Leland E. Hinsie

The treatment of dementia praecox by continuous oxygen administration in chambers and oxygen and carbon dioxide inhalations

ConclusionFrom the observations made in this study, it does not appear that oxygen and carbon dioxide treatment of catatonic dementia præcox patients is to be advocated as a general therapeutic procedure. We are unable to draw definite conclusions regarding the role played by this treatment in the recovery of two patients.From the observations made in this study, it does not appear that oxygen and carbon dioxide treatment of catatonic dementia præcox patients is to be advocated as a general therapeutic procedure. We are unable to draw definite conclusions regarding the role played by this treatment in the recovery of two patients.

Clinical manifestations of the catatonic form of dementia præcox

In investigations on the catatonic form of dementia prmcox it seems desirable to have a uniform clinical syndrome in mind, so that all may be discussing conditions that are similar and hence comparable. For research purposes one should have as clear a conception of the premises upon which one builds fur ther observations as is possible. I t is presumed that the part icipants in the symposium have selected patients whose clinical condition comes reasonably clearly in to the clinical description presented in the following outline. I t is not intended herein to cover all the questions that have been raised about catatonia, for such an approach is obviously the purpose of the other contributors to the symposium. I t is hoped to include the known and commonly accepted clinical facts that go to make up the clinical syndrome under consideration, in order that all of us may have a common s tar t ing p o i n t . Therefore, the signs and symptoms of the well-defined case are first described. The catatonic stupor is characterized by the symptoms of negativism and automatism. Tile patients are taciturn, sparing of words ; they may stop in the middle of a word or sentencr and may gradual ly cease ta lk ing entirely (tourism). Sometimes they lisp softly some unintelligible words or phrases; they may carry on whispered conversations with themselves; they may give vent to sudden bursts of laughter. Often they start to speak, but quickly stop. Generally the same principles are noted in their other activities. They may or may not write spontaneously or under inducement; they may write disconnected words or phrases; they may stop wri t ing at any point; the wri t ing nmy appear as a senseless scribble; they may write the same word or phrase or symbol over and over again. They are generally uninfluenced by environmental stimuli; they may or nlay not withdraw from what are commonly considered to be painful stimuli.

Radiothermic treatment of general paralysis

This communication is in the nature of a preliminary report on the treatment of general paralysis by a heat producing electrical device called the radiotherm. Through the courtesy of the General Electric Company the apparatus was put at our disposal and has been in use by us since June, 1930. Since that time, that is, for approximately eight months now, we have been gathering data as regards the influence of the apparatus on patients with general paralysis. Evidently in this short space of time little of a conclusive character may be said, especially with regard to the management of general paralysis. It appears, however, from the preliminary formulations that the work is well worth continuing.

The Treatment of Schizophrenia: A Survey of the Literature

A. Prophylaxis B. Psychotherapy C. Biological preparations 1. Organotherapy (a) Testicular preparations, (b) ovarian preparations, (c) thyroid preparations, (d) thymus preparations. D. Pharmacotherapy 1. Prolonged narcosis (a) Sodium nucleate 2. Artificial leucocytosis (a) Sodium nucleate 3. Sodium chloride infusion 4. Cocain hydrochloride 5. Injections of metallic salts 6. Strychnotonon 7. Magnesium sulphate intraspinally 8. Luminal 9. Arsenic E. Fever therapy 1. Tuberculin 2. Typhoid vaccine 3. Malaria F. Aseptic meningitis 1. Horse serum intraspinally G. Serotherapy 1. Heterogenous serum 2. Autogenous serum

Studies in parotid secretion of patients before, during and after insulin hypoglycemic therapy

