O.- an officer, enjoying habitual good health, and strong constitution,
had in his youth indulged in a multitude of excesses which had not, been
followed by any appreciable bad consequence. He was irritable, violent,
flighty, and so unstable in his talk, that often, in telling a story, he
would pass from one to another without finishing any. For a long time he
lived carelessly in that fashion; and dark, hypochondriacal ideas gradually
took possession of him. He Suffered from constipation and internal haemorrhoids.
He was always dejected, and nothing could distract him. In a fall which
he had from his horse, he received a severe contusion on the head and on
the leg, and was obliged for three months to maintain a horizontal position.
The congestion of the head, combined with the haemorrhoidal affection,
now increased to such a degree, that he experienced frequent attacks of
vertigo and confusion, and could only with great difficulty perform the
duties of his office. His pulse was full and slow; his belly distended
his countenance flushed He had violent headaches and lumbar pains' had
a constant feeling of tiredness; micturition was painful, and the bowels
constipated. At the same time, he was in a constant state of mental anxiety.
He often clasped his hands, as if he were the victim of the most profound
despair; He refused at times to eat or drink, and constantly dreaded that
for his neglect of military duty and for his crimes (purely imaginary)
he would be degraded and prosecuted criminally, etc. At the end of two
months he felt improved, and in two months more was completely restored.
But when his physician saw him again in the commencement of November,
he found him in an agitated condition, occupying a well-furnished apartment.
He observed in him at the same time an extraordinary flow of language,
and great agitation of the whole body. Already on the following morning
the... exaltation had reached a very considerable height. He got ready
to visit the daughter of a superior officer, whom he was but slightly acquainted
with, and whose hand he was about to ask. He had already bought a carriage
and horse for the purpose of making a long journey with this lady through
Europe. He declared himself to be of noble blood, and announced that his
promotion was to be very rapid. His happiness was at the highest pitch,
and he wished to share it with the whole world. Checked in his desires,
he fell intoa fit of frenzy.
Towards the end of November he entered Sieburg. The pupils were somewhat
contracted the haemorrhoidal vessels were swollen he had pains
in the joints; there was a determination of blood to the head; the pulse
was rapid. He was very irritable, and easily became enraged. He imagined
that he possessed a considerable fortune, and was of lofty station; he
believed himself endowed with supernatural power, etc. Every minute he
distributes the largest sums of money, afterwards he says that he is God
the Father; but if any one asked who his father was, he replied that he
was a judge in the court of exchequer; and it was in vain that one tried
to show him that he said was absurd and impossible...
What
was the course of the illness and the diagnosis given?
What was
likely the correct diagnosis?
O (p.219)Ten months after
his admission, the attacks of vertigo returned and by degrees symptoms
of general paralysis with increasing dementia developed themselves; apoplectiform
attacks; death. (Jacobi, “Beobachtungen,” i,1830 p.372)
cerebral congestion; melancholy; monomania terminating in dementia.