Bear with me, I am thinking this through. I do not think it an accident that attacks of manic depressive insanity develop as the skeleton [our bones] reach the end of their growth. Even after the vertical skeletal and hormonal explosion of puberty , the growth and development of some body systems continues until the second decade of life [significantly – this includes the brain, the bones [eg the xiphoid process of the chest], and the lungs].
Many things can go wrong with the process of physical growth and development.. Genetics, nutrition, injury, accidents, child abuse, blood loss, infection, hypothermia, hyperthermia, etc…many things can derail this intricate and complicated process.
What does the skeleton have to do with breathing? or mind? A lot, it seems.
VARIATIONS IN DIMENSIONS AND SHAPE OF THORACIC CAGE WITH AGING: AN ANATOMICAL REVIEW
The thoracic cage variations in dimensions and proportions are influenced by age, sex and race. The objective of the present review was to describe the age related changes occurring in thoracic wall and its influence on the pattern of respiration in infants, adult and elderly. We had systematically reviewed, compared and analysed many original and review articles related to aging changes in chest wall images and with the aid of radiological findings recorded in a span of four years. We have concluded that alterations in the geometric dimensions of thoracic wall, change in the pattern and mechanism of respiration are influenced not only due to change in the inclination of the rib, curvature of the vertebral column even the position of the sternum plays a pivotal role. Awareness of basic anatomical changes in thoracic wall and respiratory physiology with aging would help clinicians in better understanding, interpretation and to differentiate between normal aging and chest wall deformation. Joshua, Allwyn & Shetty, Lathika & Pare, Vidyashambhava & Allwyn, S. (2014). VARIATIONS IN DIMENSIONS AND SHAPE OF THORACIC CAGE WITH AGING: AN ANATOMICAL REVIEW. anatomy journal of africa. 3. 346-355.
Maybe both Paula and Jerry and Kraepelin’s patients had alterations affecting the bones or muscles of the chest cavity, resulting in difficulty breathing in an effective way?
Lets look closer at the thoracic cavity, specifically the ribs.
Pediatric Ribs: A Spectrum of Abnormalities
Ronald B. J. Glass, Karen I. Norton, Sandra A. Mitre, Eugene Kang
Published Online:Jan 1 2002https://doi.org/10.1148/radiographics.22.1.g02ja1287
“Rib development begins at 9 weeks; secondary ossification centers appear at 15 years”
The manifestations of many congenital and acquired conditions can be seen in the ribs of children. Normal variants are usually clinically insignificant; they are occasionally palpated at clinical examination or detected incidentally at chest radiography. Signs of abnormality can appear in the ribs as variations in number, size, mineralization, and shape. These changes can be focal or generalized. Abnormalities detected in the ribs may be the initial indication of previously unsuspected systemic disease. The ribs can yield important diagnostic clues in the work-up of patients with congenital bone dysplasias, acquired metabolic diseases, iatrogenic conditions, trauma (especially child abuse), infection, and neoplasms. Routine evaluation of the ribs on every chest radiograph is important so that valuable diagnostic data will not be overlooked. The diagnostic information obtained from evaluation of the ribs can help tailor the radiologic and laboratory studies that may be necessary to complete a patient’s diagnostic work-up.
© RSNA, 2002
In the case of Jerry – remember his mother had Rickets as an infant and all her siblings had cardiac and/or muscular disorders, some of them fatal . Her father died of nonalcoholic liver failure in his 50’s. “Rickets results from abnormal calcium metabolism due to vitamin D deficiency or disturbance of hydroxylation in the kidney or liver”.
Did you know that ‘”all the bone manifestations of chronic renal insufficiency (ie, osteopenia, sclerosis, rickets, and hyperparathyroidism) can be seen in the ribs”.?
Did Jerry suffer from a muscular or bone disorder as well? Did he have metabolic dysfunctions that contributed to his periods of mental confusion? Both kidney and liver dysfunction can lead to madness. Was there a problem with his ribs and/or his thoracic cavity that made breathing invisibly difficult or inefficient? I guess we will never know.