Remarks on Leprosy in the British Empire
Authors: P. S. Abraham
Journal: BMJ (1897)

continued to do duty until, losing his place, he became again excited, and was returned to the hospital July ixth, 1894.Again he quieted down, and began to assist at1 light work on the ward, out mentally he lost ground, and epileptiform seizures appeared, each one leaving him physi- cally and mentally on a lower plane.He went down rapidly, became bedridden, ceased to talk, and now, in the fourth year of his malady, wds near the end.Removed to the Toner Building October 3rd, I895, and subjected to the treatment.Improvement was wonderful as unexpected.In less than three months was up and about the ward, talking rationally, doing his work again, and with much of his old mental vigour.Sud- denly epileptiform seizures returned, and he died June ist, x896, of general paralysis, having come nearer to spontaneous recovery in the early stages than any other paretic in the hospital for a decade, and afterwards In the third stage, brought back by active treatment.Unfortunately no necropsy could be obtained.J. B. McD., admitted March 2nd, I894.with the characteristic symptoms of general paralysis.This case, as well as the preceding qne, were detailed at length in the z8g6 Report of the Government Hospital for the Insane, Medical Supplement.Suffice it to say herethat this was a typical case of the active destructive dementia type of the disease wearing out every body and steadily going down..He was transferred to the Toner Building June 6th, I895, the disease being then of over eighteen montbs' duration.Under the wet-pack treatment and opium he came back from an untidy dementia and silence to his old cleanly habits and the old activities of life, wl'h the delusions of grandeur no longer present.He took up his profession, that of a musician, and played as well as ever.He was allowed to leave the hospital to play in an orchestra in the summer of I896, he reporting from time to time, and was finally discharged February zith, 1897.He has continued in the orchestra, and with no recurrence of the disease up to the present time.P. B. M., admitted in the acute stage of general paralysis, April x6th, 1897.Transferred to the Toner Building, April 2oth, 1897.Aged 5. Driver; married; habits temperate.About two months before admission became markedly absent-minded, with general restlessness and expansive ideas of grandeur, thinks he Is going to build big houses, constantly building useless boxes; talkative and excitable, easily diverted, memory imper- fect, perceptions impaired.A typical case of the disease, delusions being of the expansive form.Coachman of a family of social prominence, and for months suffered loss of sleep.He has aortic valvular disease with both systolic and diastolic murmurs, the result of rheumatic endocarditis.This double cause of cerebral malnutrition is of Interest, and etiologi- cally of greatimportance.There was irregularity of pupils, tremor of tongue and lips, slurring of words in speech, and delusions of unbounded wealthcharacteristic of the disease.He was treated by rest in bed for six weeks, with wet packs of two hours' duration twice daily, followed by massage.Temperature one to three degrees F. in excess of normal during most of the time.and for this ice was applied to the head, and 2fr gr.phenacetin administered morning and evening.Milk was freely given.At the end of six weeks, temperature having become normal, some in- crease of flesh and mental improvement having taken place.he was allowed gradually to get about the building.The duration of pack re- duced to an hour ana a half each, with cold douche immediately follow- ing.Has now (August z897) lost'all his delusions, gained many pounds in weight, and seems well advanced on the road to a normal mental condition, if not recovery.This is the only case reaching the Toner Building in the early stages of the disease.This was due to the building not being fitted for active, violent cases, but this has now been provided for, and hereafter these cases will pass directly under the St. Elizabeth treatment.