following eases will prompt those interested in the study of insanity among the natives of this country to investigate the registers in their possession, and to make known the result of their enquiries, that lias induced me to publish the details of the only cases which have occurred in the Dacca Asylum during the last 27 years
:?
CASE
Ram Kishore
I.
Rukhit, Hindoo, aged
45 years, was admitted with dementia on the 23rd January, 1850. On his admission, he was in a state of nearly complete mental imbecility. In the following Novomber, his speech became impeded, and the motions of his tongue and free movement of his into the
asylum
became impaired. He halted in walking, and he dragged his lower limbs after him. No further details of his case can be discovered. On the 11th December, 1851, he died of
jaw
cholera.
post-mortem examination, a state of general congestion engorgement of the cerebral circulation was observed. effusion beneath, and raising up, the There was serous arachnoid ; also at the base of the brain, and in the ventricles; seated on the corpus striatum, on the right side beneath the lining membrane of the ventricle, was a spot of broken down brain, the circumference being about the size of an eight-anna piece. The ragged, degenerated, and softened cerebral substance was of a yellowish colour." The above are all the particulars that I have been able to discover regarding this interesting case. At the
and
CASE
II.
mohurrir, aged about 35, was admitted into the asylum in 1850. The following history was given by his friends:?He followed actively his business as a clork, but was also passionately fond of singing and playing upon musical instruments. Upon the occasion of some festival, lie spent the night in the bazaar, performing to a crowd of listeners: from that night he becamo insane. In October, 1850, while in the asylum, he was observed for the first time to drag his leg after him. On admission, it is noted that he was noisy, but that he answered questions put to him. By January, 1851, he could not be induced to speak, although he was heard to sing to himA Hindoo
GENERAL PARALYSIS OF THE INSANE. By Db. Wise. One of the most remarkable points connected with, insanity among the natives of India is the rarity of general paralysis. In the Patna Asylum Report for 1866, the deaths of two women, aged, respectively, 26 and 35 years, are recorded. With this exception, no other cases are cited in the reports of the Dhullunda, Patna, and Moydapore Asylums between 1862 and 1867. In the Dacca Asylum, between 1841 and 1867, I have only been able to discover 3 cases among 1,576 admissions, and 925 deaths.
This
infrequency
self at times. found.
are
contrasted
with those of
CASE
Bengal. of opinion that there was one general paralytic in every 15 male patients, and 1 in 50 among women. Foville calculated 31 general paralytics to 334 insanes, or 9 2 per cent. According to Bayle (1855), the proportion of paralytics in the asylums of Paris was 1 in 4; but Baillarger, on the other hand, gives for Bicetre and Salpetriere together the proportion of 1 Calmeil
was
in 16.
When
.
assigned causes of this mysterious unfreqnent appearance in Indian disease, asylums i9 not explained, as the native is as much exposed to most of them as is the resident of Europe. Intemperance, sexual debauchery, excessive use of tobacco, mental excitement, violent emotional agitation, hereditary predisposition, and concussion of the brain following blows on the head, have either singly or conjointly been pointed to as the causes of general paralysis. The use of ardent spirits is certainly less common among Hindoos and Mahomedans than among Europeans, and this fact corroborates the statement of Giiislam, that general paralysis is caused by the combined action of drink and study, examine the the reason of its we
drink and trouble. It seems probable, however, that if search is made in the case books of the different asylums, cases will be found classed under the head of chronic meningitis which were really cases of general paralysis. It is the hope that the record of the ?r
The further progress of this case is not to bo report for 1851, it is stated that the issue
being to all appearance hopeless, he earnest solicitation of his friends.
becomes more unaccount-
able when the records of the European asylums
In the
Eadlia
was
taken away at the
III.
