the stain
owing to the method of fixation (bichroit is, therefore, impossible to say to what extent they exhibit morbid changes. The vascular changes are those of Gr. P. T., and
mate), and,
there can be little doubt that the case was one of this nature?two microscopical preparations are sent herewith." Dr. Win. Eeid, Medical Supdt. of the Hoyal Asylum, Aberdeen, in forwarding this report writes :?" The report and microscopical preparations seem quite conclusive, especially when one considers the patient's history, which was that of a general paralytic. The case shortly described below, and to which the above refers may then be definitely said to have been one of general paralysis, despite the patient being a native and a whole-life dweller in India and in the absence of the usually described macroscopic findings. As regards the absence of macroscopic evidence, Gr. It. Scliwein, in the " Journal of Nervous and Mental diseases " (December 1910), describes three cases, in which the microscopic evidence of Of. P. I. was clear, while post-mortem macroscopic findings were absent; he concludes with a plea for histological study of all cases of suspected paresis
coining
to
autopsy.
With regard to general paralysis occurring in Natives of India, Major Ewens in his book in India," 1907, writes :? Insanity " This disease is, like tabes dorsalis, unknown among natives of India." In the I. M. Gazette, January 1911, Capt. Heffernan, i.m.s., describes a fatal case,?a Pariah in Madras, with post-mortem and microscopical findings?which leave little doubt as to the correctness of the diagnosis, and he further quotes three cases diagnosed as paresis in the Rangoon Asylum. Col. Harris, i.m.s., in his annual report of Bengal Asylums for 1910, says: "During thirty years' experience in India, I have only seen three genuine cases of general paralysis; one, in a Hindu, one in a Cabuli, and one in an Armenian." I now append a short history of my case. Name, Zaliuruddin, astat. 38, Moliamedan, and Police-Court Interpreter, was admitted on 17th January 1909, no history of syphilis or "
A CASE OF GENERAL PARALYSIS. 13v A.
J
COCHRANE, F.H.C.S., MAJOR, I.M.S.,
Supdt.,
Central
Asylum, Agra.
The following is the report by Dr. Fordliobertson, Pathologist to the Scottish Asylums,
Upon
a
patient 1910. "
of cerebral cortex, taken from a who died in this asylum, in December
piece
The section shows well-marked though not A ery extensive peri-arteritis ; the affected vessels contain in their walls aggregations of lymphocytes, and numerous plasma cells. There is wellmarked hypertrophy of the neuraglia in the first layer of the cortex $ the nerve-cells do not retain
alcoholism.
Symptoms.?Boasting and familiarity, with excitement. Comprehension, cognition, memory, and orientation good. Signs.?Speech clear, pupils regular, react to light slowly, no tremors. Writing and walking natural, knee-jerks general
absent. On 8tli March 1909, lie was discharged free of symptoms, but with signs unaltered. On 17tli August 1909, he was readmitted with a return of symptoms, and the signs now were? Speech, a little slurring; pupils, regular, contracted, react very sluggishly.
SURGICAL CASUS.
Nov., 1911.J
tongue and facial muscles, of lips Writing, normal. Walking, jerky and straggling; knee-jerk,
Tremors of and fingers.
absent. On 5th April 1910 the condition was of more marked tremor, and his writing now showed this. Speech had become more difficult, so that words were slowly produced and jerked out; though apparently robust he was weak and could walk with difficulty owing partly to feebleness and partly to inco-ordination, he appeared depressed, boasting only when led on to do so ; memory had rapidly failed and was now almost absent except for faces and a few names ; comprehension, cognition, and orientation were bad. Wasserman reaction in blood, positive. On I7tli November 1910, condition was one of marked dementia, tremors of tongue, face, and extremities marked; he could barely blurt out his name ; was unable to walk owing to inco- I ordination ; held a pencil with difficulty, but was able to write his name, the writing showing much tremor and missing out" of syllables; pupils were quite fixed to light ; he was still stout but obviously very weak; the bladder at times had to be catheterised; motions passed under him but no paralysis of bowels. 20th November 1910, died of asthenia; bed-sores developed the last three weeks. Examination of the skull and contents showed a thin, very dense skull cap?dura mater and arachnoid thickened and tough, not adherent to skull or to pia mater, except along middle line of vertex pia mater, thickened ; adherent to that of opposite hemisphere but not to brain substance? cerebro-spinal fluid, in much excess. Brain, distended, and with congested surface; grey matter, not compressed or wasted ; cavities, distended with fluid. Arteries, not thickened, or
thrombosed,
no area
no
gumma
of softening.
