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SELF-MUTILATION.—TRACHEOTOMY. 
REPORTED BY WALTER CHANNING, M. D., 
Late Assistant Physician New York State Asylum for Insane Criminals. 
[From the American Journal of Insanity, for January, 1878.] Case of Helen Miller. 
SELF-MUTILATION.—TRACHEOTOMY. 
EEPOETED BY WALTEE CHANNINO, M. D. 
Late Assistant Physician New York State Asylum for Insane Criminals. 
Mrs. Helen Miller was first admitted to the State 
Asylum for Insane Criminals at Auburn, N; Y., in 
October, 1872, and discharged from there in December 
1874. No medical record was made of her case, but it 
is stated that she passed most of the time in bed, her 
disease being “indisposition.” Various sores made 
their appearance on her body, supposed to be syphilitic 
though she denied ever having had syphilis. She 
was discharged as “ cured ” on the expiration of her 
sentence. During her two years residence at the Asy 
lum she made no attempt to mutilate herself. 
A few months only after her discharge, she was again 
arrested for grand larceny and sentenced to the State 
Prison at Sing Sing for five years. Being anxious to 
be transferred to the Asylum, she began to “ cut up,” 
as she expresses it, and finally was transferred and 
re-admitted in July 1875. 
The following information concerning her previous 
history, we have obtained from a physician in New 
York, who, Mrs. Miller stated, was a friend of hers. In 
a letter kindly written in answer to our enquiries, he 
says: “I first saw Helen Miller seven years ago when 
she visited my office and proposed putting herself under 
my care. Shortly afterward she was arrested, tried and 
convicted of stealing from Dr. . She has been the 
patient of a dozen physicians of my acquaintance. She 
never stole anything from me, but would never sit 2 
alone in my office for a single moment, preferring to 
remain in the street. I spoke to her about it and she 
said she was afraid that something might be stolen and 
I would probably ascribe it to her, knowing that she 
had served a term in Sing Sing. Her last trial was 
for stealing a stuffed canary and a microscope lens. I 
had my doubts of her guilt in this case, as she had 
been at my office just before and after the time of the 
robbery. She swore she had never been tried before, 
but the evidence of her former conviction was shown by 
the District Attorney and this caused her second con- 
viction. I believe her to be a kleptomaniac, if one ever 
existed, and probably her rooms are filled with things 
taken from doctor’s offices. I was treating her for 
dysmenorrhoea, and was also trying to break her of the 
opium habit. I never saw the slightest evidence of 
her having led a fast life. She always dressed plainly 
and was cleanly in her person and conversation. Had 
a habit of boasting of all the physicians who had at- 
tended her and was fond of claiming acquaintanceship 
without much ground. I never thought her perfectly 
sane,” 
Mrs. Miller was first seen by us in August 1875, a 
month after admittance to the Asylum. She was an 
intelligent German Jewess, rather below medium size, 
thirty years of age, hair and complexion light.. She 
was then thin in flesh, pulse weak, hands red and cold, 
lips blueish, tongue pale and tremulous when extended. 
But few of her teeth remained, and her face had a pinched 
look. Her smile was very pleasant, but her expression 
at other times was suspicious and irritable. 
She was in bed suffering from what seemed to be a 
severe attack of hsematemesis. Various remedies were 
applied, but the haemorrhage continued several days 
unabated. Her bodily condition continuing, however, 3 
perfectly good, notwithstanding the blood lost, simula- 
tion was suspected: treatment was suspended and the 
bleeding ceased. The coffee ground appearance of 
ejected matter she had imitated by vomiting food into 
her chamber-vessel and covering it with blood, (pricked 
and sucked from her gums,) and' urine. This attack 
was followed by others of hysterical dysmenorrhoea, 
and dysentery. Through September she was confined 
to her bed most of the time with these attacks. Toward 
the end of the month, she became much depressed, 
feeling that she had a long sentence to serve in prison, 
and that she had no friends and but little to hope for 
in the future. On the 25th of the month, in a paroxysm 
of despair, she broke twenty three panes of glass. With 
a small piece of the glass she cut her left wrist and in- 
serting it into the wound endeavored to reach the 
arteries. Her right hand, which she had used to break 
the window-panes, was slightly cut in several places. 