Summary1.The general secretory level, after a series of insulin hypoglycemic treatments, dropped considerably below the secretory level during the trial period, with the exception of the one case previously described. In the latter case a rise of secretory rate associated with regression in psychiatric condition was found.2.The secretory level during the hypoglycemic state showed a sharp rise with the onset of stupor and coma. However, sleep, which often occurs soon after insulin administration, has the opposite effect, namely, a drop in secretory level.3.As the secretory rate increased, a drop in the potassium and chloride concentrations occurred, this drop tending to reach a plateau beyond which further increases in rate resulting from the hypoglycemic state produce little effect.4.The increase in rate occurring during insulin hypoglycemia was accompanied by a pronounced increase in cloudiness of the cretion together with a rise in its protein content. These were first manifested at the onset of stupor and became more pronounced during coma.1. The general secretory level, after a series of insulin hypoglycemic treatments, dropped considerably below the secretory level during the trial period, with the exception of the one case previously described. In the latter case a rise of secretory rate associated with regression in psychiatric condition was found. 2. The secretory level during the hypoglycemic state showed a sharp rise with the onset of stupor and coma. However, sleep, which often occurs soon after insulin administration, has the opposite effect, namely, a drop in secretory level. 3. As the secretory rate increased, a drop in the potassium and chloride concentrations occurred, this drop tending to reach a plateau beyond which further increases in rate resulting from the hypoglycemic state produce little effect. 4. The increase in rate occurring during insulin hypoglycemia was accompanied by a pronounced increase in cloudiness of the cretion together with a rise in its protein content. These were first manifested at the onset of stupor and became more pronounced during coma. The general secretory level, after a series of insulin hypoglycemic treatments, dropped considerably below the secretory level during the trial period, with the exception of the one case previously described. In the latter case a rise of secretory rate associated with regression in psychiatric condition was found. The secretory level during the hypoglycemic state showed a sharp rise with the onset of stupor and coma. However, sleep, which often occurs soon after insulin administration, has the opposite effect, namely, a drop in secretory level. As the secretory rate increased, a drop in the potassium and chloride concentrations occurred, this drop tending to reach a plateau beyond which further increases in rate resulting from the hypoglycemic state produce little effect. The increase in rate occurring during insulin hypoglycemia was accompanied by a pronounced increase in cloudiness of the cretion together with a rise in its protein content. These were first manifested at the onset of stupor and became more pronounced during coma.

The catatonic syndrome in dementia praecox

In an effort to assemble facts gathered from the observations on patients in the various New York State hospitals and to foster a more intense interest in the various problems of the catatonic syndrome in dementia pra~cox, Dr. C. O. Cheney, director of the New York State Psychiatric Institute and Hospital, planned and directed a symposium on that topic. The present communication comprises a summary of the observations presented by the several participants in the symposium. The symposium was opened by a description of the clinical picture of catatonia, following the observations of Kahlbaum and of Kr~epelin in particular, but including also such subsequent observations as appear to have gained more or less general agreement among those who have made special studies on catatonia. It was considered advisable to have a uniform clbTical picture in mind, so that those who contributed to the symposium would be discussing the same syndrome. The clinical cases included in the symposium therefore met the following requirements: (1) Diagnostic uniformity, based on the description formulated by Kr~epelin; (2) all cases were over the age of puberty and under the perio.d of the climacterium; (3) the catatonic syndrome did not appear by direction or by inference to be associated with any recognizable organic disease. For example, no case was included, no matter how closely it resembled the catatonic type of dementia prmcox, if there was any question of associated infectious disorders (e. g., epidemic encephalitis, syphilis), trauma, brain tumor, or any other form of known organic disorders. Pre-psychotic personality characteristics. Careful observations were made with respect to the personality reactions of those in.dividuals who later developed the catatonic form of dementia pra~cox. Hoch and others had expressed the opinion several years ago that a certain percentage of patients with dementia pr~ecox did not, before the onset of the mental disorder, possess the so-termed shut-in, or schizoid or introverted type of personality. In the present sym-

Serology in general paresis

The data presented herein cover all available serological information on patients treated at the New York State Psychiatric Institute and Hospital from 1923 to 1935 inclusive. The total time included in the survey is somewhat over twelve years. During this period there were over 300 patients under treatment. Our reports sometimes refer to different numbers of patients, the differences being due to the number of patients accessible at any given time to the different laboratory tests employed. The report refers only to patients with adult acquired general paresis and does not include any of the juvenile forms. Moreover the patients were carefully selected on the basis of suitability for the treatment planned for them. Patients who were to have the heat form of treatment had to meet the requirements that are commonly laid down for heat therapy. Likewise, patients entering the hospital for the purpose of getting chemotherapy were carefully selected. There was no selection made on the basis of duration of psychosis before treatment was instituted. Furthermore, there was no selection with regard to the clinical condition of the patient unless there were clinical signs and symptoms that would contraindicate the employment of a given method of therapy. I t is perhaps unnecessary to state that no selection was made on the grounds of severity of the serological reports. Each patient reported upon exhibited serological data (in addition to clinical findings) that placed the patient in the general paretic diagnostic grouping. From the standpoint of therapeutic response there is no unanimity of opinion among investigators that sex plays a decisive r6]e. I t will be noted that among our patients the ratio of males to females was approximately two to one. Chart I and Tables 1 to 5 summarize serological data with reference to all the patients available for study, irrespective of the

