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Alzheimer Disease
SOURCEBOOK

Seventh Edition
 Health Reference Series

Alzheimer Disease
SOURCEBOOK
Seventh Edition

Basic Consumer Health Information about Alzheimer

Disease and Other Forms of Dementia, Including Mild
Cognitive Impairment, Corticobasal Degeneration, Dementia
with Lewy Bodies, Frontotemporal Dementia, Huntington
Disease, Parkinson Disease, and Vascular Dementia
Along with Information about Recent Research on the
Diagnosis and Prevention of Alzheimer Disease and Genetic
Testing, Tips for Maintaining Cognitive Functioning,
Strategies for Long-Term Planning, Advice for Caregivers, a
Glossary of Related Terms, and Directories of Resources for
Additional Help and Information
615 Griswold, Ste. 901, Detroit, MI 48226
 Bibliographic Note
Because this page cannot legibly accommodate all the copyright
notices, the Bibliographic Note portion of the Preface constitutes an
extension of the copyright notice.

***
OMNIGRAPHICS
Angela L. Williams, Managing Editor

***
Copyright © 2019 Omnigraphics

ISBN 978-0-7808-1677-0
E-ISBN 978-0-7808-1678-7

Library of Congress Cataloging-in-Publication Data

Names: Omnigraphics, Inc., issuing body.
Title: Alzheimer disease sourcebook: basic consumer health
information about alzheimer disease and other forms of dementia,
including mild cognitive impairment, corticobasal degeneration,
dementia with lewy bodies, frontotemporal dementia, huntington
disease, parkinson disease, and vascular dementia; along with
information about recent research on the diagnosis and
prevention of alzheimer disease and genetic testing, tips for
maintaining cognitive functioning, strategies for long-term
planning, advice for caregivers, a glossary of related terms, and
directories of resources for additional help and information.
Description: Seventh edition. | Detroit, MI: Omnigraphics, Inc.,
[2019] | Series: Health reference series | “Angela L. Williams,
editorial manager.” | Includes bibliographical references and index.
Identifiers: LCCN 2018053288| ISBN 9780780816770 (hard cover:
alk. paper) | ISBN 9780780816787 (ebook)
 Subjects: LCSH: Alzheimer’s disease--Popular works. | Dementia--
Popular works.
Classification: LCC RC523.2.A45 2019 | DDC 616.8/311--dc23
LC record available at https://lccn.loc.gov/2018053288

Electronic or mechanical reproduction, including photography,

recording, or any other information storage and retrieval system for
the purpose of resale is strictly prohibited without permission in
writing from the publisher.
The information in this publication was compiled from the sources
cited and from other sources considered reliable. While every
possible effort has been made to ensure reliability, the publisher will
not assume liability for damages caused by inaccuracies in the data,
and makes no warranty, express or implied, on the accuracy of the
information contained herein.

This book is printed on acid-free paper meeting the ANSI Z39.48

Standard. The infinity symbol that appears above indicates that the
paper in this book meets that standard.

Printed in the United States

 Table of Contents

Preface

Part I: Facts about the Brain and Cognitive

Decline
Chapter 1—The Basics of a Healthy Brain
Chapter 2—The Changing Brain in Healthy Aging
Chapter 3—Understanding Memory Loss
Chapter 4—What Is Dementia?
Chapter 5—Dementia: Causes and Risk Factors
Chapter 6—Statistics on Dementia Prevalence and Mortality
Chapter 7—National Plan to Address Alzheimer Disease: 2017
Update

Part II: Alzheimer Disease: The Most Common

Type of Dementia
Chapter 8—Facts about Alzheimer Disease
Chapter 9—What Happens to the Brain in Alzheimer Disease
Chapter 10—Signs and Symptoms of Alzheimer Disease
Chapter 11—The Connection between Alzheimer Disease and Genes
Chapter 12—Clinical Stages of Alzheimer Disease
Chapter 13—Early-Onset Alzheimer Disease
Chapter 14—The Genetics of Alzheimer Disease
Section 14.1—Alzheimer Disease Genetics Fact Sheet
Section 14.2—Gene Linked to Alzheimer Disease Plays
Key Role in Cell Survival
Section 14.3—Genetic Risk Variants Linked to Alzheimer
Disease Amyloid Brain Changes
Chapter 15—Health Conditions Linked to Alzheimer Disease
Section 15.1—Down Syndrome and Alzheimer Disease
Section 15.2—Obesity May Raise Risk of Alzheimer
Disease and Dementia
Section 15.3—Diabetes, Dementia, and Alzheimer
Disease
Chapter 16—Traumatic Brain Injury, Alzheimer Disease, and
Dementia
Chapter 17—Other Factors That Influence Alzheimer Disease Risk
Section 17.1—Alcohol Use and the Risk of Developing
Alzheimer Disease
Section 17.2—Effects of Nicotine on Cognitive Function
Section 17.3—Heart Health
Section 17.4—Sleep Deprivation Increases Alzheimer
Disease Protein
Section 17.5—Decade after Menopause Poses Highest
Risk of Alzheimer Disease for Women with
ApoE4 Gene
Section 17.6—Connection between Hearing and
Cognitive Health
Part III: Other Dementia Disorders
Chapter 18—Cognitive Impairment
Chapter 19—Degenerative Neurological Disease
Section 19.1—Corticobasal Degeneration
Section 19.2—Dementia with Lewy Bodies
Section 19.3—Frontotemporal Dementia
Section 19.4—Huntington Disease
Section 19.5—Parkinson Disease
Chapter 20—Vascular Dementia
Section 20.1—What Is Vascular Dementia?
Section 20.2—Binswanger Disease (Subcortical Vascular
Dementia)
Section 20.3—Cerebral Autosomal Dominant
Arteriopathy with Subcortical Infarcts and
Leukoencephalopathy (CADASIL)
Section 20.4—Multi-Infarct Dementia
Chapter 21—Dementia Caused by Infection
Section 21.1—Creutzfeldt-Jakob Disease
Section 21.2—Acquired Immunodeficiency Syndrome
Dementia Complex
Chapter 22—Other Health Conditions That Cause Dementia
Section 22.1—Cancer, Delirium, and Dementia
Section 22.2—Dementia: A Symptom of Normal
Pressure Hydrocephalus

Part IV: Recognizing, Diagnosing, and Treating

Symptoms of Alzheimer Disease and
Dementias
Chapter 23—Forgetfulness: Knowing When to Ask for Help
Chapter 24—Talking with Your Doctor
Chapter 25—Diagnosing Alzheimer Disease
Section 25.1—How Is Alzheimer Disease Diagnosed?
Section 25.2—Alzheimer Disease Diagnostic Guidelines
Chapter 26—Testing for Alzheimer Disease
Section 26.1—Test for Assessing Cognitive Impairment
Section 26.2—Positron Emission Tomography and Single
Photon Emission Computed Tomography
Section 26.3—Magnetic Resonance Imaging
Section 26.4—Biomarker Testing for Alzheimer Disease
Chapter 27—Medications for Alzheimer Disease
Chapter 28—Participating in Alzheimer Disease Clinical Trials and
Studies
Chapter 29—Can Alzheimer Disease Be Prevented?
Chapter 30—Recent Alzheimer Disease Research
Section 30.1—Researchers Map How Alzheimer Disease
Pathology Spreads across Brain Networks
Section 30.2—NIH-Funded Study Finds New Evidence
That Viruses May Play a Role in Alzheimer
Disease
Section 30.3—Lack of Sleep May Be Linked to Risk
Factor for Alzheimer Disease
Section 30.4—Clearing Senescent Cells from the Brain in
Mice Preserves Cognition
 Section 30.5—Higher Brain Glucose Levels May Mean
More Severe Alzheimer Disease
Section 30.6—Blood, Brain Metabolites Could Be Earlier
Biomarkers of Alzheimer Disease

Part V: Living with Alzheimer Disease and

Dementias
Chapter 31—Talking about Your Diagnosis
Section 31.1—Telling Others about an Alzheimer Disease
Diagnosis
Section 31.2—Talking to Children about Alzheimer
Disease
Chapter 32—Getting Support for Alzheimer Disease and Dementia
Chapter 33—Preventing Cognitive Decline If You Have Alzheimer
Disease or Dementia
Chapter 34—Nutrition, Exercise, and Therapeutic Recommendations
Section 34.1—Questions and Answers about Alzheimer
Disease Prevention
Section 34.2—Healthy Eating and Alzheimer Disease
Section 34.3—Physical Activity Benefits Nursing-Home
Residents with Alzheimer Disease
Section 34.4—Dance Your Way to Better Brain Health
Section 34.5—Complementary Health Approaches for
Alzheimer Disease and Dementia
Chapter 35—Medications’ Effects on Older Adults’ Brain Functions
Chapter 36—Common Medical Problems in People with Alzheimer
Disease
Chapter 37—Alzheimer Disease and Hallucinations, Delusions, and
Paranoia
Chapter 38—Pain and Dementia
Chapter 39—Sexuality and Alzheimer Disease
Chapter 40—Managing Sleep Problems in Alzheimer Disease
Chapter 41—Driving Safety and Alzheimer Disease
Chapter 42—Living Alone with Alzheimer Disease or Dementia
Chapter 43—Financial Concerns and Alzheimer Disease
Chapter 44—Medicare and Alzheimer Disease
Chapter 45—Getting Your Affairs in Order
Section 45.1—Planning for the Future
Section 45.2—Legal and Healthcare Planning Document
Section 45.3—Healthcare Decisions at the End of Life

Part VI: Caregiver Concerns

Chapter 46—Caring for a Person with Alzheimer Disease or Dementia
Chapter 47—Helping Family Members and Others Understand
Alzheimer Disease
Chapter 48—Long-Distance Caregiving
Chapter 49—Coping with Challenging Behaviors
Section 49.1—Personality and Behavior Changes in
Alzheimer Disease
Section 49.2—Agitation and Aggression in Alzheimer
Disease
Section 49.3—When a Person with Alzheimer Disease
Rummages and Hides Things
Section 49.4—Coping with Sundowning
Chapter 50—Coping with Late-Stage Alzheimer Disease
Chapter 51—Techniques for Communicating with Someone with
Alzheimer Disease
Chapter 52—Planning the Day for Someone with Dementia
Chapter 53—Safety Issues for People with Alzheimer Disease
Section 53.1—Safety at Home
Section 53.2—Using Medicines Safely
Section 53.3—Wandering
Section 53.4—Disaster Preparedness for Patients with
Alzheimer Disease Caregivers
Section 53.5—Understanding Elder Abuse
Chapter 54—Dementia, Caregiving, and Controlling Frustration
Chapter 55—Respite Care: Giving Caregivers a Break
Chapter 56—Residential Facilities, Assisted Living, and Nursing
Homes
Chapter 57—Choosing a Nursing Home
Chapter 58—Hospitalization and Alzheimer Disease
Chapter 59—Making Decisions about Resuscitation and Tube Feeding
Chapter 60—Caring for Someone near the End of Life
Chapter 61—What Happens When Someone Dies

