May 1.Case 3rd. W-C-, a male, aged 21, unmarried, a native of Ireland,
was admitted November 21st, 1853, and was said to have been insane for only seven days previously. This patient was found to be excessively addicted to masturbation. He had not, however, the sly, stealthy, and cast-down aspect of this class of lunatics. He was active, noisy, an inveterate whistler, and quarrelsome. He continued in the asylum for nearly eight months, during which time nothing remarkable Vol. XIII. No. 1. c
18 Journal of Insanity. [July, in his health was observed until about three weeks prior to his decease, when his appetite began to flag, and he became languid and feverish. In a few days the pupils were observed to be dilated, and he had frequent, copious sweats. Three days before death his breathing became labored and stridulous. He passed into a comatose state, and expired on the 10th of July. On removing the calvarium, the glandulae Pacchioni were found to be very numerous and large; the dura mater thickened and adhering to the cranium ; the pia mater was very vascular; the substance of the brain was much softened; the thalami nervorum opticorum were greatly disorganized ; there was considerable serous effusion in the ventricles; and along the base of the brain, anterior to the medulla oblongata, and stretching to the surface of the pons varolii, was a large deposit of pus. The general surface of the cerebrum was covered with lymphy deposits. The cerebellum was much disorganized, and covered with lymph.
Case 4th. j —_——s N - -n, a male, aged 32 ; a native of Ireland; inmate of the Asylum for nearly five years. Stated by the attendants to have been formerly epileptic, but not so latterly. His head was very large, and, phrenologically, well formed. He was a very quiet patient, though rather peevish and childish. His general health was feeble. He had no marked symptoms of formidable disease until a few days before death, three weeks prior to which, he complained of pains in various parts of his body, and in consequence was confined to his bed. On the day preceding his death he had a fit of syncope, from which he soon rallied, but suffered under a subsequent difficulty of breathing, and depression. In a few hours afterwards he complained of a pain across the lower part of the chest, to relieve which a mustard cataplasm was applied, but without benefit. On the following morning he fell into a state of collapse, and expired. Post-mortem examination was made during the same day. The dura mater was found thickened, and strongly attached to the cranium. The arachnoid and pia mater were very vascular, especially at the base. On opening the lateral ventricles, they were found to contain a large quantity of water, by which they had been so distended as to appear many times their natural size ; and the adjacent portions of the brain were very firm, as if from pressure by the fluid within. The base of 1856.] Workman on General Paralysis. 19 the brain was softened. The orbital processes of the frontal bone stood unusually high, and thus decreased the size of the cerebral chamber. The basilar arteries were ossified. The medulla oblongata was very soft. On opening the thorax, the lungs were found adherent to the ribs, by pleuritic deposits, of old formation. The upper lobes of the lungs were filled with tubercles, but no cavities were discovered. A large cyst, with very thick, membranous walls, and containing about a pint of serum, was found in the right thorax, under the lower lobe of the lung, and resting on the diaphragm. The heart was dilated to more than double its normal size. The arch of the aorta was likewise dilated. The auriculo-ventricular openings, and the columnac carnese were covered with fibrinous deposits. The liver was twice the natural size, but of healthy appearance. The spleen also was enlarged. The pancreas was slightly indurated. The mesentery was thickened, and its glands were much enlarged. On several spots in the tract of the intestinal canal, ulceration of the mucous membrane was observed.
Case 5th. I-c P-11, a male, aged 48, an Englishman, admitted 4th Nov., 1853. Continued an inmate until his death on 3rd Feb’y, 1855 : was stated to have been insane for one month before admission. His insanity was characterized by great restlessness, extreme sim¬ plicity, and incessant talking. His discourse was all in poetic measure ; and the readiness with which he found his linear rhymes might have been envied by many of our modern poets. He was a poet of the per¬ ipatetic school—he walked whilst he sang, and a certain space round his bed-room served as the measuring-tape of his verses. Whether in all versification a certain dash of insanity is not essential to correct prosody, may be a question for future, useful discussion. In every asylum we are sure to find some patients who speak only in verse. They have their periods of inspiration too, but they alternate, some¬ times, with sad gaps of mental exhaustion. During the second winter of his residence in the Asylum he became very feeble; and his articulation, which had formerly been characterized by a measured slowness, now became thick, indistinct, and dragging. His gait was unsteady and tottering, and a total mental vacuity appeared to obtain. About two weeks before his death he was found constantly 20 Journal of Insanity . [July, gnashing and grinding his teeth. Muscular twitchings in the face and arms were observed. The pupils were much dilated for a day or two before death. Post-mortem examination showed the brain to be much softened, and all its vessels distended with blood. A large quantity of serum was effused between the arachnoid and the pia mater, and the ventricles contained a quantity of sero-sanguineous fluid. The spinal marrow was examined throughout its whole extent, and a large quantity of serum was found in the canal. The cord was re¬ markably soft, and its vessels much congested. The heart was atrophied; its outer surface was nodulated, and a coat of coagulated lymph, of former deposit, covered it. The arch of the aorta was largely dilated. In the diaphragm, over the right lobe of the liver, was found a large cartilaginous formation. The liver was large, soft, and tawny-colored.