Chamarnie, aged 45,
a
midwifo
by profession,
admitted into the asylum on the 27th December, 18G0, in an insane state. She had previously been an inmate of the asylum from the 5th September to the 27th November, 1860. The cause of her insanity was jealousy on account of her husband living with another woman. On admission, sho was was
j
melancholic, incoherent, intractable, sleepless, variable, unsettled, and very abusive. She took her food, dressed, and bathed, like a sane person. She was emaciated, and out of health. In June, 18G1, slight tremor of the whole muscular system, without paralysis, was noted. In September, the tremor,* increased ; she had great difficulty in speaking and moving I about. Her expression was idiotic, and her mental faculties were impaired. She had to be fed, as she was unablo to feed herself. Bowels wore regular. By blisters and mild stimulants, she rallied ; but about- the beginning of November, 18G1, she became very talkative and excited, screaming at night without apparent cause, and rarely sleeping. Pulse weak, mental faculties less dull, and the muscular tremors less uncontrollable. On tho morning of the 9th November, while eating bread, sho suddenly choked, and was dead before the native doctor could reach her. Post-mortem examination :?A mass of half-masticated bread, 3 ounces 20 grains, was found lodged in the pharynx,
weighing
and
completely blocking up the larynx. The membranes of were healthy. There was considerable sub-arachnoid effusion. The pia mater was congested, the cortical substance was darker than natural; the white was healthy. The right ventricle was larger than the left, and distended with serum; the latter was abnormally enlarged. The cerebellum was softer than usual, and 110 softening from disease could be
the brain
There was considerable serous effusion at the base ; was healthy. The lungs and heart were normal. No disease of the abdominal organs was found. There was a retroversion of the uterus, there being a firm fibrous band binding it to the rectum. She had never been detected.
hut the medulla
pregnant. IV.
Jcoloo or oilman, a Mahomedan, aged 40, was admitted asylum on the 29th July, 1868, from Knmroop. The following account of his case was sent with him :?In February
Peloo,
into the
last, he sustained a loss in money, and his wife deserted him. His habits and disposition changed. He became violent, variable, talkative, and incoherent. He neglected his business, adopted filthy habits, and wandered from home in a state of nudity. He was never addicted to gunjah, opium, or ardent
known to have suffered from epilepsy. None of his relatives were insane. While under observation in the dispensary at Gowhatty, the civil surgeon reported that he and
spirits,
was
never
incoherent and unsettled
an
sense,
that he
objected
that he
the mud, capricious
as
was
regards
manner
;
that he talked
non-
clothes, that he wallowed in threatening in his behaviour, and very to
wear
food.
asylum, he was noisy, talkative, and incoherent, passing the night shouting, without sleep. He had a voracious appetite, bolting his food without masticating it. Bromide of potassium in 20 gr. doses twice a day was occasionally given, and now and then f; of a grain of acetate of morphia was liypodermically injected. By the middle of On his admission into this
August, the paroxysm of excitement had abated ; but he was left very weak and anoemic. On the 25th August, he was unable to walk, and his hands trembled violently when stretched in the limbs
was unimpaired. He talked in imperfect manner, so as not to be understood. On the 28th August he had an epileptic fit, which lasted half an hour. On the 19th September he was unable to stand upright, and at night ho rolled off his platform, and was unable to replace himself. From knocking against objects, sores were
out. a
"
Sensibility
muffled" and
formed
on
antly. slept for
his knees and elbows. His hand strembled incesincessantly and incoherently. He only
He talked
periods; was so feeble, that lie could not feed guide his hand to his mouth ; his appetite was good. Sensibility was normal, but voluntary motion was seriously impaired. Between the 19th and 29th September he rapidly himself
short
or
became weaker. He was unable to stand erect, to command his extremities, or to guide his hand. The limbs were in a constant tremor, and they remained cold and bathed in perspiration. was wcuk ; deglutition was performed slowly, and with His
pulse difficulty.
His stools were passed in bed, unconsciously. On the 1st October, his disease was for the first time understood. His tongue was then protruded with difficulty, and when beyond the lips, it shook laterally; the irides were of equal size, and contracted normally. The face was without expression; and the facial muscles, especially around the mouth, quivered The most distressing symptom of his disease was closure of the jaw, followed by violent grinding the
incessantly.
spasmodic
On the 6th October, his eyes were unnaturally His bright, which gave a more intelligent look to his face. to the constant subsultus counted be not owing could pube of the flexor tendons. The fingors of the right hand were of the teeth.