Part VII: Additional Help and Information

Chapter 62—Glossary of Terms Related to Alzheimer Disease and
Dementia
Chapter 63—Directory of Resources for People with Dementia and
Their Caregivers

Index
 Preface

About This Book

Approximately 5 million Americans are estimated to be living with
the progressive, incurable, fatal brain disorder known as Alzheimer
disease (AD). By 2050, this number is projected to quadruple and
affect 14 million U.S. adults aged 65 years of age or older. AD, which
accounts for between 60 percent and 80 percent of all cases of
dementia, destroys brain cells, causes memory loss and confusion,
and worsens over time until patients eventually lose the ability to
work, walk, and communicate.
Alzheimer Disease Sourcebook, Seventh Edition provides updated
information about the causes, symptoms, and stages of AD and
other forms of dementia, including mild cognitive impairment,
corticobasal degeneration, dementia with Lewy bodies,
frontotemporal dementia, Huntington disease, Parkinson disease,
and dementia caused by infections. It discusses the structure of the
brain, how it changes with age, and the cognitive decline and
degeneration that occur in dementia. Facts about genetic testing,
cognitive and behavioral symptoms, AD clinical trials, and recent
research efforts are also included, along with information about
legal, financial, and medical planning and coping strategies for
caregivers. The book concludes with a glossary of related terms and
directories of resources.

How to Use This Book

 This book is divided into parts and chapters. Parts focus on broad
areas of interest. Chapters are devoted to single topics within a part.
Part One: Facts about the Brain and Cognitive Decline provides
information about healthy brain function and examines changes in
cognitive functions and memory that occur during the typical aging
process. Facts about the types, symptoms, causes, risk factors, and
prevalence of dementia—a brain disorder that significantly impairs
intellectual functions—are also included.
Part Two: Alzheimer Disease: The Most Common Type of Dementia
discusses Alzheimer disease (AD), an irreversible and progressive
brain disease and identifies the signs, symptoms, and diagnostic
stages of this disorder. Information about the role that genetics,
brain injuries, weight, and injuries play in the development of AD is
also presented, along with facts about early-onset AD, a form of the
disease that affects people under the age of 65. It also discusses the
factors that influence AD risk, such as alcohol, nicotine, and sleep
deprivation.
Part Three: Other Dementia Disorders identifies types, signs, and
symptoms of dementia other than AD, including cognitive
impairment, corticobasal degeneration, dementia with Lewy bodies,
frontotemporal disorders, Huntington disease, Parkinson disease,
and vascular dementia. It details various causes of dementia, such
as AIDS, cancer, delirium, and other diseases.
Part Four: Recognizing, Diagnosing, and Treating Symptoms of
Alzheimer Disease and Dementias explains neurocognitive and
imaging tools used to assess and diagnose dementia, such as
positron emission tomography, single photon emission computed
tomography, magnetic resonance imaging, and biomarker testing.
Medications used manage AD and other dementias, are identified,
and information about participating in AD clinical trials and studies is
included. An explanation of recent developments in AD research is
also provided.
Part Five: Living with Alzheimer Disease and Dementias describes
strategies for maintaining health and wellness after a dementia
diagnosis. Patients and caregivers will find information about
nutrition, exercises, and dental care for dementia patients, tips on
telling someone about the diagnosis, strategies for slowing the rate
of cognitive decline, and advice on pain, sleep problems, and
sexuality in people with dementia. Information about Medicare and
financial, legal, and healthcare planning is included.
Part Six: Caregiver Concerns offers advice to those who care for
people with AD or dementia. Strategies for coping with challenging
behaviors, communicating, and planning daily activities for someone
with dementia are discussed, along with tips on creating a safe
environment at home. Caregivers struggling to control frustration
and cope with fatigue will find information about respite, home
health, and nursing home care, as well as suggestions on evaluating
difficult health decisions near the end of life.
Part Seven: Additional Help and Information provides a glossary of
terms related to AD and dementia and a directory of organizations
that provide health information about AD and dementia.

Bibliographic Note
This volume contains documents and excerpts from publications
issued by the following U.S. government agencies: Administration for
Community Living (ACL); Agency for Healthcare Research and
Quality (AHRQ); Centers for Disease Control and Prevention (CDC);
Centers for Medicare & Medicaid Services (CMS); National Cancer
Institute (NCI); National Center for Biotechnology Information
(NCBI); National Center for Complementary and Integrative Health
(NCCIH); National Heart, Lung, and Blood Institute (NHLBI);
National Institute of Biomedical Imaging and Bioengineering
(NIBIB); National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK); National Institute of Neurological Disorders and
Stroke (NINDS); National Institute on Aging (NIA); National Institute
on Alcohol Abuse and Alcoholism (NIAAA); National Institutes of
Health (NIH); NIH News in Health; Office of the Assistant Secretary
for Planning and Evaluation (ASPE); Office of the Surgeon General
(OSG); U.S. Department of Veterans Affairs (VA); and U.S. Social
Security Administration (SSA).

About the Health Reference Series

The Health Reference Series is designed to provide basic medical
information for patients, families, caregivers, and the general public.
Each volume takes a particular topic and provides comprehensive
coverage. This is especially important for people who may be dealing
with a newly diagnosed disease or a chronic disorder in themselves
or in a family member. People looking for preventive guidance,
information about disease warning signs, medical statistics, and risk
factors for health problems will also find answers to their questions
in the Health Reference Series. The Series, however, is not intended
to serve as a tool for diagnosing illness, in prescribing treatments, or
as a substitute for the physician/patient relationship. All people
concerned about medical symptoms or the possibility of disease are
encouraged to seek professional care from an appropriate healthcare
provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary
as an authority for questions related to the spelling of medical terms
and the Chicago Manual of Style for questions related to
grammatical structures, punctuation, and other editorial concerns.
Consistent adherence is not always possible, however, because the
individual volumes within the Series include many documents from a
wide variety of different producers, and the editor’s primary goal is
to present material from each source as accurately as is possible.
This sometimes means that information in different chapters or
sections may follow other guidelines and alternate spelling
authorities. For example, occasionally a copyright holder may require
that eponymous terms be shown in possessive forms (Crohn’s
disease vs. Crohn disease) or that British spelling norms be retained
(leukaemia vs. leukemia).

Medical Review
Omnigraphics contracts with a team of qualified, senior medical
professionals who serve as medical consultants for the Health ­‐
Reference Series. As necessary, medical consultants review reprinted
material for currency and accuracy. Citations including the phrase
“Reviewed (month, year)” indicate material reviewed by this team.
Medical consultation services are provided to the Health Reference
Series editors by:
Dr. Vijayalakshmi, MBBS, DGO, MD
Dr. Senthil Selvan, MBBS, DCH, MD
Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Our Advisory Board

We would like to thank the following board members for
providing initial guidance on the development of this series:

Dr. Lynda Baker, Associate Professor of Library and Information

Science, Wayne State University, Detroit, MI
Nancy Bulgarelli, William Beaumont Hospital Library, Royal Oak,
MI
Karen Imarisio, Bloomfield Township Public Library, Bloomfield
Township, MI
Karen Morgan, Mardigian Library, University of ­Michigan-
Dearborn, Dearborn, MI
Rosemary Orlando, St. Clair Shores Public Library, St. Clair
Shores, MI
 Health Reference Series Update Policy
The inaugural book in the Health Reference Series was the first
edition of Cancer Sourcebook published in 1989. Since then, the
Series has been enthusiastically received by librarians and in the
medical community. In order to maintain the standard of providing
high-quality health information for the layperson the editorial staff at
Omnigraphics felt it was necessary to implement a policy of updating
volumes when warranted.
Medical researchers have been making tremendous strides, and it
is the purpose of the Health Reference Series to stay current with
the most recent advances. Each decision to update a volume is
made on an individual basis. Some of the considerations include how
much new information is available and the feedback we receive from
people who use the books. If there is a topic you would like to see
added to the update list, or an area of medical concern you feel has
not been adequately addressed, please write to:
Managing Editor
Health Reference Series
Omnigraphics
615 Griswold, Ste. 901
Detroit, MI 48226
 Part One

Facts about the Brain and Cognitive

Decline
 Chapter 1

The Basics of a Healthy Brain

The brain is the most complex part of the human body. This
three-pound organ is the seat of intelligence, interpreter of the
senses, initiator of body movement, and controller of behavior. Lying
in its bony shell and washed by protective fluid, the brain is the
source of all the qualities that define our humanity. The brain is the
crown jewel of the human body.
For centuries, scientists and philosophers have been fascinated
by the brain, but until recently they viewed the brain as nearly
incomprehensible. Now, however, the brain is beginning to relinquish
its secrets. Scientists have learned more about the brain in the last
few years than in all previous centuries because of the accelerating
pace of research in neurological and behavioral science and the
development of new research techniques. As a result, Congress
named the 1990s the Decade of the Brain. At the forefront of
research on the brain and other elements of the nervous system is
the National Institute of Neurological Disorders and Stroke (NINDS),
which conducts and supports scientific studies in the United States
and around the world.
This chapter is a basic introduction to the human brain. It may
help you understand how the healthy brain works, how to keep it
healthy, and what happens when the brain is diseased or
dysfunctional.

The Architecture of the Brain

The brain is like a committee of experts. All the parts of the brain
work together, but each part has its own special properties. The
brain can be divided into three basic units: the forebrain, the
midbrain, and the hindbrain.

