Postencephalitic respiratory disorders : review of syndromy, case reports, physiopathology, psychopathology and therapy / by Smith Ely Jelliffe.

  • Smith Ely Jelliffe
Date:
1927
Catalogue details

Licence: In copyright

Credit: Postencephalitic respiratory disorders : review of syndromy, case reports, physiopathology, psychopathology and therapy / by Smith Ely Jelliffe. Source: Wellcome Collection.

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    fever. Several months later, the respiratory tic ceased. The cause of the cessation I do not know, but I am sure it was not the curative effect of the fever. He returned to high school when eighteen years old (Janu¬ ary, 1923), but did not do well and soon began to have “drowsy spells.” The teacher, two months after his return, notified his parents that he would either have to keep awake or leave the school. No one suspected illness; everyone, like the teacher, assumed laziness. During the Easter vacation, almost three months after somnolence began, he suddenly became acutely ill with sore throat, vomiting and fever, and two days after the onset delirium appeared. At the end of a week, he seemed to be well, and returned to school, which he attended until the end of the school year, but he did not do well. The periods of sleepiness continued, and he failed in his examinations. [This encepha¬ litis attack was one year earlier and preceded the tics. J.] He was brought to me when nineteen years old because of personality changes. His parents stated that from the time the tic began they had noticed alterations in his conduct, which they thought indicated vicious¬ ness. Previous to its appearance he had been a bright, happy, ambitious and industrious schoolboy. He grew lazy, surly, had outbursts of cause¬ less anger and became disrespectful toward his parents. They verified the history of attacks of sleepiness, and rapid breathing and were posi¬ tive that the acute febrile attack, mentioned above, occurred months after the other symptoms.* Examination.— The most striking thing in his appearance was the facial rigidity. He had the facies of paralysis agitans. The skin was oily over the entire body, and he had facial acne. During my first examination he had an attack of “ hysterical ” rapid breathing. Neither attitude, excluding the face, nor gait suggested paralysis agitans, but at times he showed local catalepsy. If I put either arm in any position, he would hold it so for an indefinite period, and then it would slowly drop to the side. He was pleasant in manner toward me (this changed later) but was somewhat childish, making me suspect the beginning of an adolescent dementia. Treatment and Course.—I sent him to the Infirmary for Nervous Diseases for observation. While there, his mental symptoms became marked. He had periods of surliness, was childish in manner and took interest in nothing. He had no periods of drowsiness; on the contrary, he slept poorly. He had several attacks as follows: he would hold his breath, become blue in the face, stand with eyes wide open staring into space, extend the arms and fingers stiffly, remain rigid and speechless for about half a minute, then relax and become normal. He was not unconscious during the attacks, and they were manifestly hysterical. I sent him away under the care of a skilled companion, but he rapidly * See note by Dercum in Jelliffe’s report proving this is incorrect.