Kraepelin's 'lost biological psychiatry'? Autointoxication, organotherapy and surgery for dementia praecox

Kraepelin believed that a chronic metabolic autointoxication, perhaps arising from the sex glands, eventually caused chemical damage to the brain and led to the symptoms of dementia praecox. The evolution of Kraepelin's autointoxication theory of dementia praecox is traced through the 5th to 8th (1895 to 1913) editions of his textbook, Psychiatrie. The historical context of autointoxication theory in medicine is explored in depth to enable the understanding of Kraepelin's aetiological assumption and his application of a rational treatment based on it-organotherapy. A brief account of the North American reception of Kraepelin's concept of dementia praecox, its autotoxic basis, and the preferred American style of rational treatment-surgery-concludes the discussion.