Figure 1.1. The Human Brain

The hindbrain includes the upper part of the spinal cord, the
brain stem, and a wrinkled ball of tissue called the cerebellum (1).
The hindbrain controls the body’s vital functions such as respiration
and heart rate. The cerebellum coordinates movement and is
involved in learned rote movements. When you play the piano or hit
a tennis ball you are activating the cerebellum. The uppermost part
of the brainstem is the midbrain, which controls some reflex actions
and is part of the circuit involved in the control of eye movements
and other voluntary movements. The forebrain is the largest and
most highly developed part of the human brain: it consists primarily
of the cerebrum (2) and the structures are hidden beneath it.
When people see pictures of the brain it is usually the cerebrum
that they notice. The cerebrum sits at the topmost part of the brain
and is the source of intellectual activities. It holds your memories,
allows you to plan, enables you to imagine and think. It allows you
to recognize friends, read books, and play games.
The cerebrum is split into two halves (hemispheres) by a deep
fissure. Despite the split, the two cerebral hemispheres communicate
with each other through a thick tract of nerve fibers that lies at the
base of this fissure. Although the two hemispheres seem to be
mirror images of each other, they are different. For instance, the
ability to form words seems to lie primarily in the left hemisphere,
while the right hemisphere seems to control many abstract
reasoning skills.
For some as-yet-unknown reason, nearly all of the signals from
the brain to the body and vice versa crossover on their way to and
from the brain. This means that the right cerebral hemisphere
primarily controls the left side of the body and the left hemisphere
primarily controls the right side. When one side of the brain is
damaged, the opposite side of the body is affected. For example, a
stroke in the right hemisphere of the brain can leave the left arm
and leg paralyzed.
Figure 1.2. Forebrain, Midbrain, and Hindbrain

The Geography of Thought

Each cerebral hemisphere can be divided into sections, or lobes,
each of which specializes in different functions. To understand each
lobe and its specialty we will take a tour of the cerebral
hemispheres, starting with the two frontal lobes (3), which lie
directly behind the forehead. When you plan a schedule, imagine the
future, or use reasoned arguments, these two lobes do much of the
work. One of the ways the frontal lobes seem to do these things is
by acting as short-term storage sites, allowing one idea to be kept in
mind while other ideas are considered. In the rearmost portion of
each frontal lobe is a motor area (4), which helps control voluntary
movement. A nearby place on the left frontal lobe called Broca area
(5) allows thoughts to be transformed into words.
When you enjoy a good meal—the taste, aroma, and texture of
the food—two sections behind the frontal lobes called the parietal
lobes (6) are at work. The forward parts of these lobes, just behind
the motor areas, are the primary sensory areas (7). These areas
receive information about temperature, taste, touch, and movement
from the rest of the body. Reading and arithmetic are also functions
in the repertoire of each parietal lobe.
As you look at the words and pictures on this page, two areas at
the back of the brain are at work. These lobes, called the occipital
lobes (8), process images from the eyes and link that information
with images stored in memory. Damage to the occipital lobes can
cause blindness.
The last lobes on our tour of the cerebral hemispheres are the
temporal lobes (9), which lie in front of the visual areas and nest
under the parietal and frontal lobes. Whether you appreciate
symphonies or rock music, your brain responds through the activity
of these lobes. At the top of each temporal lobe is an area
responsible for receiving information from the ears. The underside of
each temporal lobe plays a crucial role in forming and retrieving
memories, including those associated with music. Other parts of this
lobe seem to integrate memories and sensations of taste, sound,
sight, and touch.

The Cerebral Cortex

Coating the surface of the cerebrum and the cerebellum is a vital
layer of tissue the thickness of a stack of two or three dimes. It is
called the cortex, from the Latin word for bark. Most of the actual
information processing in the brain takes place in the cerebral
cortex. When people talk about “gray matter” in the brain they are
talking about this thin rind. The cortex is gray because nerves in this
area lack the insulation that makes most other parts of the brain
appear to be white. The folds in the brain add to its surface area,
and therefore, increase the amount of gray matter and the quantity
of information that can be processed.

The Inner Brain

Deep within the brain, hidden from view, lie structures that are
the gatekeepers between the spinal cord and the cerebral
hemispheres. These structures not only determine our emotional
state, they also modify our perceptions and responses depending on
that state, and allow us to initiate movements that you make without
thinking about them. Like the lobes in the cerebral hemispheres, the
structures described below come in pairs: each is duplicated in the
opposite half of the brain.
Figure 1.3. Inner Brain
The hypothalamus (10), about the size of a pearl, directs a
multitude of important functions. It wakes you up in the morning,
and gets the adrenaline flowing during a test or job interview. The
hypothalamus is also an important emotional center, controlling the
molecules that make you feel exhilarated, angry, or unhappy. Near
the hypothalamus lies the thalamus (11), a major clearinghouse
for information going to and from the spinal cord and the cerebrum.
An arching tract of nerve cells leads from the hypothalamus and
the thalamus to the hippocampus (12). This tiny nub acts as a
memory indexer—sending memories out to the appropriate part of
the cerebral hemisphere for long-term storage and retrieving them
when necessary. The basal ganglia are clusters of nerve cells
surrounding the thalamus. They are responsible for initiating and
integrating movements. Parkinson disease (PD), which results in
tremors, rigidity, and a stiff, shuffling walk, is a disease of nerve cells
that lead into the basal ganglia.

Making Connections
The brain and the rest of the nervous system are composed of
many different types of cells, but the primary functional unit is a cell
called the neuron. All sensations, movements, thoughts, memories,
and feelings are the result of signals that pass through neurons.
Neurons consist of three parts. The cell body (13) contains the
nucleus, where most of the molecules that the neuron needs to
survive and function are manufactured. Dendrites (14) extend out
from the cell body like the branches of a tree and receive messages
from other nerve cells. Signals then pass from the dendrites through
the cell body and may travel away from the cell body down an axon
(15) to another neuron, a muscle cell, or cells in some other organ.
The neuron is usually surrounded by many support cells. Some types
of cells wrap around the axon to form an insulating sheath (16).
This sheath can include a fatty molecule called myelin, which
provides insulation for the axon and helps nerve signals travel faster
and farther. Axons may be very short, such as those that carry
signals from one cell in the cortex to another cell less than a hair’s
width away. Or axons may be very long, such as those that carry
messages from the brain all the way down the spinal cord.
Scientists have learned a great deal about neurons by studying
the synapse—the place where a signal passes from the neuron to
another cell. When the signal reaches the end of the axon it
stimulates the release of tiny sacs (17). These sacs release
chemicals known as neurotransmitters (18) into the synapse
(19). The neurotransmitters cross the synapse and attach to
receptors (20) on the neighboring cell. These receptors can
change the properties of the receiving cell. If the receiving cell is
also a neuron, the signal can continue the transmission to the next
cell.
 Some Key Neurotransmitters at Work
Acetylcholine is called an excitatory neurotransmitter because it
generally makes cells more excitable. It governs muscle contractions
and causes glands to secrete hormones. Alzheimer disease (AD),
which initially affects memory formation, is associated with a
shortage of acetylcholine.
Gamma-aminobutyric acid (GABA) is called an inhibitory
neurotransmitter because it tends to make cells less excitable. It
helps control muscle activity and is an important part of the visual
system. Drugs that increase GABA levels in the brain are used to
treat epileptic seizures and tremors in patients with Huntington
disease (HD).
Serotonin is a neurotransmitter that constricts blood vessels and
brings on sleep. It is also involved in temperature regulation.
Dopamine is an inhibitory neurotransmitter involved in mood and the
control of complex movements. The loss of dopamine activity in
some portions of the brain leads to the muscular rigidity of Parkinson
disease. Many medications used to treat behavioral disorders work
by modifying the action of dopamine in the brain.

Neurological Disorders
When the brain is healthy it functions quickly and automatically.
But when problems occur, the results can be devastating. Some 50
million people in this country—one in five—suffer from damage to
the nervous system. The NINDS supports research on more than
600 neurological diseases. Some of the major types of disorders
include: neurogenetic diseases (such as Huntington disease and
muscular dystrophy (MD)), developmental disorders (such as
cerebral palsy (CP)), degenerative diseases of adult life (such as
Parkinson disease and Alzheimer disease), metabolic diseases (such
as Gaucher disease), cerebrovascular diseases (such as stroke and
vascular dementia), trauma (such as spinal cord and head injury),
convulsive disorders (such as epilepsy), infectious diseases (such as
acquired immunodeficiency syndrome (AIDS) dementia), and brain
tumors.
_____________
This chapter includes text excerpted from “Brain Basics: Know Your Brain,”
National Institute of Neurological Disorders and Stroke (NINDS), October 28,
2018.
 Chapter 2

The Changing Brain in Healthy

Aging

The brain controls many aspects of thinking—remembering,

planning and organizing, making decisions, and much more. These
cognitive abilities can decline with age. Exactly what controls aging
in the brain, however, is not clear.
You naturally lose brain cells with age. Certain regions of the
brain have cells called neural stem cells that can regenerate. These
stem cells serve as a sort of internal repair system, dividing to
replenish other cells. They have only been found in a few brain
regions, including the hypothalamus. The hypothalamus is critical for
regulating the endocrine system—the glands and hormones
throughout the body. The region is known to play a role in
development, reproduction, and metabolism. It has also been
implicated in aging.
To investigate whether stem cells in the hypothalamus influence
the aging process, a team of scientists led by Dr. Dongsheng Cai at
Albert Einstein College of Medicine examined these cells in mice. The
study was funded by National Institutes of Health’s (NIH) National
Institute on Aging (NIA), National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK), and National Heart, Lung, and Blood
Institute (NHLBI). Results were published in the August 3, 2017,
issue of Nature.
The researchers first observed what happens to stem cells in the
hypothalamus as healthy mice age. They found that the number of
stem cells gradually diminished in early to middle-aged mice and
were almost completely absent in older mice. They then
experimentally disrupted these stem cells in middle-aged mice and
examined the effects on aging over three to four months. Mice with
the disrupted stem cells showed signs of cognitive impairment and
other signs of aging earlier than control mice. Mice with the
disrupted stem cells also had a shortened lifespan.
The researchers were able to slow these signs of aging by
implanting hypothalamic stem cells harvested from newborn mice
into the brains of middle-aged mice. The mice also lived longer than
control mice. These antiaging effects could be replicated by injecting
the tiny fluid-filled sacs, called exosomes, that are secreted by
hypothalamic neural stem cells. Exosomes circulate in blood and
carry genetic material called microRNA (miRNA), which regulates
genes in tissues throughout the body.
These results suggest that it’s the endocrine function of the
hypothalamic stem cells that essentially controls the aging process.
It remains to be seen what role the cells’ regenerative properties
play in the long-term control of aging.
“Our research shows that the number of hypothalamic neural
stem cells naturally declines over the life of the animal, and this
decline accelerates aging,” Cai says. “But we also found that the
effects of this loss are not irreversible. By replenishing these stem
cells or the molecules they produce, it’s possible to slow and even
reverse various aspects of aging throughout the body.”