generally
on spasms of the limbs preceded his death, which occurred the morning of the 7th October. Post-mortem examination:?Calvarium was very hard and thick. The frontal sinuses were unusually large. In the left for The parietal bone were several
diaphanous spots.
grooves
the arteries were very deep, and quite transparent The membranes were not coherent. The arachnoid was found distended
by
a
jelly-like effusion, The pia mater
colour.
which here and there
was
of
a
milky
not coherent to the convolutions. Its vessels were loaded with blood. Both lateral ventricles were enlarged and distended with serum?the right more than the left. A few cysts were imbedded in the choroid flexures, which consisted of varicose vessels. The medulla between the was
large
CASE
had
[April 1, 1869.
the INDIAN MEDICAL GAZETTE.
76
closed, aud the wrist
was
bent.
A few convulsive
corpora striata and optic tlialami was occupied by a yellow albuminous deposit, which concealed the large vein which runs through this space. This deposit was of hard consistence, and adhered
firmly
The whole
to the
pia
mater.
of the cerebrum
was
an comic
but the corpus
;
striatum, in the right hemisphere, was as soft as putty, and of an ivory whiteness. The anterior lobes were less coherent than the other parts. The cineritious matter of this hemisphere of a dark brown colour. The cerebellum was large and softened. The pons varolii was broke down on the slightest pressure. The spinal canal laid open. No atrophy of the cord was detected. Considerable serous effusion existed. The cord itself was found to be of the was
The grey matter was very pale; while of the white was increased. The arteries at vascularity the base of the brain were healthy. The only other morbid the appearances found were a few crude masses of tubercles at ^ie in of the left a few apex atheromatous deposits lung, aorta, and a lartje congested liver. The following were the consistence of butter.
the
weights
of the different viscera
Brain Lunfrs ljUng8
...
( riflllt' I left,
Heart Liver
Spleen Kidneys
:
?
...
...
11,5 80Z< 1 1ft 7oz. )
lbs.
oz.
2
14
2 2
is 15
...
...
0
7
...
...
...
3
0
...
...
...
0
5
...
...
...
0
9
...
13
In this case, the rapidity with which the disease progressed peculiar. On the 25th August, the first tremors were observed. Forty-four days afterwards he died, with all the indications of an advanced state of the disease.
:?
CASE
Ram Kishore
I.
Rukhit, Hindoo, aged
45 years, was admitted with dementia on the 23rd January, 1850. On his admission, he was in a state of nearly complete mental imbecility. In the following Novomber, his speech became impeded, and the motions of his tongue and free movement of his into the
asylum
became impaired. He halted in walking, and he dragged his lower limbs after him. No further details of his case can be discovered. On the 11th December, 1851, he died of
jaw
cholera.
post-mortem examination, a state of general congestion engorgement of the cerebral circulation was observed. effusion beneath, and raising up, the There was serous arachnoid ; also at the base of the brain, and in the ventricles; seated on the corpus striatum, on the right side beneath the lining membrane of the ventricle, was a spot of broken down brain, the circumference being about the size of an eight-anna piece. The ragged, degenerated, and softened cerebral substance was of a yellowish colour." The above are all the particulars that I have been able to discover regarding this interesting case. At the
and
CASE
II.
mohurrir, aged about 35, was admitted into the asylum in 1850. The following history was given by his friends:?He followed actively his business as a clork, but was also passionately fond of singing and playing upon musical instruments. Upon the occasion of some festival, lie spent the night in the bazaar, performing to a crowd of listeners: from that night he becamo insane. In October, 1850, while in the asylum, he was observed for the first time to drag his leg after him. On admission, it is noted that he was noisy, but that he answered questions put to him. By January, 1851, he could not be induced to speak, although he was heard to sing to himA Hindoo
GENERAL PARALYSIS OF THE INSANE. By Db. Wise. One of the most remarkable points connected with, insanity among the natives of India is the rarity of general paralysis. In the Patna Asylum Report for 1866, the deaths of two women, aged, respectively, 26 and 35 years, are recorded. With this exception, no other cases are cited in the reports of the Dhullunda, Patna, and Moydapore Asylums between 1862 and 1867. In the Dacca Asylum, between 1841 and 1867, I have only been able to discover 3 cases among 1,576 admissions, and 925 deaths.