Case 6th. S——1 McC-y, a male, aged 45, a native of Ireland, latterly of very intemperate habits. This patient was first admitted into the Asy¬ lum on the 2nd of May, 1854. He had a halt in his walk, manifestly the result of a partial paralysis. His speech also was affected. His ideas were of the most lofty order. He invested d£l0,000 in the Asy¬ lum within an hour after his entrance, and made most munificent dona¬ tions to numerous charitable institutions. He proposed very soon to proceed to Rome, on a visit to the Pope, with the view of inducing his Holiness to make him a bishop, and place him at the head of one hun¬ dred young priests, with whom he was to return to Canada, and evan¬ gelize the whole country. His daughters, he said, had all taken the veil; and his wife was soon to become a nun, and to found many convents, all of which he would himself amply endow. After six weeks’ residence in the Asylum he became impatient of restraint, and made his escape. In the meantime he had improved much in his bodily condition, and had become a little less visionary in his specula¬ tions. He was not long at home until he began to evince his reforming propensities. He had some books on divinity and church history, on which he placed a high value ; and to improve their exterior, he took a whitewash brush, and gave them a good coating. His friends sent him to the country, where he had good air and free exercise. 1856.] Workman on General Paralysis. 21 On the 24th of February, 1855, he was brought back to the Asylum, and certainly looked better than when he had left it, eight months previously. He was ruddy, and rather robust, and his speech was not so indistinct as at his former entrance. The opinion was expressed, on his re-admission, that he would soon deteriorate in an asylum, and that his friends had, by withdrawing him from the country, and its congenial pleasures, adopted the surest course of bringing his case to an early and fatal termination. The symptoms of brain-softening and general paralysis, which, in his past months of rustic indulgence, had manifestly receded, soon began to exhibit them¬ selves in a very threatening form. He spoke with gradually increasing difficulty, his unsteadiness of gait increased, and in three months he could not rise from the bed without the almost certain risk of losing his balance and falling at length. The sphincters of the bladder and anus shared in the paralysis. Bed-sores soon formed. A series of apoplectic seizures were ushered in by severe chills ; after each the paralytic symptoms remained more aggravated. Finally, the power of speech almost entirely failed. There were severe muscular twitch- ings on one side, with dilatation of one of the pupils. The breathing became slow and labored, and he expired in a state of exhaustion, free from coma. The post-mortem examination was made twelve hours after death. The integuments of the head, as well as the bones themselves, were thin and dry. The arachnoid membrane was, in numerous places, ad¬ herent to the dura mater (or, properly speaking, to its own reflected portion, lining the dura mater), and the interspaces between the adhe¬ sions were formed into sacs containing serous deposits. The gray mat¬ ter of the brain was very much attenuated, and the cerebral sulci were remarkably shallow. The substance of the cerebrum was but slightly softened. The lateral ventricles were tilled with serum. The cere¬ bellum and medulla oblongata were much softened, and the theca verte- bralis was distended with serum. The lungs were quite healthy, and free from pleuritic adhesions—a very unusual fact in autopsies of the insane in Canada. The right lung was united to the diaphragm by an osseous formation of an inch in length, by three quarters of an inch in breadth. The heart was free from any abnormal appearance. The abdominal viscera were all healthy. [July, 22 Journal of Insanity.
Case 7th. G-R-, a mulatto, male, aged 22, a young man of large stature, and fine, athletic appearance, was admitted into the Asylum on the 5th of July, 1855. He was a native of Maryland, and had been a slave. His insanity was ascribed to excitement at a religious meeting. After admission he was found to be generally tranquil and very docile, but was subject to short and very violent paroxysms, in which he was dangerously furious. His bowels were usually found constipated prior to these attacks. He complained of want of feeling in his feet, and the anterior surface of his legs, farther up on one side than on the other. He manifested a great desire for education ; and frequently was found to be weeping because he could not read. He evinced, also, a strong determination to elope ; and on one occasion contrived to escape from the Asylum grounds, but was detected and brought back. On the twenty-third day after his admission he picked the lock of one of the ward doors, by which he got access to the roof of the Asylum, * and thence leaped to the ground, about fifty feet below. Instant death resulted. A fracture of the styloid process of the radius of the left arm was all the injury which had resulted to the osseous system from the fall. The place on which he descended was a soft meadow-ground, with a thick coat of rich grass. The brain was found, on examination, very much softened, and in all parts devoid of its proper cohesiveness, so that it broke down on the gentlest manipulation ; there was much venous congestion of the organ and its meninges, but no extravasation or vascular lesion. In all other parts of the body the organs appeared in a healthy state. Case 8th. W-m R-ts, aged 37, a male, an Englishman, married, by trade a tailor, of industrious and sober habits, and of a religious turn of mind, was admitted into the Asylum, July 6th, 1854, and was then stated to have been insane for two weeks. It was subsequently learned from his wife that he had been disturbed in his intellect for more than a year before coming to the Asylum, and had had occasional chills, followed by febrile reaction. He had complained of severe pain in the head, at times, and a feeling of pressure, or weight, over the skull. On his entrance he was observed to drag one of his legs, and to walk with an unsteady gait.
Digitized by the Internet Archive in 2020 with funding from Wellcome Library https://archive.org/details/s6059id1378414 THE A M E R I C A N •JOURNAL EDITED BY THE MEDICAL OFFICERS OF THE NEW YORK STATE LUNATIC ASYLUM. VOL. XIII. The care of the human mind is the most noble branch of medicine. —Grotius. UTICA, NEW YORK: PRINTED AND PUBLISHED AT THE ASYLUM. 1856 - 7 . WELLCOME INSTITUTE LIBRARY