How the Aging Brain Affects Thinking

Some changes in thinking are common as people get older. For
example, older adults may have:
 Increased difficulty finding words and recalling names
More problems with multitasking
Mild decreases in the ability to pay attention

Aging may also bring positive cognitive changes. People often

have more knowledge and insight from a lifetime of experiences.
Research shows that older adults can still:

Learn new things

Create new memories
Improve vocabulary and language skills

The Older, Healthy Brain

As a person gets older, changes occur in all parts of the body,
including the brain.

Certain parts of the brain shrink, especially those important to

learning and other complex mental activities.
In certain brain regions, communication between neurons
(nerve cells) can be reduced.
Blood flow in the brain may also decrease.
Inflammation, which occurs when the body responds to an
injury or disease, may increase.

These changes in the brain can affect mental function, even in

healthy older people. For example, some older adults find that they
don’t do as well as younger people on complex memory or learning
tests. Given enough time, though, they can do as well. There is
growing evidence that the brain remains “plastic”—able to adapt to
new challenges and tasks—as people age.
It is not clear why some people think well as they get older while
others do not. One possible reason is “cognitive reserve,” the brain’s
ability to work well even when some part of it is disrupted. People
with more education seem to have more cognitive reserve than
others.
Some brain changes, like those associated with Alzheimer disease
(AD), are NOT a normal part of aging. Talk with your healthcare
provider if you are concerned.

Brain Regions
The brain is complex and has many specialized parts. For
example, the two halves of the brain, called cerebral hemispheres,
are responsible for intelligence.
The cerebral hemispheres have an outer layer called the cerebral
cortex. This region, the brain’s “gray matter,” is where the brain
processes sensory information, such as what we see and hear. The
cerebral cortex also controls movement and regulates functions such
as thinking, learning, and remembering.

How Brain Cells Work

The healthy human brain contains many different types of cells.
Neurons are nerve cells that process and send information
throughout the brain, and from the brain to the muscles and organs
of the body.
The ability of neurons to function and survive depends on three
important processes:

Communication. When a neuron receives signals from other

neurons, it generates an electrical charge. This charge travels to
the synapse, a tiny gap where chemicals called
neurotransmitters are released and move across to another
neuron.
Metabolism. This process involves all chemical reactions that
take place in a cell to support its survival and function. These
 reactions require oxygen and glucose, which are carried in blood
flowing through the brain.
Repair, remodeling, and regeneration. Neurons live a long
time—more than 100 years in humans. As a result, they must
constantly maintain and repair themselves. In addition, some
brain regions continue to make new neurons.

Other types of brain cells, called glial cells, play critical roles in
supporting neurons. In addition, the brain has an enormous network
of blood vessels. Although the brain is only 2 percent of the body’s
weight, it receives 20 percent of the body’s blood supply.
_____________
This chapter contains text excerpted from the following sources: Text in this
chapter begins with excerpts from “Brain Cells That Influence Aging,” National
Institutes of Health (NIH), August 15, 2017; Text beginning with the heading “How
the Aging Brain Affects Thinking” is excerpted from “How the Aging Brain Affects
Thinking,” National Institute on Aging (NIA), National Institutes of Health (NIH),
May 17, 2017.
 Chapter 3

Understanding Memory Loss

Memory and Thinking: What’s Normal and

What’s Not?
Many older people worry about their memory and other thinking
abilities. For example, they might be concerned about taking longer
than before to learn new things, or they might sometimes forget to
pay a bill. These changes are usually signs of mild forgetfulness—
often a normal part of aging—not serious memory problems.
Talk with your doctor to determine if memory and other thinking
problems are normal or not, and what is causing them.

What’s Normal and What’s Not?

What’s the difference between normal, age-related forgetfulness
and a serious memory problem? Serious memory problems make it
hard to do everyday things like driving and shopping. Signs may
include:

Asking the same questions over and over again

Getting lost in familiar places
 Not being able to follow instructions
Becoming confused about time, people, and places

Differences between Mild Forgetfulness and More Serious Memory

Problems

What Is Mild Forgetfulness?

It is true that some of us get more forgetful as we age. It may

take longer to learn new things, remember certain words, or find our
glasses. These changes are often signs of mild forgetfulness, not
serious memory problems.
See your doctor if you’re worried about your forgetfulness. Tell
him or her about your concerns. Be sure to make a follow-up
appointment to check your memory in the next six months to a year.
If you think you might forget, ask a family member, friend, or the
doctor’s office to remind you.

What Can I Do about Mild Forgetfulness?

You can do many things to help your memory. Here are some
ways to help your memory:

Learn a new skill

Volunteer in your community, at a school, or at your place of
worship
Spend time with friends and family
Use memory tools such as big calendars, to-do lists, and notes
to yourself
Put your wallet or purse, keys, and glasses in the same place
each day
Get lots of rest
Exercise and eat well
 Don’t drink a lot of alcohol
Get help if you feel depressed for weeks at a time

What Is a Serious Memory Problem?

Serious memory problems make it hard to do everyday things.
For example, you may find it hard to drive, shop, or even talk with a
friend. Signs of serious memory problems may include:

Asking the same questions over and over again

Getting lost in places you know well
Not being able to follow directions
Becoming more confused about time, people, and places
Not taking care of yourself—eating poorly, not bathing
Being unsafe

What Can I Do about Serious Memory

Problems?
See your doctor if you are having any of the problems listed
above. It’s important to find out what might be causing a serious
memory problem. Once you know the cause, you can get the right
treatment.

Causes of Serious Memory Problems

Many things can cause serious memory problems, such as blood
clots, depression, and Alzheimer disease (AD).

Medical Conditions
 Certain medical conditions can cause serious memory problems.
These problems should go away once you get treatment. Some
medical conditions that may cause memory problems are:

Bad reaction to certain medicines

Depression
Not eating enough healthy foods, or too few vitamins and
minerals in your body
Drinking too much alcohol
Blood clots or tumors in the brain
Head injury, such as a concussion from a fall or accident
Thyroid, kidney, or liver problems.

Emotional Problems
Some emotional problems in older people can cause serious
memory problems. Feeling sad, lonely, worried, or bored can cause
you to be confused or forgetful.

Mild Cognitive Impairment

As some people grow older, they have more memory problems
than other people their age. This condition is called mild cognitive
impairment, or MCI. People with MCI can take care of themselves
and do their normal activities. MCI memory problems may include:

Losing things often

Forgetting to go to events or appointments
Having more trouble coming up with words than other people of
the same age
 Your doctor can do thinking, memory, and language tests to see
if you have MCI. She or he also may suggest that you see a
specialist for more tests. Because MCI may be an early sign of
Alzheimer disease, it’s important to see your doctor or specialist
every 6–12 months.

Alzheimer Disease
Alzheimer disease causes serious memory problems. The signs of
Alzheimer disease begin slowly and get worse over time. This is
because changes in the brain cause large numbers of brain cells to
die. It may look like simple forgetfulness at first, but over time,
people with Alzheimer disease have trouble thinking clearly. They
find it hard to do everyday things like shopping, driving, and
cooking. As the illness gets worse, people with Alzheimer disease
may need someone to take care of all their needs at home or in a
nursing home. These needs may include feeding, bathing, and
dressing.

Vascular Dementia
Many people have never heard of vascular dementia. Like
Alzheimer disease, it is a medical condition that causes serious
memory problems. Unlike Alzheimer disease, signs of vascular
dementia may appear suddenly. This is because the memory loss
and confusion are caused by changes in the blood supply to the
brain, often after a stroke. If the strokes stop, you may get better or
stay the same for a long time. If you have more strokes, you may
get worse.

Noticing Memory Problems? What to Do

Next
 We’ve all forgotten a name, where we put our keys, or if we
locked the front door. It’s normal to forget things once in a while.
But serious memory problems make it hard to do everyday things.
Forgetting how to make change, use the telephone, or find your way
home may be signs of a more serious memory problem.
For some older people, memory problems are a sign of mild
cognitive impairment, Alzheimer disease, or a related dementia.
People who are worried about memory problems should see a
doctor. Signs that it might be time to talk to a doctor include:

Asking the same questions over and over again

Getting lost in places a person knows well
Not being able to follow directions
Becoming more confused about time, people, and places
Not taking care of oneself—eating poorly, not bathing, or being
unsafe

People with memory complaints should make a follow-up

appointment to check their memory after six months to a year. They
can ask a family member, friend, or the doctor’s office to remind
them if they’re worried they’ll forget.
_____________
This chapter contains text excerpted from the following sources: Text under
the heading “Memory and Thinking: What’s Normal and What’s Not?” is excerpted
from “Memory and Thinking: What’s Normal and What’s Not?” National Institute
on Aging (NIA), National Institutes of Health (NIH), May 17, 2017; Text beginning
with the heading “Differences between Mild Forgetfulness and More Serious
Memory Problems” is excerpted from “Understanding Memory Loss,” National
Institute on Aging (NIA), National Institutes of Health (NIH), January 2018; Text
under the heading “Noticing Memory Problems? What to Do Next” is excerpted
from “Noticing Memory Problems? What to Do Next,” National Institute on Aging
(NIA), National Institutes of Health (NIH), May 17, 2017.
 Chapter 4

What Is Dementia?

Dementia is the loss of cognitive functioning—the ability to think,

remember, problem solve or reason—to such an extent that it
interferes with a person’s daily life and activities. Dementia ranges in
severity from the mildest stage, when it is just beginning to affect a
person’s functioning, to the most severe stage, when the person
must depend completely on others for basic activities of daily living.
Functions affected include memory, language skills, visual
perception, problem-solving, self-management, and the ability to
focus and pay attention. Some people with dementia cannot control
their emotions, and their personalities may change.

