On atrophy of the brain in imbeciles / by Fletcher Beach.

  • Beach, Fletcher, 1845-1929.
Date:
1884
    Published Qua^ferly. Pari ZZFP] ^'i i [Price 3«. 6<i. > BEAIN: A JOURNAL OF NEUROLOGY. / . / Gv' ■ / . ' >- / •■•' ■ 7 :<> S N.> ■ ' 'G C / EDITED BY .A \ BUCKNILL, M.D., F ^ /. CKICHTON-BEOWNE, D. FERKIER, M.D., F.R.S., J. HUGHLINGS-JACKSON, A. DE WATTEVILLE, M.A., M.D., B.Sc. Jonboit: MACMILLAN AND CO. July, 1884. WM, CLOWES AKD SOK8, LIMITED.] [STAMFORD STREET, LONDON
    ON ATROPHY OF THE J3RAIN IN II\[BECILES. BY FLETCHER BEACH, M.B., M.R.C.P., Medical Superintendent of the Darenth Asylum. Many writers speak of two forms of atrophy of the brain, and it is a convenient method of describing the disease. In the first, there is incomplete development; in the second, there is loss of nervous elements which had previously been present. Taking first that variety in which there is incomplete de- velopment, and excluding that form of it in which the hemi- spheres are completely wanting and vegetative life merely exists, I would remark that cases illustrating this condition are commonly found in Asylums for Imbeciles. Microcephalic imbeciles are instances of this class. Microcephaly may be general or partial. Some portions of the brain may be too small or altogether absent. I have found the convolutions of certain parts very much reduced in size from non-development, while the remaining portions are too large or normal. The occipital lobes are usually arrested in growth in microcephalic cases, and the island of Reil may be left uncovered. The corpus callosum is sometimes shortened posteriorly, and cases are on record where this portion of the brain has been wanting and the commissures deficient. As an instance of the arrest of growth of the occipital lobes, I would refer to a case related by Dr. Shuttleworth in the ‘Journal of Mental Science for 1878,’ in which the frontal and parietal lobes were comparatively well-developed, but the occipital lobes were quite rudimentary. Usually, however, microcephaly is general, and the deficiency consists in the smallness of the hemispheres. In the ‘ Trans- actions of the International Medical Congress ’ for 18811 have related two cases, in one of which the brain when removed from
    tlie body weighed only 7 ounces, yet a minute examination of it showed that nearly all the convolutions were present, tliongh very small in size. In the other, the brain weighed 20.V ounces. Two brains of microcephalic cases have since come under my notice, and these weighed 20j and 24i ounces respectively. The nerves of special sense are nsnally well- developed in microcephaly, and the ganglia of the base and the spinal cord are of nearly normal size. The cerebellum is relatively much larger than in the normal brain, often being in the proportion of 1 to 3 or 4, the ordinary relation being I to 8. The following are illustrative cases : G. L., aged 13 years, admitted into Darenth Asylum, January 19th, 1878. The father is a very hard drinker and often ill-uses the mother. He has an impediment in his speech, and so have all his side of the family. The mother is a temperate ^voman, but has a brother in Colney Hatch Asylum. Intemperance and hereditary predisposition to in- sanity are therefore present. T4ie parents are not connected by consanguinity. G. L. had a small head when born. He did not walk till 5 years old, and has never spoken. The mother ascribes his condition to ill-nsage by the father during pregnancy. He is a twin; the other child is dead, but his head was of normal size. There have been twelve children, of whom one, a girl aged 8 years, is also microcephalic. Seven have died, and of these one was microcephalic and died in convulsions. On admission, G. L. was found to be rather thin, with a mudtly complexion and a bird-like aspect. His head measured 17| inches in circumference (3 to 4 inches below the normal size), lOJ inches transversely (3J inches with calipers), and II inches aiitero-posteriorly ((J inches with calipers). Since his residence in the Asylum his head has increased a little in size, being now I8|- inches in circumference, II inches in the transverse diameter, and 11^ inches in the longitudinal direction ; but even now the outline of it, when compared with one of normal size, shows the great difference at once. His forehead was 3f inches in breadth. He had good use of his limbs and was not snl)jcct to fits. In temper he was some-