tory.
From the medical certificate which accompanied him on admission it
appeared that soon after the commission of the crime the patient began
to show evidence of insanity by incoherent talk, false ideas,
nervousness, and outbursts of vicious excitement. Later, this was
followed by mutism, refusal to eat, and stupor. On admission to this
hospital he was in a deep stupor, absolutely oblivious to everything
about him. Eyes were wide open and staring, pupils dilated, voluntary
movements markedly in abeyance. He was mute except for an occasional
incoherent mumbling to himself. He evidenced no initiative in feeding
himself, but swallowed food when it was placed in his mouth. Habits
were very untidy; involuntary evacuation of bladder and bowels were
present. His mental content could not be determined at the time, as
his replies were indistinct and monosyllabic, and were obtained only
after much effort. He appeared to comprehend what was wanted of him,
although this was not absolutely certain. His perception was very
dull, ideation slow and laborious. His attention could be gained only
after considerable difficulty, and he had to be aroused first from a
more or less profound stupor. Spontaneous speech was almost wholly
absent, but occasionally he would utter a word or two about his wife
and children. No delusions or hallucinations could be elicited.
Physical examination showed him to be quite thin and emaciated. Gait
slow and unsteady. Voluntary movements retarded. Knees trembled and
knocked against each other. No paralyses or pareses noted. Marked
general tremors were occasionally seen. Musculature well developed but
flaccid. All deep reflexes diminished. Cremasteric absent. Other
superficial reflexes were noted to be normal. Organic reflexes
abolished. Involuntary urination and defecation. There was a systolic
murmur present and a slight impairment of the upper lobe of the right
lung. Breath very offensive. He remained in this stuporous condition,
leading a more or less passive existence, for about a month after
admission. For two months following this he was quite agitated, and
his outward reactions indicated that he was quite depressed. On
April 25th, about four and a half months after admission, when asked
how long he had been in the Hospital, he replied three days. From that
time on he began to improve. Consciousness became clearer. In June, he
talke