Symptoms
Signs and symptoms of dementia result when once-healthy
neurons (nerve cells) in the brain stop working, lose connections
with other brain cells, and die. While everyone loses some neurons
as they age, people with dementia experience far greater loss.
Unlike dementia, age-related memory loss isn’t disabling. While
dementia is more common with advanced age (as many as half of all
people age 85 or older may have some form of dementia), it is not
normal part of aging. Many people live into their 90s and beyond
without any signs of dementia. The causes of dementia can vary.
Many people with dementia have both Alzheimer disease (AD) and
one or more closely related disorders that share brain scanning or
clinical (and sometimes both) features with Alzheimer disease. When
a person is affected by more than one dementia disorder, the
dementia can be referred to as a mixed dementia. Some people may
have mixed dementia caused by Alzheimer-related
neurodegenerative processes, vascular disease-related processes, or
another neurodegenerative condition. Many other conditions such as
Creutzfeldt-Jakob disease (CJD), Huntington disease (HD), and
chronic traumatic encephalopathy (CTE) can cause dementia or
dementia-like symptoms. Risk factors for dementia include
advancing age, stroke, high blood pressure, poorly controlled
diabetes, and a thickening of blood vessel walls (atherosclerosis).
Other dementias include frontotemporal disorders (FTD), vascular
dementia, and Lewy body dementia (LBD).

Treatment
No treatments currently exist to stop or slow dementia caused by
neurodegenerative diseases (ND) or progressive dementias. Drugs
such as donepezil, rivastigmine, and galantamine can temporarily
improve or stabilize memory and thinking skills in some people.
Some studies suggest that drugs that improve memory in AD might
benefit people with early vascular dementia. Some diseases that
occur at the same time as dementia, such as diabetes and
depression, can be treated. Other drugs may help manage certain
symptoms and behavioral problems associated with the disorders.
Some symptoms that may occur in dementia-like conditions can also
be treated, although some symptoms may only respond to treatment
for a period of time. A team of specialists—doctors, nurses, and
speech, physical, and other therapists—familiar with these disorders
can help guide patient care.

Prognosis
 Many disorders can cause dementia or dementia-like symptoms.
Some, such as Alzheimer disease or Huntington disease, lead to a
progressive loss of mental functions. Many conditions that cause
dementia-like symptoms can be halted or even reversed with the
appropriate treatment. Individuals with dementia and caregivers can
face challenges including the person’s ability to handle tasks,
changes in family relationships, loss of work, and long-term care.
Individuals may need assistance with daily activities. People with
advanced dementia may need constant care and supervision.
Dementia disorders are not easy to live with, but with help, people
can meet the challenges and prepare for the future. Getting an early
accurate diagnosis and the right medical team are crucial first steps.
_____________
This chapter includes text excerpted from “Dementia Information Page,”
National Institute of Neurological Disorders and Stroke (NINDS), June 12, 2018.
 Chapter 5

Dementia: Causes and Risk Factors

Doctors have identified many other conditions that can cause

dementia or dementia-like symptoms. The diseases have different
symptoms that involve body and brain functions, and affect mental
health and cognition.
Argyrophilic grain disease (AGD) is a common, late-onset
degenerative disease that affects brain regions involved in memory
and emotion. It causes cognitive decline and changes in memory
and behavior, with difficulty finding words. The disease’s signs and
symptoms are indistinguishable from late-onset Alzheimer disease
(LOAD). Confirmation of the diagnosis can be made only at autopsy.
Creutzfeldt-Jakob disease (CJD) is a rare brain disorder that
is characterized by rapidly progressing dementia. Scientists found
that infectious proteins called prions become misfolded and tend to
clump together, causing the brain damage. Initial symptoms include
impaired memory, judgment, and thinking, along with loss of muscle
coordination and impaired vision. Some symptoms of CJD can be
similar to symptoms of other progressive neurological diseases
(PND), such as Alzheimer disease.
Chronic traumatic encephalopathy (CTE) is caused by
repeated traumatic brain injury (TBI) in some people who suffered
multiple concussions. People with CTE may develop dementia, poor
coordination, slurred speech, and other symptoms similar to those
seen in Parkinson disease (PD) twenty years or more after the injury.
Late-stage CTE is also characterized by brain atrophy and
widespread deposits of tau in nerve cells. In some people, even just
5–10 years beyond the traumatic brain injury, behavioral and mood
changes may occur. Dementia may not yet be present and the brain
may not have started to shrink, but small deposits of tau are seen in
specific brain regions at autopsy.
Huntington disease (HD) is an inherited, progressive brain
disease that affects a person’s judgment, memory, ability to plan and
organize, and other cognitive functions. Symptoms typically begin
around age 30–40 years and include abnormal and uncontrollable
movements called chorea, as well as problems with walking and lack
of coordination. Cognitive problems worsen as the disease
progresses, and problems controlling movement lead to complete
loss of ability for self-care.
HIV-associated dementia (HAD) can occur in people who
have human immunodeficiency virus (HIV), the virus that causes
acquired immunodeficiency syndrome (AIDS). HAD damages the
brain’s white matter and leads to a type of dementia associated with
memory problems, social withdrawal, and trouble concentrating.
People with HAD may develop movement problems as well. The
incidence of HAD has dropped dramatically with the availability of
effective antiviral therapies for managing the underlying HIV
infections.
Secondary dementias occur in people with disorders that
damage brain tissue. Such disorders may include multiple sclerosis,
meningitis, and encephalitis, as well as Wilson disease (in which
excessive amounts of copper build up to cause brain damage).
People with malignant brain tumors may develop dementia or
dementia-like symptoms because of damage to their brain circuits or
a buildup of pressure inside the skull.
 Risk Factors for Dementia and Vascular
Cognitive Impairment
The following risk factors may increase a person’s chance of
developing one or more kinds of dementia. Some of these factors
can be modified, while others cannot.