The wound of the wrist was superficial, an inch in 
length and drawn together with two stitches. She 
seemed to suffer almost no pain when the stitches were 
put in. She was much agitated, trembling from head 
to foot, and crying, but however, said nothing. The 
next day she was very repentant for wliat she had done 
and said that she would never do it again, but in 
about three weeks she again became u discouraged,” to 
use her own word, or depressed, irritable and suspicious, 
and being enraged because she was refused opium, 
cut her arms to avenge her wrongs. The wounds were 
immediately below the elbow, on the inner surface of 
the forearm where the flexors are thickest. One cut 
was six inches in length, the other four. The skin and 
superficial fascia were cut in a straight line and as 
cleanly as if done by a surgeon, but the muscular tissue 
below was hacked in every direction and nearly to the 4 
bone. She was crying and endeavoring to conceal the 
cuts when seen, and would say nothing as to the situa- 
tion or number of pieces of glass she was said to have 
thrust into the wounds. As before she was much agi- 
tated, but sat perfectly still and allowed the wounds to 
be probed. For greater convenience she was etherized, 
several pieces of glass were then found deep in the 
wounds, after removing which the cuts were brought 
together with stitches. The wounds suppurated freely 
and at intervals of a few days, pieces of glass and 
splinters of wood were found and removed. The 
wounds healed rapidly, she gained in flesh and strength, 
worked about the ward, was very tractable and prom- 
ised never to injure herself again. In six weeks the 
wounds were healed and she again became “ dis- 
couraged,” As before she was very irritable and 
abused the other patients, saying they were trying to 
torment and tantalize her. The attendants she also 
felt were “down on her.” Some trifle again aroused 
her anger, and with the same motives as before she cut 
both her arms exactly where she had cut them on the 
previous occasion. She was etherized and two pieces 
of glass and a splinter of wood removed from the right 
arm, after which the wounds were brought together 
with stitches. The right arm healed readily, but the 
wound in the left arm became indolent, the granula- 
tions were pale and flabby, and after a few days an 
erysipelatous inflammation showed itself* followed by 
constitutional symptoms. These culminated in an 
attack of oedema glottidis, of such severity that suffoca- 
tion appeared imminent. The tissues of the neck were 
much infiltrated, the face became livid and the pulse 
was hardly perceptible at the wrist. As a last resort, 
all remedies proving futile, tracheotomy was performed, 
a German, gutta-percha tracheotomy tube being used. 5 
The operation gave immediate relief, but the patient 
being very weak and the wound showing no activity, 
(being in a sloughy, erysipelatous condition,) her 
chances of recovery seemed small. She rallied how- 
ever, her strength increased, the wound began to 
granulate healthily and in eleven days the tube was 
removed. Three wreeks after the operation, the wound 
had entirely healed, and she breathed naturally through 
her throat. The arm had also nearly healed during 
this time. During recovery an unusual degree of 
tetanus was overcome by the use of eighty grains of 
chloral daily. The effects of the prostration occasioned 
by the operation did not entirely disappear for nearly 
two months. During this time she was very patient, 
though tful pf others, anxious to. do claming or other 
light work, very neat in her person, a,constant attend- 
ant at church, always cheerful and hopeful, ,and very 
grateful for what had been nloiae for her.. Much of the 
time, she read aqd% al§o wrote long letters to some of 
her old doctors in New York, tilled with eulogies of all 
that had been done for her. She talked perfectly 
coherently and improved decidedly in general health, 
gaining in flesh and acquiring a good appetite. 
This period of apparent convalescence continued 
about two weeks longer, when she became depressed 
as before, and cut her arms in the same places. From 
this time (December, 1875,) to April, 1876, she cut her 
arms and inserted glass, splinters and other objects into 
the wounds at intervals of six weeks, there generally 
being a wound of some kind in one arm. In April she 
was in a quiet, reasonable condition, and expressed a 
strong desire to be transferred to the Prison at Sing 
Sing. She was told this would be done if she would 
not cut herself for six months. This time had almost 
expired when, as usual, for the merest trifle, she again 6 
mutilated her arms in about the same places, and buried 
pieces of glass in the wounds. The next cutting 
occurred six months after this. The wound in one arm 
was seven inches in length and deep, in the other super- 
ficial, and not more than three inches Ions;. In the 
7 O 
deep wound there were as many as thirty pieces of 
glass, several long splinters, the longest nearly six 
inches in length, and five shoe-nails. Some of the pieces 
of glass were covered with cloth, and could not there- 
fore be felt with a probe. 
In June, 1877, she cut herself for the last time. The 
gash was superficial, only two inches in length, and 
made with a piece of tie. 
