Popular Science Monthly/Volume 15/August 1879/The Re-Education of the Adult Brain
| THE RE-EDUCATION OF THE ADULT BRAIN. |
By WILLIAM SHARPEY, M. D., LL. D., F. R. S.,
EMERITUS PROFESSOR OF ANATOMY AND PHYSIOLOGY, UNIVERSITY COLLEGE, LONDON.
MRS. H, the subject of the following case, is about twenty-four years of age,[1] of a pale complexion and slender make. She was married in July, 1823, and, with the exception of occasional headaches to which she, in common with some of the rest of her family, was subject, and slight bowel complaints, she previously to that time enjoyed good health, both of body and mind. After her marriage she resided in England till the end of April, 1824, when, in consequence of ill health, she was brought here by her husband, on a visit to her friends who live in this neighborhood,[2] and with whom she had passed a great part of her previous life. From her husband's account, it appeared that for about three months after their marriage she enjoyed perfect health and spirits, but that after that time she complained a good deal of pain in her stomach and bowels; her appetite was bad, she began to lose spirits, imagining herself unequal to the concerns of the house, though her family consisted only of herself and her husband; and now also it was observed that she slept more than usual. The medical gentlemen consulted, believing some of her complaints might be owing to an affection of the liver, administered mercury in small quantities and applied leeches to the temples in considerable numbers, with a view to relieve an uneasy feeling of lightness which she complained of in her head; but these remedies proved of little or no avail, and for some time before leaving England, excepting a laxative which she took twice a week, she had given up the use of medicine altogether. No probable cause could be assigned for these complaints.
On her arrival in this place, which, as already mentioned, was about the end of April last, she had lost but little flesh, and by no means looked sickly; indeed, she was little, if at all, changed in her appearance; all her external senses were sound, but her memory was impaired, and she was very inattentive to surrounding objects, which made her dull and absent in company. The sleepiness had been very gradually increasing, and was now arrived at such a height that, unless when conversing with another person, or engaged in some manual occupation, she fell asleep at all times, and in whatever situation or position she might be. When in this state her eyes were nearly closed, she breathed softly, and, in short, very much resembled a person in natural sleep, except that when she happened to fall asleep in a position in which the body naturally requires to be supported, as for instance on a chair, she did not lean forward or backward as is commonly the case, but sat with her body quite erect, and her head gently inclined to one side. While in this state she was subject to frequent startings, during which she raised herself up, talked as if she were frightened, drew herself back as if to avoid something disagreeable, and then after a few seconds lay quietly down again without having waked. What she said on these occasions, though quite incoherent, was yet always nearly of the same nature, and for the most part consisted even of the same expressions, which were those of great aversion or horror; of this she had no recollection when awake, nor of anything connected with it; and she herself remarked as something extraordinary that now she did not dream, although she used formerly to be very subject to dreaming. From this sleep she never awoke of her own accord, except to obey the calls of nature; and there was no other way of rousing her up upon other occasions, but by placing her on her feet and endeavoring to make her walk. When thus forcibly awakened, she was fretful, and cried for some time after. She took food in sufficient quantity, and often with evident relish; but it required much entreaty to make her take the first two or three mouthfuls. The pulse varied a little, but on the whole was nearly natural; during sleep it was commonly from fifty-six to seventy, and somewhat more when awake. Her bowels were very costive, and constantly required the use of laxative medicine; the discharge of urine was natural; the catamenia had hitherto been regular in their appearance, but in small quantity. She complained of no pain or other uneasiness, except a peculiar feeling in the top of the head across the bregma, which she called "funny."
For five weeks after her arrival the torpid state and indifference to surrounding objects continued gradually to become worse, and the difficulty of awakening her daily increased; till at length, about the 8th or 10th of June, it was found impossible to rouse her up at all by any means that could be thought of; and from that time forth, excepting a few short intervals, she remained in a state of constant sleep till the beginning of August. Her condition was now singular enough. She still made an attempt to get out of bed when she required to go to stool; when food was presented to her lips with a spoon, she readily took it into her mouth and swallowed it, and in this way she was fed as long as the torpor continued; when she had taken what appeared a sufficiency, she closed her teeth as a sign she was satisfied, and if importuned to take more, turned away her mouth from the spoon. She appeared also to distinguish different tastes, for she gave an evident preference to some sorts of food and obstinately refused others. She sometimes even, to all appearance, judged of the nature of the food or medicines offered to her, by the sense of smelling; and, when the latter were such as possessed a strong odor, she would often close her mouth in a determined manner before they touched her lips.
By this time the startings in her sleep had left her; and although the expressions she uttered when in that state were, with some slight additions, nearly the same as formerly, yet her manner of speaking was now indicative of satisfaction and not of fright. She often even sang to a simple but cheerful air nearly the same words which she used formerly to cry out with every appearance of the greatest terror.