Age. Advancing age is the best-known risk factor for developing

dementia.
Hypertension. High blood pressure has been linked to
cognitive decline, stroke, and types of dementia that damage
the white matter regions of the brain. High blood pressure
causes “wear-and-tear” to brain blood vessel walls called
arteriosclerosis.
Stroke. A single major stroke or a series of smaller strokes
increases a person’s risk of developing vascular dementia. A
person who has had a stroke is at an increased risk of having
additional strokes, which further increases the risk of developing
dementia.
Alcohol use. Most studies suggest that regularly drinking large
amounts of alcohol increases the risk of dementia. Specific
dementias are associated with alcohol abuse, such as Wernicke-
Korsakoff syndrome (WKS).
Atherosclerosis. The accumulation of fats and cholesterol in
the lining of arteries, coupled with an inflammatory process that
leads to a thickening of the vessel walls (known as
atherosclerosis), can lead to stroke, which raises the risk for
vascular dementia.
Diabetes. People with diabetes appear to have a higher risk for
dementia. Poorly controlled diabetes is a risk factor for stroke
and cardiovascular disease (CVD), which in turn increase the
risk for vascular dementia.
Another random document with
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system, giving it elegance of style and completeness of method. He
thought it possible to change law from a system of habits into a
system of commands. These were, of course, the ideas which were
most attractive, most congenial, to the mind of Austin.
But, however natural such conceptions may have been to Austin,
it must certainly be regarded as singular that, although rejected on
the Continent, where sovereignty had throughout the most important
formative periods of European history been quite unequivocally
lodged in unmistakable sovereigns, these notions should have been
accepted in England, the land where law had been least subject to
doctrine, most observant of times and circumstances, most
piecemeal in its manner of construction, least like a set of
commands, and most like a set of habits and conventions. Doubtless
we are to remember, however, that the feudal theory of law had long
been held with perfect confidence by English lawyers in calm despite
of fact. Probably it is true that the English mind (our own), with its
practical habit, likes nice systems well enough because of their
appearance of completeness, has a sense of order which enjoys
logic, without having any curiosity or capacity for the examination of
premises. The Englishman has always been found ready to accept,
from those who had the leisure to amuse themselves in that way,
interesting explanations of his institutions which did not at all fit the
actual facts. It has caused him no inconvenience, for he has not
perceived the lack of adjustment between his actual transactions and
the theory he has accepted concerning them. He has, of course, not
troubled himself to alter his institutions to suit his philosophy. That
philosophy satisfied his thought and inconvenienced neither
Parliament nor the law courts. And so he had no doubt Austin was
right.
Austin’s logic is unrelenting, and the loyalty of his followers
unflinching. Sir Henry Maine having shown that throughout the
greater part of history the world has been full of independent political
societies possessing no law-making sovereign at all, and it having
become notorious that legislation has everywhere played a late and
comparatively subordinate part in the production of law, the latest
writers of the Austinian school have reduced jurisprudence to a
merely formal science, professing to care nothing for the actual
manner in which law may originate, nothing even for most of the
motives which induce men to obey law, provided you will but
concede that there is, among a great many other imperative motives,
one which is universally operative, namely, the fear of the
compulsion of physical force, and that there is at least one sovereign
function, namely, the application of that physical force in the carrying
out of the law. They ask to be allowed to confine themselves to such
a definition of positive law as will limit it to “rules which are enforced
by a political superior in his capacity as such.” They take for their
province only a systematic description of the forms and method “of
the influence of government upon human conduct” through the
operation of law. They thus virtually abandon the attempt to find any
universal doctrines respecting the rôle of government as a maker of
laws. For them government is not a creative agent, but only an
instrumentality for the effectuation of legal rules already in existence.
So hard is the principle of life to get at that they give over all
attempts to find it, and, turning away from the larger topics of the
biology, restrict themselves to the morphology, of law.
When it came to pointing out the body of persons with which
sovereignty was lodged in particular states of complex constitutional
structure, Austin was sometimes very unsatisfactory. Sovereignty is
lodged in England, he says, in the king, the peers, and—not the
House of Commons, but—the electorate. For he holds the House of
Commons to be merely a trustee of the electors, notwithstanding the
fact that the electors exercise their right of franchise under laws
which Parliament itself enacted and may change. In the United
States he “believes” it to be lodged “in the States’ governments, as
forming an aggregate body;” and he explains that by the government
of a State he does not mean its “ordinary legislature, but the body of
its citizens which appoints its ordinary legislature, and which, the
Union apart, is properly sovereign therein.” Apparently he is led thus
to go back of the House of Commons and the legislatures of our
States to the electorates by which they are chosen, because of his
conception of sovereignty as unlimited. If he stopped short of the
electors, some part of his sovereign body would be subject to
political superiors. If he were to go beyond the electors, to the larger
body of the people—to the women and the children and the men
who cannot vote—he would come upon, not a “determinate,” but an
indeterminate body of persons.
Our own writers, however, having made bold to embrace the
dogma of popular sovereignty with a certain fervor of patriotism,
have no hesitation about taking the additional step. They maintain,
with Lieber, that “according to the views of free men,” sovereignty
“can dwell with society, the nation, only.” Writers like the late Judge
Jameson, of Chicago, declare that they have very definite ideas of
what this means. They think that Mr. Bryce expounded the doctrine
when he wrote his chapter on “Government by Public Opinion.”
“When the true sovereign has spoken,” says Judge Jameson, “at
public meetings, by the press, or by personal argument or
solicitation, the electorate, when it acts, either registers the behests
of the people or ceases betimes further to represent them.” “The
pressure of public opinion consciously brought to bear upon the
electorate,” he declares to be, even when “inarticulate” (whatever
inarticulate pressure may be), “a clear and legitimate exercise of
sovereign power;” and he thinks that Mr. Herbert Spencer meant the
same thing when he declared that “that which, from hour to hour, in
every country, governed despotically or otherwise, produces the
obedience making political action possible, is the accumulated and
organized sentiment felt towards inherited institutions made sacred
by tradition,” inasmuch as Mr. Spencer proceeds to say with all
plainness, “Hence it is undeniable that, taken in its widest
acceptation, the feeling of the community is the sole source of
political power; in those communities, at least, which are not under
foreign domination. It is so at the outset of social life, and it still
continues substantially so.” And yet, if Mr. Spencer means the same
thing that Judge Jameson means, what are we to think of the
present fraternization of France and Russia? If the people be
sovereign in France and the Czar sovereign in Russia, it is doubtless
quite conceivable that one sovereign should love another; but if it be
true, as Judge Jameson makes Mr. Spencer say, that it is the
people, even in Russia, who are after all sovereign, what are we to
think of the fondness of the French sovereign for a government
which is holding the Russian sovereign in subjection? If this be
correct thinking, it puts us into awkward quandaries, troubling our
logic as well as condemning our lives.
Apply this doctrine of our masters in American law to our actual
political conditions, and see how far it simplifies the matter. In the
United States (so runs the orthodox creed) the People is sovereign.
—the verb is singular because the people, under this doctrine,
constitute a unit. And yet it is notorious that they never have acted as
a unit, nor ever can act as a unit under our existing constitution.
They have always acted, and must always act, in state groups. And
in state groups what action do they take? They assent to
constitutional provisions, or refuse to assent to them; and they select
certain persons to act as law-makers, as judges, or as executive
officers of government. Do they choose policies? No. Do they frame
constitutional provisions? Certainly not; they only accept or reject
them. In the only case in which they speak directly concerning
specific provisions of law, they neither command nor originate. They
receive or decline what is offered them. They must wait until they are
asked. They have neither initiative nor opportunity to construct. They
must be consulted concerning government, but they do not conduct
it.
Nor is it otherwise, upon last analysis, in Switzerland, where the
Referendum exists, where, that is, the people vote upon specific
measures of ordinary legislation not only, but where they are also
provided with means of imperative initiative in legislation. By
petitions bearing a certain large number of signatures they can
propose definite legislation, compel action upon the matter of their
petitions by their legislatures, and an ultimate submission of the
question to popular vote. But see what this is, when examined. The
eyes of the community, the men of observation and progress, get up
a petition; that is, an indeterminate body and a minority demand that
certain laws be formulated and put to the vote. The thing is done, but
the measure defeated, let us suppose, at the polls. The eyes of the
community have desired certain things, have offered them to the
slow digestive organs, and they have been rejected. Are the
digestive organs, then, sovereign, and not the initiative parts, the
eyes and the reason? Is it sovereign to stomach a thing, and not
sovereign to purpose a thing?
But turn the chase in another direction, if peradventure we may
yet run the sovereign people to cover. The more absolute democratic
theorists decline to restrict the sovereign body to the electorate, to
those who have formal votes. Voters are simply the agents of the
community, they say. The press and the pulpit, the private argument
and the curtain lecture, command—voters, if they are faithful, obey.
Others, no less democratic, but more precise, seek for a more
determinate body, content themselves with the qualified voters, and
think with relief that all difficulties are removed. The electorate is
sovereign.
But is the electorate a more determinate body than the
population? Does registration afford us any more certain results than
the census yields? Do the electors act in determinate numbers? Is
there a quorum? Have they any choice but to act under the forms
and within the limits assigned by law? Can they command without
invitation, or assent without suggestion? Are not the agencies which
Judge Jameson calls sovereign after all more active, more self-
directed, freer to criticise, to suggest, to insist? The newspapers, the
clergymen, the mass-meeting orators, the urgent friends, the
restless, ambitious wives, the pert and forward children can at any
rate keep on talking in the intervals, when the electors are reduced
to silence, patiently awaiting an opportunity to vote. Certainly, if we
can accept this miscellaneous sovereign of men-women-and-
children, the history of sovereignty is much simplified. This
determinate body of persons, the free population, is always present,
and always has been present, under all constitutions. All that we
have to inquire is, What means had they for expressing their will?
How were their dispositions and judgments made to tell upon the
consciousness of those who framed the laws? True, this sovereign
body has its points of resemblance to the god Baal. Those who call
upon it call in vain, if it be not the season appointed for voting; there
is no voice, nor any that answer, nor any that regardeth. No fire
consumes the sacrifice. Perhaps the People is talking, or is pursuing,
or is in a journey, or peradventure it sleepeth, and must be awaked.
 Surely this is a singular undertaking, this mad pursuit of a
sovereign amidst the obvious phenomena of politics! If laws be
indeed commands, the commands of a determinate person or body
of persons, it ought to be possible to discover this determinate
source of authority without much curious research. And yet it would
seem that it demands ingenious analysis. Look how uneasily Mr.
Sidgwick casts about in the last chapter of his recent “Elements of
Politics,” to find Supreme Political Power—which is his name for
sovereignty. He has been looking forward to this inquiry, not without
nervousness, throughout the chapters which precede. Political power
is exercised, he perceives, through some organ of government; but
he cannot conceive that the power of this organ is its own power. He
engages in a study of dynamics. What moves this organ: whence
does it derive its power? How is it influenced? Is it itself commanded,
overawed, constrained from any quarter? This is a door to the
metaphysics of government. Taking a prince as a simple and normal
organ of government, he analyzes the subjection of princes to their
ministers, to priests, to mistresses, to the violent protests of an
insubordinate people. No influence that the prince can throw off
without losing his own authority, he thinks, can be a sovereign
influence; but any influence which can threaten his power if he
resists is a sovereign influence, the true depository of supreme
political power. Sovereignty thus becomes a catalogue of influences.
Can we accept these singular processes? If a physicist were to
discard all the separate laws, all the differential analysis of his
science, and were to reduce its entire body of principles to some
general statement of the correlation of forces, he would hardly be
conceived to have done physics a service. If in our study of anatomy
we should turn away from structural adjustment and functional force
to take account of the thousand and one influences which in
individual cases affect the organs from without, we should obviously
be abandoning the science itself. It seems to me that we do a very
like thing if, in studying the structural forces and organic actions of
society, its organs of origination and command, its organs of
execution, its superior and its subordinate authorities, its habitual
modes of structural life, we abandon all attempts at differentiation,
throw all analysis into hotch-potch, and reduce everything to terms of
the general forces which mould and govern society as a whole. We
confuse our thought in our effort to simplify it. We lose, we do not
gain, by putting powers of radically different sorts together into the
same categories, and driving them abreast, as if they pulled
together, in the same propositions.
There is no unlimited power, except the sum of all powers. Our
legal theorists have sought unlimited sovereignty by a process of
summation; have made it consist in the combined forces of the
community. Sovereignty, if it be a definite and separable thing at all,
is not unlimited power; is not identical with the powers of the
community. It is not the general vitality of the organism, but the
specific originative power of certain organs. Sovereigns have always
been subject in greater or less degree to the community; have
always been organs of the State; have never been the State itself.
But they have been sovereigns none the less; they, and not the
community over which they presided.
It is necessary, if there is to be any clear thinking at all upon this
subject, to distinguish very sharply two radically different things;
namely, the powers and processes of governing, on the one hand,
from the relations of the people to those powers and processes, on
the other. Those relations are relations of assent and obedience; and
the degree of assent and obedience marks in every case the limits,