ThMd-dy 
The following is a list of articles which have been 
removed from her arms and saved; ninety-four pieces 
of glass, thirty-four splinters, two tacks, four shoe nails, 
one pin, one needle. Several pieces of glass and the pins 
and needles first removed were unfortunately mislaid and 
lost. Including these the whole number of objects re- 
moved amounted to one hundred and fifty. Once she 
cut herself with a piece of tin, and once with a sharp 
splinter, but on all other occasions with glass. The 
glass was generally taken from windows, but once from 
a hand-glass, and once from a bottle. The pieces were 
of various sizes and shapes. Some were pointed, three 
inches in length, and one-half inch wide at the broad 
end; others were square, oblong, etc. The pieces from 
the hand-glass and bottle varied from a quarter of an inch.-to an inch in length and diameter, and were rough 
and jagged. The smallest pieces were the size of small 
cherry stones. The longest splinter was nearly six inches 
long, the shortest less than one-fourth of an inch. The 
shoe nails, tacks, pins and needles were of ordinary size. 
The screen in Mrs. Miller’s room, over the 
was kept locked; she was not allowed to use any 
article made of glass, was constantly watched, and 
if at all excited searched and secluded, and on a 
few occasions her hands were restrained; but, notwith- 
standing these precautions, she would procure the glass. 
On one occasion she wrapped a very small, sharp 
piece in a rag, and held it in her mouth ; on another 
it was concealed in the vagina, and several times 
it was given her by other patients. Some pieces 
of glass she removed, and others she smeared with 
blood and said she had removed. If pieces by any 
accident came out, as they occasionally did, she 
saved them for the medical officers with scrupu- 
lous care. She would talk of her wounds as if 
she herself was the nurse, and the case was an in- 
teresting; one for the doctors. When the inflamma- 
tion was intense she would allow the wounds to be en- 
larged, and probed incessantly for an hour if necessary. 
Often in extracting a small splinter or a piece of glass 
wrapped in a rag, deep in the wound, it was difficult to 
obtain a grasp sufficiently strong to draw it out, and 
the forceps would slip off or a bit of ragged muscle 
would become entangled in them. The pain these 
things caused her was so little, however, that she would 
hold her arms generally perfectly still, and always 
absolutely refuse to take ether. Strange as it seems 
she apparently experienced actual errotic pleasure from 
the probings she was subjected to. She stated that 
she felt no pain when she inflicted the wounds. 8 
. -vk. 
During the past two years patient has had a dis- 
tinct history of syphilis, shown by the characteristic 
eruption and pains in the bones that frequently con- 
fined her to the bed. She has been very hysterical, 
having frequent attacks of choking, globus hystericus, 
and imagined at one time that she had a spool in 
her throat, and could only swallow through the 
hole in the middle. For several days she refused 
food, but no attention was paid to her, and she recov- 
ered, being fed surreptitiously as usual. Her thieving 
propensities have often shown themselves. She would 
pick up any little thing she saw (particularly, when off 
the ward,) whether of any service to her or not, and 
always stoutly asserted, when discovered, that the 
articles were hers. 
Her happiest periods were when the wounds were 
healing, and she was an object of surgical interest. She 
took a special pride in having the attention of the 
physicians directed toward her. At these times she 
worked about the ward, and even insisted on doing 
scrubbing and other heavy work, experiencing no in- 
convenience from the wounds. But even at these 
times, when tranquil and rational in conversation, and 
showing both unusual intelligence and cheerfulness, her 
tongue was very tremulous, her pulse rapid, and her 
whole system in a condition of such tension that the 
merest trifle would throw her off her balance. She 
was evidently struggling with all her might to control 
her actions with the slight amount of will remaining. 
These remissions would last only a short time, to be 
succeeded by doubts, suspicion, jealousy of all about 
her, and final despondency, in which state she was con- 
stantly angry with the other patients, thinking that 
they were maligning and persecuting her, and in utter 
hopelessness and despair as to herself. She would feel 9 
that she must get relief in some way, and the idea of 
death seemed welcome, but she would hesitate and 
doubt, and fear to go any further. Finally, however, 
an innocent remark made to her by another patient 
would be construed into an insult of the blackest kind, 
or a simple refusal to give her extra diet or medicine, 
would be looked upon as a reflection on her honesty, 
and wishing to end her misery she would endeavor to 
kill herself and punish her enemies, and thus avenge 
her wrongs. That she should endeavor to commit sui- 
cide, and to make others suffer, by cutting the muscular 
tissue of her own arms, is only an example of the won- 
derful mystery of insanity. 