This
infrequency
self at times. found.
are
contrasted
with those of
CASE
Bengal. of opinion that there was one general paralytic in every 15 male patients, and 1 in 50 among women. Foville calculated 31 general paralytics to 334 insanes, or 9 2 per cent. According to Bayle (1855), the proportion of paralytics in the asylums of Paris was 1 in 4; but Baillarger, on the other hand, gives for Bicetre and Salpetriere together the proportion of 1 Calmeil
was
in 16.
When
.
assigned causes of this mysterious unfreqnent appearance in Indian disease, asylums i9 not explained, as the native is as much exposed to most of them as is the resident of Europe. Intemperance, sexual debauchery, excessive use of tobacco, mental excitement, violent emotional agitation, hereditary predisposition, and concussion of the brain following blows on the head, have either singly or conjointly been pointed to as the causes of general paralysis. The use of ardent spirits is certainly less common among Hindoos and Mahomedans than among Europeans, and this fact corroborates the statement of Giiislam, that general paralysis is caused by the combined action of drink and study, examine the the reason of its we
drink and trouble. It seems probable, however, that if search is made in the case books of the different asylums, cases will be found classed under the head of chronic meningitis which were really cases of general paralysis. It is the hope that the record of the ?r
The further progress of this case is not to bo report for 1851, it is stated that the issue
being to all appearance hopeless, he earnest solicitation of his friends.
becomes more unaccount-
able when the records of the European asylums
In the
Eadlia
was
taken away at the
III.
Chamarnie, aged 45,
a
midwifo
by profession,
admitted into the asylum on the 27th December, 18G0, in an insane state. She had previously been an inmate of the asylum from the 5th September to the 27th November, 1860. The cause of her insanity was jealousy on account of her husband living with another woman. On admission, sho was was
j
melancholic, incoherent, intractable, sleepless, variable, unsettled, and very abusive. She took her food, dressed, and bathed, like a sane person. She was emaciated, and out of health. In June, 18G1, slight tremor of the whole muscular system, without paralysis, was noted. In September, the tremor,* increased ; she had great difficulty in speaking and moving I about. Her expression was idiotic, and her mental faculties were impaired. She had to be fed, as she was unablo to feed herself. Bowels wore regular. By blisters and mild stimulants, she rallied ; but about- the beginning of November, 18G1, she became very talkative and excited, screaming at night without apparent cause, and rarely sleeping. Pulse weak, mental faculties less dull, and the muscular tremors less uncontrollable. On tho morning of the 9th November, while eating bread, sho suddenly choked, and was dead before the native doctor could reach her. Post-mortem examination :?A mass of half-masticated bread, 3 ounces 20 grains, was found lodged in the pharynx,
weighing
and
completely blocking up the larynx. The membranes of were healthy. There was considerable sub-arachnoid effusion. The pia mater was congested, the cortical substance was darker than natural; the white was healthy. The right ventricle was larger than the left, and distended with serum; the latter was abnormally enlarged. The cerebellum was softer than usual, and 110 softening from disease could be
the brain
There was considerable serous effusion at the base ; was healthy. The lungs and heart were normal. No disease of the abdominal organs was found. There was a retroversion of the uterus, there being a firm fibrous band binding it to the rectum. She had never been detected.
hut the medulla
pregnant. IV.
Jcoloo or oilman, a Mahomedan, aged 40, was admitted asylum on the 29th July, 1868, from Knmroop. The following account of his case was sent with him :?In February
Peloo,
into the
last, he sustained a loss in money, and his wife deserted him. His habits and disposition changed. He became violent, variable, talkative, and incoherent. He neglected his business, adopted filthy habits, and wandered from home in a state of nudity. He was never addicted to gunjah, opium, or ardent
known to have suffered from epilepsy. None of his relatives were insane. While under observation in the dispensary at Gowhatty, the civil surgeon reported that he and
spirits,
was
never
incoherent and unsettled
an
sense,
that he
objected
that he
the mud, capricious
as
was
regards
manner
;
that he talked
non-
clothes, that he wallowed in threatening in his behaviour, and very to
wear
food.