that is, the sphere, of sovereignty. Sovereignty is the daily operative
power of framing and giving efficacy to laws. It is the originative,
directive, governing power. It lives; it plans; it executes. It is the
organic origination by the State of its law and policy; and the
sovereign power is the highest originative organ of the State. It is
none the less sovereign because it must be observant of the
preferences of those whom it governs. The obedience of the subject
has always limited the power of the sovereign. “The Eastern
politicians never do anything,” says Burke, “without the opinion of the
astrologers on the fortunate moment.... Statesmen of a more
judicious prescience look for the fortunate moment too; but they seek
it, not in the conjunctions and oppositions of planets, but in the
conjunctions and oppositions of men and things.” This is the covert
admission of the Austinian definition itself: the sovereign power is
that to which “the bulk of the community is habitually obedient.”
When we discuss, with Mr. Sidgwick, the influences which tell upon
the action of the originative organs of the State, we are not
discussing sovereignty, but the natural and universal limitations of
sovereignty, the structural checks and balances of the organism.
There is no hope for theory if we neglect these obvious distinctions.
At all times and under all systems there have been two sets of
phenomena visible in government: the phenomena of command and
the phenomena of obedience, the phenomena of governing and the
phenomena of being governed. Obedience, moreover, is not always
an automatic or unconscious thing. It is a submission of the will—an
acquiescence which is either the product of choice, of necessity, or
of habit. This has been observed from the first; was observed by
Bodin, from whom we get our word sovereignty, and much of our
conception of the thing, sovereignty. He perceived that the
supremacy of the sovereign—even of the mediæval French
sovereign before his eyes—was in fact limited, the frontiers of
sovereignty being marked by certain antecedent rights, by divers
established prerogatives of property and vested privilege—not a
scientific, but a natural frontier, lying along the old mountains of
habit, the well-known rivers of precedent.
We know that the history of politics has been the history of
liberty; a history of the enlargement of the sphere of independent
individual action at the expense of the sphere of dictatorial authority.
It has revealed a process of differentiation. Certain freedoms of
opinion and utterance, of choice of occupation and of allegiance, of
fair trial and equitable condemnation, have been blocked out as
inviolable territories, lying quite beyond the jurisdiction of political
sovereignty. Beginning with that singular and interesting order of the
classical states of the ancient world, under which the individual was
merged in the community and liberty became identical with a share
in the exercise of the public power, we witness something like a
gradual disintegration, a resolution of the State into its constituent
elements, until at length those who govern and those who are
governed are no longer one and the same, but stand face to face
treating with one another, agreeing upon terms of command and
obedience, as at Runnymede. Conditions of submission have been
contested, and, as liberty has gained upon authority, have been
jealously formulated. The procedure and the prerogatives of
authority have been agreed upon; liberty has encroached upon
sovereignty and set bounds to it. The process is old; only some of its
results are new. What both political philosophers and political
revolutionists have sought for time out of mind has been a final
definition for that part of the Austinian conception which concerns the
habitual obedience of the community. These definitions, in their
practical shape as institutions, we now call constitutions. At last
peoples have become conscious of their relations to the highest
powers of the State, and have sought to give permanence and
certainty to those relations by setting the conditions of their
subordination fast in stubborn practices or in the solemn covenants
of written documents. A constitution government has always had; but
not until this latest age these deliberate formulations of principle and
practice which determine the whole organization and action of the
State, the domain of authority, the neutral territory of liberty, the
postulates of obedience.
Constitutions are definitive rather than creative. They sum up
experiences. They register consents. Assuredly Mr. Spencer is right
when he declares that that which in every country, under whatever
system governed, “produces the obedience making political action
possible, is the accumulated and organized sentiment of the
community towards inherited institutions,” and that “the feeling of the
community is the sole source of political power.” But this does not
mean what Judge Jameson reads into it, that sovereignty and the
feeling of the community are one and the same thing; that the
conditions of sovereignty and the exercise of sovereignty are
identical. Sovereignty has at all times and under all systems of
government been dependent upon the temper and disposition of the
people. The will of the community, the inclinations and desires of the
body politic as a whole, are always, in the last analysis, the
foundation, as they are also in many instances the direct and
immediate source, of law. But these preferences of the general body
are exercised by way of approval or disapproval, acquiescence or
resistance; they are not agencies of initial choice. The sanctioning
judgments of a people are passive, dormant, waiting to have things
put to them, unable themselves to suggest anything, because
without organs of utterance or suggestion. I cannot predicate
sovereignty of my physical parts, but must ascribe it to my will,
notwithstanding the fact that my physical parts must assent to the
purposes of my will, and that my will is dependent upon their
obedience. The organism unquestionably dominates the organs; but
there are organs, nevertheless, organs of origination, which direct
and rule with a sovereign presidency.
A written constitution adopted by popular vote affords, perhaps,
some of the nicest tests of theory. Here we have the most specific
form of popular assent. In such a document the powers of the
government are explicitly set forth and specifically lodged; and the
means by which they may be differently constituted or bestowed are
definitively determined. Now we know that these documents are the
result of experience, the outcome of a contest of forces, the fruits of
struggle. Nations have taken knowledge of despotism. They have
seen authority abused and have refused to submit; have perceived
justice to be arbitrary and hidden away in secret tribunals, and have
insisted that it be made uniform and open; have seen ministers
chosen from among favorites, and have demanded that they be
taken from among representatives of the people; have found
legislation regardful of classes, and have clamored to have laws
made by men selected without regard to class; have felt obedience
irksome because government was disordered in form and confused
in respect of responsibility, and have insisted that responsibility be
fixed and forms of order and publicity observed. Sometimes only a
steady practice has accomplished all this; sometimes documentary
securities have been demanded. These documentary securities are
written constitutions.
It is easy, as it is also impressive, to believe that a written
constitution proceeds from the people, and constitutes their
sovereign behest concerning government. But of course it does not.
It proceeds always either from some ordinary or from some
extraordinary organ of the state; its provisions are the fruit of the
debated determinations of a comparatively small deliberative body,
acting usually under some form of legal commission. It is accepted
as a whole and without discrimination by the diffused, undeliberative
body of voters.
What confuses our view is the fact that these formal
documentary statements of the kinds and degrees of obedience to
which the people assent, the methods of power to which they submit,
the sort of responsibility upon which they insist, have become, from
the very necessity of their nature, a distinct and superior sort of
precise and positive law. We seek the sovereign who utters them.
But they are not the utterances of a sovereign. They are the
covenants of a community. Time out of mind communities have
made covenants with their sovereigns. When despotism in France
was ‘tempered by epigram,’ the sharp tongues of the wits spoke,
after a sort, the constitution of the country,—a positive law whose
sanction was ridicule. But the wits were not sovereign; the salons did
not conduct government. Our written constitutions are only very
formal statements of the standards to which the people, upon whom
government depends for support, will hold those who exercise the
sovereign power.
I do not, of course, deny the power of the people. Ultimately they
condition the action of those who govern; and it is salutary that it
should be so. It is wise also, if it be not indispensable, that the extent
and manner of their control should be explicitly set forth and
definitively agreed upon in documents of unmistakable tenor. I say
simply that such control is no new thing. It is only the precise
formulation of it that is new.
If it seem to be after all a question of words, a little closer
scrutiny will disclose the fact that it is much more than that. Mr.
Ritchie, of Oxford University, in an able article on “The Conception of
Sovereignty,” contributed to the Annals of the American Academy of
Political and Social Science (January, 1891), perceiving some part of
the distinction that I have pointed out, and wishing to realize it in his
thought, proposes to distinguish three several kinds of sovereigns:
viz. a nominal sovereign—the English queen, for example; a legal
sovereign—the law-making body; and a political sovereign—the
voters, whom we might call the sovereign of appeal. But why not
confine ourselves to substantives, if we may, and avoid the
quicksands of adjectives? Sovereignty is something quite definite; so
also is power; so also is control. Sovereignty is the highest political
power in the state, lodged in active organs, for the purposes of
governing. Sovereign power is a positive thing; control a negative
thing. Power belongs to government, is lodged in organs of initiative;
control belongs to the community, is lodged with the voters. To call
these two things by the same name is simply to impoverish language
by making one word serve for a variety of meanings.
It is never easy to point out in our complex modern governments
the exact organs in which sovereignty is lodged. On the whole,
however, it is always safe to ascribe sovereignty to the highest
originative or law-making body of the state,—the body by whose
determinations both the tasks to be carried out by the Administration
and the rules to be applied by the courts are fixed and warranted.
Even where the courts utter authoritative interpretations of what we
call the fundamental law—the law that is embodied in constitutions—
they are rather the organs through which the limitations of
sovereignty are determined than organs of sovereignty itself. They
declare the principles of that higher, constituent law which is set
above sovereignty, which expresses the restrictions set about the
exercise of sovereign authority. Such restrictions exist in all states,
but they are given definite formulation only in some. As for the
Executive, that is the agent, not the organ, of sovereignty.
But, even if it be comparatively easy thus to fix upon the organs
of sovereignty in a unitary state, what shall we say of a federal state?
How apply our analysis to that? One is tempted to declare, with Dr.
Merkel, of Strassburg, that federal states give direct contradiction of
fact to prevailing theories respecting the necessity for unity of power,
indivisibility of sovereignty. Here, as he says, we have organs and
authorities in possession of powers exclusively their own, for the
furtherance of functions necessary to the ends of the state as a
whole, existing side by side with organs also in full possession of
powers exclusively their own, for the furtherance of the local and
special functions of the member states. We know, moreover, that
these two sets of organs are in fact co-ordinate; that the powers of
the states were not derived from the federal authority, were even
antecedent to the powers of the federal government, and historically
quite independent of them. And yet no one who ponders either the
life or the formal structure of a federal state can fail to perceive that
there is, after all, an essential unity in it, the virtual creation of a
central sovereignty. The constituent act—the manner in which the
government was created—can, I conceive, have nothing to do with
our analysis in this matter. The way in which the federal state came
into existence is immaterial to the question of sovereignty within it
after it has been created. Originative life and action, the
characteristic attributes of sovereignty, come after that. Character
and choice are postponed to birth, sovereignty to the creation of the
body politic. The constituent act creates a thing capable of exercising
sovereignty. After the creative law has done its part, by whatever
process, then the functions of independent life begin. Thereafter, in
all federal states, even the amendment of the fundamental law
becomes an organic act, depending, practically without exception,
upon the initiative of the chief originative organ of the federal state.
Confederations are here out of the question. They are, of course,
associations of sovereigns. In the federal state self-determination
with respect to their law as a whole has been lost by the member
states. They cannot extend, they cannot even determine, their own
powers conclusively without appeal to the federal authorities. They
are unquestionably subject to a political superior. They are fused,
subordinated, dominated. Though they do not exercise their powers
by virtue of delegation, though their powers are indeed inherent and
in a very important sense independent, they are yet inferior to a body
whose own powers are in reality self-determined, however much that
self-determination may be hedged about and clogged by the forms of
the fundamental federal law. They are still states, because their
powers are original and inherent, not derivative; because their
political rights are not also legal duties; and because they can apply
to their commands the full imperative sanctions of law. But their
sphere is limited by the presiding and sovereign powers of a state
superordinated to them, the extent of whose authority is determined,
under constitutional forms and guarantees, by itself. They have
dominion; but it has sovereignty. For with the federal state lie the
highest powers of originative legal determination, the ultimate
authority to warrant change and sanction jurisdiction.
Our thought is embarrassed throughout such an analysis by the
very fact which invalidates the Austinian conception and makes a
fresh analysis necessary. Very little law literally originates in
command, though its formulation and enforcement must
unquestionably be effected through the commanding authorities of
the state. It is their function to direct, to lead, rather than to
command. They originate forms, but they do not discover principles.
In a very profound sense law proceeds from the community. It is the
result of its undeliberate as well as of its deliberate developments, of
its struggles, class against class, interest against interest, and of its
compromises and adjustments of opinion. It follows, slowly, its
ethical judgments, more promptly its material necessities. But law
issues thus from the body of the community only in vague and
inchoate form. It must be taken out of the sphere of voluntary and
uncertain action and made precise and invariable. It becomes
positive law by receiving definition and being backed by an active
and recognized power within the state. The sovereign organ of a
state is, therefore, very properly said to be its law-making organ. It
transmutes selected tendencies into stiff and urgent rules. It
exercises a sovereign choice in so doing. It determines which
tendencies shall be accepted, which checked and denied efficacy. It
forms the purposes of the state, avoiding revolution if it form them
wisely and with a true insight. This is sovereignty:—to sit at the helm
and steer, marking out such free courses for the stanch craft as wind
and weather will permit. This is the only sort of sovereignty that can
be exercised in human affairs. But the pilot is sovereign, and not the
weather.
 IV
CHARACTER OF DEMOCRACY IN THE
UNITED STATES

