| Description Of Item | Royal Edinburgh Asylum Papers, eight-page pamphlet of clinical notes from the collection of Thomas Laycock. Clinical notes of this paper written by James Maclaren L.R.C.S.E Assistant-Physician, titled ‘I. On a case of microcephaly’ and ‘II. On a case of general paralysis of the insane of unusually long duration.’ Reprinted from the Edinburgh Medical Journal for October 1874. ‘Charles’ written in ink on the cover, which is otherwise blank. Printed by Oliver and Boyd, Tweeddale Court.
In Case I. Maclaren describes the features and condition of a patient known as J.G. ‘æt. 17,’ suffering a variety of physical deformities, an inability to speak, poor hearing and ‘great difficulty’ swallowing. Maclaren explained that ‘he was about the size of a child of five or six years, and extremely emaciated’ with an ‘extremely’ small head, known as microcephaly. J.G. had been ‘admitted to the Craiglockhart Poorhouse into the Royal Edinburgh Asylum on 30th May 1974.’
In Case II. Maclaren wrote that ‘general paralysis of the insane’ was a common disease found in asylum patients which generally lasted about thirteen months. Maclaren provides the details of a case in which a patient of the Royal Edinburgh Asylum suffered a much longer duration of paralysis – lasting for over fourteen years. When admitted in May 1860 the patient had an ‘inequality of the pupils, unsteadiness of gait, and indistinctness of speech.’ He was discharged after a year with no improvement noted, and returned in January 1863, still unable to ‘employ himself in any way.’ After three months of this second admission, he was able to walk around the asylum grounds but spoke ‘with the greatest difficulty and was almost unintelligible.’ The patient then developed a new symptom – delusions of grandeur. These included the belief that he was rich, married to the queen, and that he was God. These delusions subsided and the patient became ‘more subdued in mind and weak in body, but happy and good-humoured.’ Soon after this period of stability, the patient had ‘a series of epileptiform [epileptic] seizures’, with additional congestive issues – ‘he became very weak, could hardly swallow, speak or make his water, and his bowels became were very constipated.’ Two months later the patient had somewhat recovered and was walking around the grounds again. This pattern of experiencing ‘epileptiform fits’, congestion issues and speech difficulty, followed by a period of stable health and mobility, continued throughout 1864 – 1865. Maclaren explains that although he had ‘very destructive tendencies regarding plants and other objects,’ for ‘three years after this he continued to improve’ and became ‘so quiet and manageable […] that he was tried in the lunatic wards of the Leith Poorhouse.’ However, he became violent in this new institution and ‘tried to strangle his attendant,’ so was returned to the Asylum. The patient’s speech improved after a time but his ‘many grand delusions’ remained. At the point of writing these case notes, Maclaren describes the patient as ‘staggering and uncertain in his walk, and very much down on the left side’ and having uneven pupils, ‘the left being larger than the right.’ Maclaren describes the patient as having ‘dirty habits,’ often speaking in obscenities, compulsively stealing items and hoarding rubbish, being ‘full of delusions,’ and occasionally ‘being quarrelsome and violent’ but mostly ‘cheerful’ when left to himself. Maclaren concludes that altough the ‘considerable periods of remission’ might lead someone to conclude that ‘a particular remedy has led to its cure’; for patients diagnosed with general paralysis a permanent recovery was not expected.
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