family in NJ, except for the oldest son who moved to NJ some years before the rest of the family followed. The best guess is that the family move occurred between 1885 and 1889, the time of the commitment. Unfortunately, as we know, the 1890 U.S. census was mostly destroyed in a fire.
Regards,
Judith Lipmanson

Smyrna, DE USA

Sarah,

Although "Terminal Dimentia" seemed to be a catch-all diagnosis meaning the patient couldn't be cured, it included patients with all sorts of conditions -- Syphilitic Pareses among them. This man was 25 when committed, and I can't rule out the possibility of some sort of accident causing brain trauma. I need to do a thorough search of the newspapers in Alachua FL and elsewhere, as well as trying to find the original commitment papers.
Thanks.
Judith Lipmanson
Smyrna, DE USA