XII A CASE OF MONGOLIAN IDIOCY. BY WALTER A. JILLSON, M.D. W. S. H., No 10,077. A boy, age 13, was admitted to the hospital on April 6, 1912, as a thirty-days' observation case because of certain psychic manifestations which had made his care and management at home impracticable. Family History-Father is living but in poor health, being an arrested case of tuberculosis. Mother died shortly after patient's birth from causes the result of her severe parturition and puerperum, previously having been a healthy, normal woman of normal stock, so far as can be learned. Paternal grandfather living, has twice been an inmate of insane hospitals; paternal grandmother and an aunt are neurotic. Personal History.-Patient was a full-term, instrumentally-delivered, artificially-fed infant. As the result of instrumentation the head was badly injured, so much so as to cause a grave prognosis as to the possible continuance of life. Though he did live, he was delicate, and backwardness has always characterized his mental and physical development. The ability to walk and to talk were not accomplished until the age of four; neither has ever been normal. Comprehension was good at a much earlier age. When about the age of four or five he had periods of stupidity; then, for about a year, was very bright, learning rapidly. Following upon associations with other children, he developed a serious, excitable period, when for about two years he had uncontrollable spells, during which he would use profane language and would run his fingers far down his throat. During these years he required special care, and he led an out-door life, with the result that he was able to take up home lessons, but these were interrupted by occasional lapses in his mental condition and behavior. Instruction in the ordinary branches of common school knowledge has always been under the private tutelage of an aunt, with whom he has lived since the age of five, and has been slow and intermittent because of mental incapacity and numerous physical ailments, to which latter he seemed to be especially susceptible. Speech has always been slow and drawling. He has sustained several accidental injuries in the past, many of them being the result of his clumsy, awkward ways. Two severe falls, both accompanied by unconsciousness and other signs of probable concussion, are to be noted, one occurring about five years ago and the other last January, the latter being followed by the train of mental symptoms which made his commitment necessary. He has always had a childish manner and a tendency to affect a make-believe-like-others attitude in his words and acts, so that, superficially, he has often appeared wiser than his years. In early childhood he exhibited a propensity to lick various objects, and later on in life was occasionally noticed to bite in a sort of playful way, though never to such an extent as to fail to control himself when remonstrance was made. Present Psychosis began following probable cerebral concussion resulting from fall on the ice last January. Though he was able to walk to the house and to tell how his accident occurred, he showed speech disturbance within an hour and emesis within two hours, the former disappearing after about six hours and the latter lasting about six or seven hours. He appeared dazed but was at no time unconscious, and once when he tried to get to his feet he fell to the floor. About a week later, while convalescing and out walking with his aunt, he again slipped on an icy sidewalk and fell, complaining that he could not see well, and again experiencing difficulty in walking. The next morning, while lying on the couch unusually quiet, he was called from an adjoining room by one of his aunts to assist her at some light task. He went to his aunt silently and seemingly was about to assist her, when suddenly and without the least warning he started to bite her. The combined efforts of two aunts, his grandmother and later a man were necessary to restrain his violence. During this episode he not only struggled in his attempts to bite, but scratched, kicked and screamed at the top of his voice. After being controlled he remained good for about a week, opiates being administered and special observation and care required. Only occasional mild spells of violence occurred during this time. He then relapsed, bit his aunt and three days later was practically uncontrollable, except by force, and so much so that the constant services of a male attendant were required to restrain his violence. Associated with this period were frequent impulses to masturbate. The boy realized his changed mental condition and often piteously asked his relatives and nurses to help him to be good and control himself. There was mental dulling, and, with excited spells, great talkativeness with tendency to flight of ideas. Previously reliable in his promises, he became unreliable and would excuse himself by saying that he could not help it. Hospital care and treatment became necessary simply because all connected with him were becoming exhausted with his care. Here. Upon admission he was extremely violent and given at short intervals to periods during which he would bite and scratch those about him, was tearfully emotional and homesick, but when spoken to became cheerful, hopeful and optimistic. He answered questions readily, coherently and relevantly, but spoke in a slow, drawling, affected manner; made good responses to simple educational tests, consistent with advancement reported by relatives; and shortly became restless, could not be quieted and examination had to be discontinued. The following day he was found to be oriented, showed no gross memory defects and gave no evidence of hallucinations or delusions. He was very suggestible, and when biting was mentioned, immediately went towards the examiner, grasped his hands. and attempted to bite them. During his biting attacks he bit and scratched everyone who went near him; his face became contorted, his forehead wrinkled and the corners of his mouth turned down and presented the appearance of one about to cry. Alone and unobserved he would become quieter, but as anyone entered his room he would immediately leave his bed, go towards the visitor and attempt to bite. Physical Examination. General Condition.-A well-nourished boy, height 4 feet 10 inches, weight 844 lbs.; head asymmetrical and features of Mongolian type; palpebral fissures narrow and slanting and well-defined epi-canthal folds; cheek-bones high; ears large and protruding; hair brown. long, coarse, and bushy; hands short, stubby and thick-set, with disproportionate shortening of thumbs and little fingers, the latter showing characteristic incurving; tongue, unlike usual findings in these cases, was short and thick rather than long. Length-breadth index, 80.33 (slightly brachycephalic). 52.5 c.m. 36. c.m. 38. c.m. 15. c.m. 14.5 c.m. 14. c.m. 14. c.m. 17.8 c.m. 19.2 c.m. 15. c.m. 13.5 c.m. |