The torpor continued nearly in the same degree till the end of July, with occasional intervals of waking, which happened at uncertain periods, but generally at the distance of a few days from each other, and were occasioned by pain experienced in some part of her body. The first of these took place after she had been ten days in a continued state of torpor; it was caused by severe griping from laxative medicine. She awakened in great suffering, crying out, "Pain! pain!" "Die! die!" and placing her hands on the abdomen. She was relieved by means of warm fomentations; but she, notwithstanding, kept awake for some hours after, during which time she answered no question, in however loud a voice it was put to her, and recognized nobody except one old acquaintance, whom she had not seen for more than twelve months. She looked steadfastly in this person's face for a few seconds, apparently occupied in trying to remember his name, which at length she found out and repeated again and again, at the same time taking him by the hand as if overjoyed to see him; but when questioned regarding him, she answered only by calling out his name, which she continued to repeat for some time after she had fallen asleep, in addition to what she usually said. In the course of the next eight days she was twice roused from her sleep by a similar cause, but not so completely; the same individual was still the only person she knew; among others she did not recognize even her own husband, who happened then to be in Scotland.
The next interval of waking took place three or four days afterward; it appeared to be occasioned by pain in the head. She cried for some time, then awoke, complaining of pain, with her hand on the fore part of her head, on which also she placed the hand of a person near her and pressed it down firmly with her own; after thus complaining for two or three hours, she fell asleep. The same thing happened on the next and the two or three succeeding evenings, nearly at the same hour, but each time with less complaint. Other circumstances about this time showed that she was suffering considerable uneasiness in her head. She was very impatient in the erect posture, and, when lifted out of bed, would not put her feet to the ground, but drew up her legs to her body, as if to force those who held her to lay her down again. This, however, was not the case when she required to be taken up for the purpose of making any evacuation. She generally also preferred to lie on her face, and always with her head very low, with both hands firmly clasped over it, exactly on the part to which she had formerly referred the peculiar feeling already mentioned, and showed much uneasiness when they were removed, unless the pressure was continued by the hand of another person.
After this, the torpor continued for some time without being interrupted; but in the mean time the symptoms of pain in the head, and the uneasiness in the erect posture, gradually wore off, and Mrs. Hnow no longer talked in her sleep. Her bowels were kept open by laxative medicine, which now did not operate so severely as to wake her. She had, since the beginning of June, had a blister applied to the nape of the neck, and three to the head at different periods; sinapisms to the feet were also had recourse to, and two or three times electric shocks were passed through her arms. These remedies, like other painful stimulants, caused her to complain much; and one of the blisters, which was sufficiently large to cover the whole scalp, made her open her eyes; but their effects were merely temporary, leaving, to all appearance, no permanent impression on her complaint. Lest there might be any serous effusion within the cranium, digitalis was used along with the sweet spirit of niter, in such quantity as greatly to augment the flow of urine. By its operation her pulse was reduced so low as forty-four in a minute; and, while using it, she appeared to suffer from sickness at the stomach, during which she often put her fingers into her mouth, as if wishing for something to eat or drink; and she was subject to what seemed an oppressive feeling in the region of the heart, with a peculiar interruption to her breathing, which came in paroxysms; all which symptoms left her after discontinuing the medicine.
Toward the latter end of July, the torpid state, which had suffered no more intermissions, was become on the whole not quite so deep; at least Mrs. Hnow gave signs of being more conscious of anything that was done to her. She smiled and seemed pleased on receiving particular sorts of food, and when her eye was opened, or any part of her face touched with a finder, her whole countenance became suffused with a blush of redness. Some short time after, it became possible to awake her by opening her eyes, and holding anything before them likely to catch her attention, such as a glass of water, a cup, or the like. When awakened in this way, which succeeded best at the times she was getting her food, she generally laughed a good deal and seemed much delighted, and she always bestowed her whole attention on the vessel in which her food or drink was contained, and the person who held it; she, however, did not speak, and paid no attention whatever to the questions put to her. One day about this time, viz., on the 1st of August, in consequence of her usual medicines failing in their effect, she had two or three laxative clysters, and then a small dose of croton-oil, which produced very copious evacuations, but at the same time caused so much griping as to wake her. When suffering from this, she took hold of the blankets of her bed, twisted them in her hands, and applied them over the abdomen, looking wistfully all the while in the faces of the attendants, as if she had recollected the fomentations which had formerly given her relief, and wished them to be had recourse to on the present occasion; her wish was complied with, with the effect of removing the pain, which seemed to give her great satisfaction. In two or three days after this the torpor was much diminished, and she could be awakened with great ease. She likewise began to take a great liking to the young woman who waited on her, so much so that, when awake, she would hardly allow her to be a moment out of her sight. Now also she would sometimes let herself cautiously down on the floor from her bed, and creep to the fireside, where she would lay herself quietly down on the hearth-rug, as if she wished to enjoy the warmth of the fire.