Everything apprises us of the fact that we are not the same

nation now that we were when the government was formed. In
looking back to that time, the impression is inevitable that we started
with sundry wrong ideas about ourselves. We deemed ourselves
rank democrats, whereas we were in fact only progressive
Englishmen. Turn the leaves of that sage manual of constitutional
interpretation and advocacy, the Federalist, and note the perverse
tendency of its writers to refer to Greece and Rome for precedents,
—that Greece and Rome which haunted all our earlier and even
some of our more mature years. Recall, too, that familiar story of
Daniel Webster which tells of his coming home exhausted from an
interview with the first President-elect Harrison, whose Secretary of
State he was to be, and explaining that he had been obliged in the
course of the conference, which concerned the inaugural address
about to be delivered, to kill nine Roman consuls whom it had been
the intention of the good conqueror of Tippecanoe publicly to take
into office with him. The truth is that we long imagined ourselves
related in some unexplained way to all ancient republicans.
Strangely enough, too, we at the same time accepted the quite
incompatible theory that we were related also to the French
philosophical radicals. We claimed kinship with democrats
everywhere,—with all democrats. We can now scarcely realize the
atmosphere of such thoughts. We are no longer wont to refer to the
ancients or to the French for sanction of what we do. We have had
abundant experience of our own by which to reckon.
 “Hardly any fact in history,” says Mr. Bagehot, writing about the
middle of the century, “is so incredible as that forty and a few years
ago England was ruled by Mr. Perceval. It seems almost the same
as being ruled by the Record newspaper.” (Mr. Bagehot would now
probably say the Standard newspaper.) “He had the same poorness
of thought, the same petty conservatism, the same dark and narrow
superstition.” “The mere fact of such a premier being endured shows
how deeply the whole national spirit and interest was absorbed in the
contest with Napoleon, how little we understood the sort of man who
should regulate its conduct,—‘in the crisis of Europe,’ as Sydney
Smith said, ‘he safely brought the Curates’ Salaries Improvement Bill
to a hearing;’ and it still more shows the horror of all innovation
which the recent events of French history had impressed on our
wealthy and comfortable classes. They were afraid of catching
revolution, as old women of catching cold. Sir Archibald Alison to this
day holds that revolution is an infectious disease, beginning no one
knows how, and going on no one knows where. There is but one rule
of escape, explains the great historian: ‘Stay still; don’t move; do
what you have been accustomed to do; and consult your
grandmother on everything.’”
Almost equally incredible to us is the ardor of revolution that
filled the world in those first days of our national life,—the fact that
one of the rulers of the world’s mind in that generation was
Rousseau, the apostle of all that is fanciful, unreal, and misleading in
politics. To be ruled by him was like taking an account of life from Mr.
Rider Haggard. And yet there is still much sympathy in this timid
world for the dull people who felt safe in the hands of Mr. Perceval,
and, happily, much sympathy also, though little justification, for such
as caught a generous elevation of spirit from the speculative
enthusiasm of Rousseau.
For us who stand in the dusty matter-of-fact world of to-day,
there is a touch of pathos in recollections of the ardor for democratic
liberty that filled the air of Europe and America a century ago with
such quickening influences. We may sometimes catch ourselves
regretting that the inoculations of experience have closed our
systems against the infections of hopeful revolution.
 “Bliss was it in that dawn to be alive,
But to be young was very heaven! O times
In which the meagre, stale, forbidding ways
Of custom, law, and statute took at once
The attraction of a country in romance!
When Reason seemed the most to assert her rights,
When most intent on making of herself
A prime Enchantress, to assist the work
Which then was going forward in her name!
Not favored spots alone, but the whole earth,
The beauty wore of promise, that which sets
(As at some moment might not be unfelt
Among the bowers of paradise itself)
The budding rose above the rose full blown.”

Such was the inspiration which not Wordsworth alone, but

Coleridge also, and many another generous spirit whom we love,
caught in that day of hope.
It is common to say, in explanation of our regret that the dawn
and youth of democracy’s day are past, that our principles are cooler
now and more circumspect, with the coolness and circumspection of
advanced years. It seems to some that our enthusiasms have
become tamer and more decorous because our sinews have
hardened; that as experience has grown idealism has declined. But
to speak thus is to speak with the old self-deception as to the
character of our politics. If we are suffering disappointment, it is the
disappointment of an awakening: we were dreaming. For we never
had any business hearkening to Rousseau or consorting with Europe
in revolutionary sentiment. The government which we founded one
hundred years ago was no type of an experiment in advanced
democracy, as we allowed Europe and even ourselves to suppose; it
was simply an adaptation of English constitutional government. If we
suffered Europe to study our institutions as instances in point
touching experimentation in politics, she was the more deceived. If
we began the first century of our national existence under a similar
impression ourselves, there is the greater reason why we should
start out upon a new century of national life with more accurate
conceptions.
To this end it is important that the following, among other things,
should be kept prominently in mind:—
(1.) That there are certain influences astir in this century which
make for democracy the world over, and that these influences owe
their origin in part to the radical thought of the last century; but that it
was not such forces that made us democratic, nor are we
responsible for them.
(2.) That, so far from owing our governments to these general
influences, we began, not by carrying out any theory, but by simply
carrying out a history,—inventing nothing, only establishing a
specialized species of English government; that we founded, not
democracy, but constitutional government in America.
(3.) That the government which we thus set up in a perfectly
normal manner has nevertheless changed greatly under our hands,
by reason both of growth and of the operation of the general
democratic forces,—the European, or rather worldwide, democratic
forces of which I have spoken.
(4.) That two things, the great size to which our governmental
organism has attained, and, still more, this recent exposure of its
character and purposes to the common democratic forces of the age
of steam and electricity, have created new problems of organization,
which it behooves us to meet in the old spirit, but with new
measures.

I.
First, then, for the forces which are bringing in democratic
temper and method the world over. It is matter of familiar knowledge
what these forces are, but it will be profitable to our thought to pass
them once more in review. They are freedom of thought and the
diffusion of enlightenment among the people. Steam and electricity
have co-operated with systematic popular education to accomplish
this diffusion. The progress of popular education and the progress of
democracy have been inseparable. The publication of their great
encyclopædia by Diderot and his associates in France in the last
century, was the sure sign of the change that was setting in.
Learning was turning its face away from the studious few towards
the curious many. The intellectual movement of the modern time was
emerging from the narrow courses of scholastic thought, and
beginning to spread itself abroad over the extended, if shallow, levels
of the common mind. The serious forces of democracy will be found,
upon analysis, to reside, not in the disturbing doctrines of eloquent
revolutionary writers, not in the turbulent discontent of the
pauperized and oppressed, so much as in the educational forces of
the last hundred and fifty years, which have elevated the masses in
many countries to a plane of understanding and of orderly, intelligent
purpose more nearly on a level with the average man of the classes
that have hitherto been permitted to govern. The movements
towards democracy which have mastered all the other political
tendencies of our day are not older than the middle of the last
century; and that is just the age of the now ascendant movement
toward systematic popular education.
Yet organized popular education is only one of the quickening
influences that have been producing the general enlightenment
which is everywhere becoming the promise of general liberty. Rather,
it is only part of a great whole, vastly larger than itself. Schools are
but separated seed-beds, in which the staple thoughts of the steady
and stay-at-home people are prepared and nursed. Not much of the
world, moreover, goes to school in the school house. But through the
mighty influences of commerce and the press the world itself has
become a school. The air is alive with the multitudinous voices of
information. Steady trade winds of intercommunication have sprung
up which carry the seeds of education and enlightenment,
wheresoever planted, to every quarter of the globe. No scrap of new
thought can escape being borne away from its place of birth by these
all-absorbing currents. No idea can be kept exclusively at home, but
is taken up by the trader, the reporter, the traveller, the missionary,
the explorer, and is given to all the world, in the newspaper, the
novel, the memoir, the poem, the treatise, till every community may
know, not only itself, but all the world as well, for the small price of
learning to read and keeping its ears open. All the world, so far as its
news and its most insistent thoughts are concerned, is fast being
made every man’s neighbor.
Carlyle unquestionably touched one of the obvious truths
concerning modern democracy when he declared it to be the result
of printing. In the newspaper press a whole population is made critic
of all human affairs; democracy is “virtually extant,” and “democracy
virtually extant will insist on becoming palpably extant.” Looked at in
the large, the newspaper press is a type of democracy, bringing all
men without distinction under comment made by any man without
distinction; every topic is reduced to a common standard of news;
everything is noted and argued about by everybody. Nothing could
give surer promise of popular power than the activity and alertness
of thought which are made through such agencies to accompany the
training of the public schools. The activity may often be misdirected
or unwholesome, may sometimes be only feverish and mischievous,
a grievous product of narrow information and hasty conclusion; but it
is none the less a stirring and potent activity. It at least marks the
initial stages of effective thought. It makes men conscious of the
existence and interest of affairs lying outside the dull round of their
own daily lives. It gives them nations, instead of neighborhoods, to
look upon and think about. They catch glimpses of the international
connections of their trades, of the universal application of law, of the
endless variety of life, of diversities of race, of a world teeming with
men like themselves, and yet full of strange customs, puzzled by dim
omens, stained by crime, ringing with voices familiar and unfamiliar.
And all this a man can nowadays get without stirring from home,
by merely spelling out the print that covers every piece of paper
about him. If men are thrown, for any reason, into the swift and easy
currents of travel, they find themselves brought daily face to face
with persons native of every clime, with practices suggestive of
whole histories, with a thousand things which challenge curiosity,
inevitably provoking inquiries such as enlarge knowledge of life and
shake the mind imperatively loose from old preconceptions.