When she felt a paroxysm approaching she would 
beg to be secluded. Then yielding to her feelings she 
would pour forth a volley of curses and abuse toward 
the other patients. Day and night she would continue 
this, taking no food, and sleeping none. Sometimes 
she would tear her clothes off. When a paroxysm was 
at its height she would stop and reason, but generally 
end by declaring that the doctors were very good and 
kind to her, but she would not be good, and wanted to 
be let alone. She never, on any occasion, abused the 
and never attempted to injure any one. The 
outbursts lasted from one to several days, and termin- 
ated either by self-mutilation or utter exhaustion. Her 
former intervals of quiet and coherence are becoming 
less and less frequent. For the last year her delusions 
of persecution concerning the other patients have been 
very persistent, influencing her daily conduct, keeping 
her excited and noisy, and overcoming the little power 
left over her actions. Already indications of dementia 
are beginning to show themselves. 
In looking over a large number of asylum reports, 
old flies (not entirely complete,) of the American Jour- 10 
nal of Insanity, the Journal of Mental Science, and 
the English Psychological Journal, and the writings 
of Pinel, Arnold, Haslara, Burrows, Prichard, Connelly, 
Deßoismont, Bush, Poole, Bucknill and Tube, Forbes 
Winslow, Griesinger, Blanford, Maudsley and others, 
we find but few cases of self-mutilation similar to the 
one reported above. Burning, scalding, decapillation, 
emasculation are found to be the favorite methods. 
One patient bit his finger off; another cut a hole in 
his abdomen, drew out the intestines and cut a small 
portion off Haslam reports the case of a female who 
mutilated herself by grinding glass to pieces between 
her teeth, and so it would be possible to go on and 
mention many other methods of torture. 
One of the most interesting recent cases was that re- 
ported by Dr. J. B. Andrews, of the Utica Asylum, in 
the Journal of Insanity for July, 1872, in which he 
removed three hundred needles from the body of an 
insane female patient. The needles had all been in- 
serted before she became a patient in the Asylum. 
The patient was hysterical and in some ways resembled 
Mrs. Miller in disposition. 
In the Journal of Mental Science for July 1875, Dr. 
Bobie of the Dundee Asylum, reported the case of a 
woman who swallowed a circular tea-caddy one and 
one-fourth inches in diameter with suicidal intent. 
Though in some of the reported cases the patients had 
concealed knives and other weapons with which to in- 
flict injuries, most of the attempts were sudden and 
unpremeditated. In the present case the hysterical ele- 
ment was always present. The wounds were made as 
lacerated as possible, the garments were covered 
unnecessarily with blood and a time of day chosen 
when help was sure to be at hand. Everything was 
done to produce as much effect as possible. Though 11 
the muscles were sometimes hacked to the bone, an 
artery sufficiently large to require ligation was never 
injured. 
Griesinger gives cases in which insane persons simu- 
late attempts at suicide. No doubt Mrs, Miller some- 
times attempted simulation, especially on the day after 
the last cutting, when angry that her word had been 
doubted, she made a scratch on her forehead, thereby 
drawing blood which trickled down her face and then 
with a loud crash broke a chamber vessel over her 
head. Her idea was to convey the impression that she 
wished to dash her brains out. THE 
AMERICAN JOURNAL OF INSANITY. 
The American Journal oe Insanity is published quarterly, at the 
State Lunatic Asylum, Utica, N. Y. The first number of each volume 
is issued in July. 
JOHN P. GRAY, M. D., LL. D., Medical Superintendent. 
Editor, 
Associate Editors, 
JUDSON B. ANDREWS, M. D., 
WILLIS E. FORD, M. D., 
ALFRED T. LIVINGSTON, M. D., 
T. F. KENRICK, M. D., 
"v 
)■ Assistant Physicians. 
J 
THEODORE DEECKE, Special Pathologist. 
TERMS OF SUBSCRIPTION, 
Five Dollars per Annum, in Advance. 
Exchanges, Books for Review, and Business Communications 
may be sent to the Editor, directed as “Journal op 
Insanity, State Lunatic Asylum, Utica, N. Y.” 
The Journal is now in its thirty-fourth year. It was established 
by the late Dr. Brigham, the first Superintendent of the New York 
State Lunatic Asylum, and after his death edited by Dr. T. Romeyn 
Beck, author of “Beck’s Medical Jurisprudence;” and since 1854, by 
Dr. John P. Gray, and the Medical Staff of the Asylum. It is the 
oldest journal devoted especially to Insanity, its Treatment, Juris- 
prudence, &c., and is particulaidy valuable to the medical and legal 
professions, and to all interested in the subject of Insanity and Psy- 
chological Science