At length, after progressively improving for some days, she was by the third week in August almost free from torpor, and slept little more than a person in health. During all this period, except that her feet were sometimes cold, the temperature of her body was very nearly natural. Her face was for the most part pale, but sometimes a little flushed, and the pupil of the eye uniformly contracted on exposure to the light. Her pulse, which had been rendered slow by the digitalis, was observed to be rather higher for some time preceding her recovery than it had been even before the use of that medicine. She had undoubtedly lost flesh during her illness, but at this time she was not so thin as she had been a short time before. The catamenia had not appeared since the month of May; but, with the exception of considerable loss of strength, her bodily health was now on the whole tolerably good.
On her recovery from the torpor she appeared to have forgotten nearly all her previous knowledge; everything seemed new to her, and she did not recognize a single individual, not even her nearest relatives. In her behavior she was restless and inattentive, but very lively and cheerful; she was delighted with everything she saw or heard, and altogether resembled a child more than a grown person.
In a short time she became rather more sedate, and her attention could be longer fixed on one object. Her memory too, so entirely lost as far as regarded previous knowledge, was soon found to be most acute and retentive with respect to everything she saw or heard subsequently to her disorder; and she has by this time recovered many of her former acquirements, some with greater, others with less facility. With regard to these, it is remarkable that though the process followed in regaining many of them apparently consisted in recalling them to mind with the assistance of her neighbors, rather than in studying them anew, yet even now she does not appear to be in the smallest degree conscious of having possessed them before.
At first it was scarcely possible to engage her in conversation; in place of answering a question she repeated it aloud in the same words in which it was put, and even long after she came to answer questions she constantly repeated them once over before giving her reply. At first she had very few words, but she soon acquired a great many, and often strangely misapplied them. She did this, however, for the most part in particular ways; she often, for instance, made one word answer for all others, which were in any way allied to it; thus in place of "tea," she would ask for "juice," and this word she long used for liquids. For a long time also in expressing the qualities of objects, she invariably, where it was possible, used the words denoting the very opposite of what she intended. And thus she would say "white" in place of "black," "hot" for "cold," etc. She would often also talk of her arm when she meant her leg, her eye when she meant her tooth, etc. She now generally uses her words with propriety, although she is sometimes apt to change their terminations, or compose new ones of her own.
She has as yet recognized no person, not even her nearest connections; that is to say, she has no recollection of having seen or known them previously to her illness, though she is aware of having seen them since, and calls them either by their right names or by those of her own giving; but she knows them only as new acquaintances, and has no idea in what relation they stand to herself. She has not seen above a dozen people since her illness, and she looks on these as all that she has ever known.
Among other acquirements she has recovered that of reading; but it was requisite to begin her with the alphabet, as she at first did not know a single letter. She afterward learned to form syllables and small words, and now she reads tolerably well, and has shown herself much interested in several stories previously unknown to her, which she has read since her recovery. The reacquisition of her reading was eventually facilitated by singing the words of familiar songs, from the printed page, while she played on the piano. In learning to write she began with the most elementary lessons, but made much more rapid progress than a person who had never before been taught. Very soon after the torpor left her, she could sing many of her old songs, and play on the piano-forte with little or no assistance; and she has since continued to practice her music, which now affords her great pleasure and amusement. In singing, she at first generally required to be helped to the first two or three words of a line, and made out the rest apparently from memory. She can play from the music-book several tunes which she had never seen before; and her friends are inclined to think that she now plays and sings fully as well, if not better, than she did previously to her illness. She learned backgammon, which she formerly knew, and several games at cards with very little trouble; and she can now knit worsted, and do several other sorts of work; but with regard to all these acquirements, as already mentioned, it is remarkable that she appears not to have the slightest remembrance of having possessed them before, although it is plain that the process of recovery has been greatly aided by previous knowledge, which, however, she seems unconscious of having ever acquired. When asked how she had learned to play the notes of music from a book, she replied that she could not tell, and only wondered why her questioner could not do the same.
She has once or twice had dreams, which she afterward related to her friends, and she seemed quite aware of the difference between a dream and a reality; indeed, from several casual remarks which she makes of her own accord, it would appear that she possesses many general ideas of a more or less complex nature, which she has had no opportunity of acquiring since her recovery.
In this way she has continued slowly but progressively to improve, and it is now considerably more than two months since she recovered from her sleep. Her bodily health has since then undergone little change: she is still liable to be fatigued by slight exertion, after which she is inclined to sleep; but in this state She never remains long except during the night, when she sleeps like another person. The catamenia have twice appeared, viz., in September and in October, at both times to a greater extent than usual; her bowels still require laxative medicine; but her appetite continues good, and she has evidently gained flesh since her recovery.
Postscript (March, 1879).—After a time Mrs. Hwas able to return to her home in England, where she passed the rest of her life happily with her husband, and gave birth to a daughter, who survives her. She was in the habit of corresponding by letter with her friends at a distance, and lived on the most agreeable terms with her immediate neighbors, by whom she was held in much regard on account of her kindly nature and charitable work.—Brain.