or
syphilitic change,
423
owing to the method of fixation (bichroit is, therefore, impossible to say to what extent they exhibit morbid changes. The vascular changes are those of Gr. P. T., and
mate), and,
there can be little doubt that the case was one of this nature?two microscopical preparations are sent herewith." Dr. Win. Eeid, Medical Supdt. of the Hoyal Asylum, Aberdeen, in forwarding this report writes :?" The report and microscopical preparations seem quite conclusive, especially when one considers the patient's history, which was that of a general paralytic. The case shortly described below, and to which the above refers may then be definitely said to have been one of general paralysis, despite the patient being a native and a whole-life dweller in India and in the absence of the usually described macroscopic findings. As regards the absence of macroscopic evidence, Gr. It. Scliwein, in the " Journal of Nervous and Mental diseases " (December 1910), describes three cases, in which the microscopic evidence of Of. P. I. was clear, while post-mortem macroscopic findings were absent; he concludes with a plea for histological study of all cases of suspected paresis
coining
to
autopsy.
With regard to general paralysis occurring in Natives of India, Major Ewens in his book in India," 1907, writes :? Insanity " This disease is, like tabes dorsalis, unknown among natives of India." In the I. M. Gazette, January 1911, Capt. Heffernan, i.m.s., describes a fatal case,?a Pariah in Madras, with post-mortem and microscopical findings?which leave little doubt as to the correctness of the diagnosis, and he further quotes three cases diagnosed as paresis in the Rangoon Asylum. Col. Harris, i.m.s., in his annual report of Bengal Asylums for 1910, says: "During thirty years' experience in India, I have only seen three genuine cases of general paralysis; one, in a Hindu, one in a Cabuli, and one in an Armenian." I now append a short history of my case. Name, Zaliuruddin, astat. 38, Moliamedan, and Police-Court Interpreter, was admitted on 17th January 1909, no history of syphilis or "
A CASE OF GENERAL PARALYSIS. 13v A.
J
COCHRANE, F.H.C.S., MAJOR, I.M.S.,
Supdt.,
Central
Asylum, Agra.
The following is the report by Dr. Fordliobertson, Pathologist to the Scottish Asylums,
Upon
a
patient 1910. "
of cerebral cortex, taken from a who died in this asylum, in December
piece
The section shows well-marked though not A ery extensive peri-arteritis ; the affected vessels contain in their walls aggregations of lymphocytes, and numerous plasma cells. There is wellmarked hypertrophy of the neuraglia in the first layer of the cortex $ the nerve-cells do not retain
alcoholism.
Symptoms.?Boasting and familiarity, with excitement. Comprehension, cognition, memory, and orientation good. Signs.?Speech clear, pupils regular, react to light slowly, no tremors. Writing and walking natural, knee-jerks general
absent. On 8tli March 1909, lie was discharged free of symptoms, but with signs unaltered. On 17tli August 1909, he was readmitted with a return of symptoms, and the signs now were? Speech, a little slurring; pupils, regular, contracted, react very sluggishly.
SURGICAL CASUS.
Nov., 1911.J
tongue and facial muscles, of lips Writing, normal. Walking, jerky and straggling; knee-jerk,
Tremors of and fingers.
absent. On 5th April 1910 the condition was of more marked tremor, and his writing now showed this. Speech had become more difficult, so that words were slowly produced and jerked out; though apparently robust he was weak and could walk with difficulty owing partly to feebleness and partly to inco-ordination, he appeared depressed, boasting only when led on to do so ; memory had rapidly failed and was now almost absent except for faces and a few names ; comprehension, cognition, and orientation were bad. Wasserman reaction in blood, positive. On I7tli November 1910, condition was one of marked dementia, tremors of tongue, face, and extremities marked; he could barely blurt out his name ; was unable to walk owing to inco- I ordination ; held a pencil with difficulty, but was able to write his name, the writing showing much tremor and missing out" of syllables; pupils were quite fixed to light ; he was still stout but obviously very weak; the bladder at times had to be catheterised; motions passed under him but no paralysis of bowels. 20th November 1910, died of asthenia; bed-sores developed the last three weeks. Examination of the skull and contents showed a thin, very dense skull cap?dura mater and arachnoid thickened and tough, not adherent to skull or to pia mater, except along middle line of vertex pia mater, thickened ; adherent to that of opposite hemisphere but not to brain substance? cerebro-spinal fluid, in much excess. Brain, distended, and with congested surface; grey matter, not compressed or wasted ; cavities, distended with fluid. Arteries, not thickened, or
thrombosed,
no area
no
gumma
of softening.
or
syphilitic change,
423