asylum, he was noisy, talkative, and incoherent, passing the night shouting, without sleep. He had a voracious appetite, bolting his food without masticating it. Bromide of potassium in 20 gr. doses twice a day was occasionally given, and now and then f; of a grain of acetate of morphia was liypodermically injected. By the middle of On his admission into this
August, the paroxysm of excitement had abated ; but he was left very weak and anoemic. On the 25th August, he was unable to walk, and his hands trembled violently when stretched in the limbs
was unimpaired. He talked in imperfect manner, so as not to be understood. On the 28th August he had an epileptic fit, which lasted half an hour. On the 19th September he was unable to stand upright, and at night ho rolled off his platform, and was unable to replace himself. From knocking against objects, sores were
out. a
"
Sensibility
muffled" and
formed
on
antly. slept for
his knees and elbows. His hand strembled incesincessantly and incoherently. He only
He talked
periods; was so feeble, that lie could not feed guide his hand to his mouth ; his appetite was good. Sensibility was normal, but voluntary motion was seriously impaired. Between the 19th and 29th September he rapidly himself
short
or
became weaker. He was unable to stand erect, to command his extremities, or to guide his hand. The limbs were in a constant tremor, and they remained cold and bathed in perspiration. was wcuk ; deglutition was performed slowly, and with His
pulse difficulty.
His stools were passed in bed, unconsciously. On the 1st October, his disease was for the first time understood. His tongue was then protruded with difficulty, and when beyond the lips, it shook laterally; the irides were of equal size, and contracted normally. The face was without expression; and the facial muscles, especially around the mouth, quivered The most distressing symptom of his disease was closure of the jaw, followed by violent grinding the
incessantly.
spasmodic
On the 6th October, his eyes were unnaturally His bright, which gave a more intelligent look to his face. to the constant subsultus counted be not owing could pube of the flexor tendons. The fingors of the right hand were of the teeth.
generally
on spasms of the limbs preceded his death, which occurred the morning of the 7th October. Post-mortem examination:?Calvarium was very hard and thick. The frontal sinuses were unusually large. In the left for The parietal bone were several
diaphanous spots.
grooves
the arteries were very deep, and quite transparent The membranes were not coherent. The arachnoid was found distended
by
a
jelly-like effusion, The pia mater
colour.
which here and there
was
of
a
milky
not coherent to the convolutions. Its vessels were loaded with blood. Both lateral ventricles were enlarged and distended with serum?the right more than the left. A few cysts were imbedded in the choroid flexures, which consisted of varicose vessels. The medulla between the was
large
CASE
had
[April 1, 1869.
the INDIAN MEDICAL GAZETTE.
76
closed, aud the wrist
was
bent.
A few convulsive
corpora striata and optic tlialami was occupied by a yellow albuminous deposit, which concealed the large vein which runs through this space. This deposit was of hard consistence, and adhered
firmly
The whole
to the
pia
mater.
of the cerebrum
was
an comic
but the corpus
;
striatum, in the right hemisphere, was as soft as putty, and of an ivory whiteness. The anterior lobes were less coherent than the other parts. The cineritious matter of this hemisphere of a dark brown colour. The cerebellum was large and softened. The pons varolii was broke down on the slightest pressure. The spinal canal laid open. No atrophy of the cord was detected. Considerable serous effusion existed. The cord itself was found to be of the was
The grey matter was very pale; while of the white was increased. The arteries at vascularity the base of the brain were healthy. The only other morbid the appearances found were a few crude masses of tubercles at ^ie in of the left a few apex atheromatous deposits lung, aorta, and a lartje congested liver. The following were the consistence of butter.
the
weights
of the different viscera
Brain Lunfrs ljUng8
...
( riflllt' I left,
Heart Liver
Spleen Kidneys
:
?
...
...
11,5 80Z< 1 1ft 7oz. )
lbs.
oz.
2
14
2 2
is 15
...
...
0
7
...
...
...
3
0
...
...
...
0
5
...
...
...
0
9
...
13
In this case, the rapidity with which the disease progressed peculiar. On the 25th August, the first tremors were observed. Forty-four days afterwards he died, with all the indications of an advanced state of the disease.