Tryparsamide treatment of general paralysis

The present communication constitutes a second report on the results attained in the treatment of general paralysis by a combination of tryparsamide and mercury, five years having now elapsed since the treatment of this series of cases was started. Of the 69 patients referred to in the first report the present status is known in 67 patients. Of the 67 patients 28 per cent gained and have maintained a state of remission; 26 per cent are regarded as improved; 12 per cent as unimproved; 34 per cent of the patients are dead.SummaryThe present communication constitutes a second report on the results attained in the treatment of general paralysis by a combination of tryparsamide and mercury, five years having now elapsed since the treatment of this series of cases was started. Of the 69 patients referred to in the first report the present status is known in 67 patients.Of the 67 patients 28 per cent gained and have maintained a state of remission; 26 per cent are regarded as improved; 12 per cent as unimproved; 34 per cent of the patients are dead.

Malarial treatment of female patients with general paralysis

Malarial therapy seems not to be as efficacious in female as in male patients with general paralysis. States of complete remission were obtained in 12 per cent of 66 female patients. In our experience with female patients malarial therapy does not exert as favorable influences as tryparsamide does. Women who have experienced pregnancy seem to obtain better results under malarial therapy than those who have never been pregnant. Moreover, pregnancy antedating the inception of syphilis apparently has some beneficial significance. These two suggestions are cautiously advanced. The Wassermann reactions of the blood and spinal fluid are favorably influenced less frequently in women than in men, under malarial therapy. Previous pregnancies seem not to determine the degrees of modifiability of the Wassermann findings under malarial therapy.SummaryMalarial therapy seems not to be as efficacious in female as in male patients with general paralysis. States of complete remission were obtained in 12 per cent of 66 female patients.In our experience with female patients malarial therapy does not exert as favorable influences as tryparsamide does.Women who have experienced pregnancy seem to obtain better results under malarial therapy than those who have never been pregnant. Moreover, pregnancy antedating the inception of syphilis apparently has some beneficial significance. These two suggestions are cautiously advanced.The Wassermann reactions of the blood and spinal fluid are favorably influenced less frequently in women than in men, under malarial therapy.Previous pregnancies seem not to determine the degrees of modifiability of the Wassermann findings under malarial therapy.

Present methods of treatment of general paresis and cerebral syphilis in State hospitals

I t iS almost a quarter of a century ago that Wagner-Jauregg introduced the malarial form of treatment for patients with general paresis. During the period which has elapsed since 1917, the prognosis of the disease has changed radically. The medical world was quick to realize that the new form of treatment was epoehah The course of a hopeless and pathetie disease was appreciably altered in the direction of favorable outcome. Many of the patients are now restored to full health, others have mild residual impairments, while a comparatively smaller number gain no substantial improvement. Even in the last group, however, the disease process is arrested. The malarial :form of treatment is still the first choice. Many investigators have tried to find out what happens in the treatment that brings about the favorable changes. Greatest emphasis is placed upon the rhle of fever. It is probable that the fever itself is the agent responsible for the death of the spirochetes ; it is also probable that one or more of the many biochemical changes attendant upon high fever may play an influential part. WagnerJauregg still believes that something associated with the malarial organism may be a deciding factor. Research in this field has been widespread. The most valuable opinions center upon the problems of fever. A number of febrifacient agents have been tried, and to each is attributed favorable clinical results. While malarial therapy is still most commonly employed, it cannot be said that certain other forms of febrifacient measures are not equally as efficacious. The production of heat by means of high frequency waves, such as occurs with the use of the inductotherm, is regarded with much favor; radiant heat energy has likewise gained the appreciation of careful investigators. Not long after the introduction of febrifacient measures, another new type of treatment for parenchymatous neurosyphilis was recommended. This was chemotherapy in the form of arsenic in the pentavalent series. Tryparsamide has achieved widespread distinction. The modern treatment of parenchymatous neurosyphilis includes the application of febrile and chemical agents.