IV
The second case, which I studied in company with Dr. Albertotti, was that of a boy eleven years of age, with an agreeable physiognomy and very beautiful physical proportions. He had scarcely reached his second year when he fell from a terrace, fracturing his skull and causing a severe concussion of the brain. After two years and a half he began to suffer from epileptic fits, and later, signs of insanity appeared which obliged his relatives to send him to the lunatic asylum in Turin.
When I saw him in February 1877, he had a large opening in the skull, a little above the right eye, and covered with skin; it was as big as the palm of his hand, and in the pit of it one could feel the pulsing of the brain. The terrible fall had for ever arrested his intellectual development. He was gay, smiling, and lively, like a big baby, but he could not speak. It was a saddening circumstance that in the midst of this ruin of his mind one single higher idea had remained, a remnant of his earlier intellectual life, a motto which he constantly repeated: 'I want to go to school.’
Of all the human cases I have studied, the observations made on this boy gave me the greatest trouble. As I had to do with an idiot, the least obstacles became great difficulties. No apparatus could be applied without his becoming restless, snatching it from his head, and breaking everything which fell into his hands. I had to confine myself to a few observations which could be made by surprising him while asleep. But he did not sleep regularly; I have often found him still awake, even when I made my nightly visit at a very late hour. It was more than sleeplessness, it was a nocturnal excitement, which presaged the storm of an epileptic attack. I have seen him the victim of the most terrible fits, while, on the nights following, his sleep was so deep as to leave one in doubt whether it was a natural phenomenon.
In the period of exhaustion and stupor, the blood-vessels of the brain seemed to relax, and at every contraction of the heart the pulsations became stronger. A faint noise which did not wake the patient was enough to produce a change in the brain and a more abundant gush of blood. It sufficed to touch him, or to approach him with the lamp: immediately, the volume of the brain increased, and a great elevation appeared in the curve of the pulse.
Whenever we called him by name, it seemed as though an impetuous wave of blood rushed into the brain, causing the convolutions to swell. As this was invariably the case, there could be no doubt that the brain was still sensitive to the impressions of the external world, even during a heavy sleep. When the patient was shaken till he woke, I could see the circulation changing little by little, as though the material conditions of consciousness were being restored.
He often spoke a few indistinct words, opened his eyes, or moved his hands, and then slowly fell back into the previous stupor, while we saw the pulse grow weaker, the brain decrease in volume, the rhythm and force of the breathing change.
It was one of the most interesting sights to observe in the stillness of night, by the light of a little lamp, what was going on in his brain, when there was no external cause to disturb this mysterious life of sleep. The brain-pulse remained for ten or twenty minutes quite regular and very weak, and then began suddenly, without any apparent cause, to swell and beat more vigorously. Then the agitation subsided and there was a second period of quiet; then came stronger blood-waves which flooded the convolutions, raising the height of the pulsations, which were automatically marked by the apparatus applied to the brain. We scarcely dared breathe. The one who was observing the instruments communicated with the other, who was watching over the patient, by pressing his hand. Looks full of interrogation and wonder would meet, and exclamations had to be forcibly repressed.
Did dreams, perhaps, come to cheer the repose of the unhappy boy? Did the face of his mother and the recollections of his early childhood grow bright in his memory, lighting up the darkness of his intelligence and making his brain pulsate with excitement? Or was it perhaps only a morbid phenomenon, like the jerky movements of a broken wheel, or the index of a machine out of order, swinging idly to and fro? Or was it an unconscious agitation of matter, like the ebb and flow of an unknown and solitary sea?
What a contrast between the pleasing emotion which this work roused in us and the sadness of the surroundings! Even that quarter of the city in which the asylum is situated has something characteristic about it, which De Amicis compared to the silence and mystery of an Oriental town. Sometimes, when late on winter evenings I made my way along the deserted streets, I could not even hear my own footsteps as they fell noiselessly on the snow. In the long dormitories of the hospital the dim light of the lamp could not dissipate the gloom in the remote corners of the room. However much care I took to glide softly through the room, in order not to disturb the sleep of those poor wretches, many were yet sitting upright in their beds, with staring eyes, seeming to await my coming and ready to shriek at me as I passed. Others, uncovered and naked, in spite of the winter cold, gazed at me with empty, fixed eyes; while others again, bound, to prevent their injuring either themselves or others in their mad fury, followed my steps with wild glances.
What a cheerless sight for a physician, and for me, who came amongst them to study the brain. At the end of these rooms was a little chamber in which I watched my subject. Often I had to interrupt my investigations, and, lamp in hand, go to the most noisy, begging, imploring them to be silent for one minute. It was a waste of breath. Caresses, presents, threats—all were alike of no avail. And when, late at night, discouraged at the failure of my experiments, I left that abode of pain, they were still awake, staring at me with the fixed, impenetrable gaze of a sphynx or the malignant smile of a demon; and when I stepped out into the desolate street again it seemed to me as though I had just escaped from a vision of spectres.