CASES, WITH THE APPEARANCES ON DISSECTION.
CASE I.
J. H. a man twenty-eight years of age, was admitted a patient in May,
1795. He had been disordered for about two months before he came into the
hospital. No particular cause was stated to have brought on the complaint.
It was most probably an hereditary affection, as his father had been
several times insane and confined in our hospital. During the time he was
in the house, he was in a very low and melancholic state; shewed an
aversion to food, and said he was resolved to die. His obstinacy in
refusing all nourishment was very great, and it was with much difficulty
forced upon him. He continued in this state, but became daily weaker and
more emaciated until August 1st, when he died. Upon opening the head, the
pericranium was found loosely adherent to the scull. The bones of the
cranium were thick. The pia mater was loaded with blood, and the medullary
substance, when cut into, was full of bloody points. The pineal gland
contained a large quantity of gritty matter.[8] The consistence of the
brain was natural; he was opened twenty-four hours after death.
CASE II.
J. W. was a man of sixty-two years of age, who had been many years in the
house as an incurable patient, but with the other parts of whose history I
am totally unacquainted. He appeared to be a quiet and inoffensive person,
who found amusement in his own thoughts, and seldom joined in any
conversation with the other patients: for some months he had been troubled
with a cough, attended with copious expectoration, which very much reduced
him; dropsical symptoms followed these complaints. He became every day
weaker, and on July 10th, 1795, died. He was opened eighteen hours after
death. The pericranium adhered loosely to the scull; the bones of the
cranium were unusually thin. There were slight opacities in many parts of
the tunica arachnoidea; in the ventricles about four ounces of water were
contained—some large hydatids were discovered on the plexus choroides of
the right side. The consistence of the brain was natural.
CASE III.
G. H. a man twenty-six years of age, was received into the hospital, July
18th, 1795. It was stated that he had been disordered six weeks previously
to his admission, and that he never had any former attack. He had been a
drummer with a recruiting party, and had been for some time in the habit
of constant intoxication, which was assigned as the cause of his insanity.
He continued in a violent and raving state about a month, during the whole
of which time he got little or no sleep. He had no knowledge of his
situation, but supposed himself with the regiment, and was frequently
under great anxiety and alarm for the loss of his drum, which he imagined
had been stolen and sold. The medicines which were given to him he
conceived were spirituous liquors, and swallowed them with avidity. At the
expiration of a month he was very weak and reduced; his legs became
œdematous—his pupils were much diminished. He now believed himself a
child, called upon the people about him as his playfellows, and appeared
to recal the scenes of early life with facility and correctness. Within a
few days of his decease he only muttered to himself. August 26th, he died.
He was opened six hours after death. The pericranium was loosely adherent.
The tunica arachnoidea had generally lost its transparency, and was
considerably thickened. The veins of the pia mater were loaded with blood,
and in many places seemed to contain air. There was a considerable
quantity of water between the membranes, and, as nearly as could be
ascertained, about four ounces in the ventricles, in the cavity of which,
the veins appeared remarkably turgid. The consistence of the brain was
more than usually firm.
CASE IV.
E. M. a woman, aged sixty, was admitted into the house, August 8th, 1795;
she had been disordered five months: the cause assigned was extreme grief,
in consequence of the loss of her only daughter. She was very miserable
and restless; conceived she had been accused of some horrid crime, for
which she apprehended she should be burned alive. When any persons entered
her room she supposed them officers of justice, who were about to drag her
to some cruel punishment. She was frequently violent, and would strike
and bite those who came near her. Upon the idea that she should shortly be
put to death, she refused all sustenance; and it became necessary to force
her to take it. In this state she continued, growing daily weaker and more
emaciated, until October 3d, when she died.
Upon opening the head, there was a copious determination of blood to the
whole contents of the cranium. The pia mater was considerably inflamed;
there was not any water either in the ventricles or between the membranes.
The brain was particularly soft. She was opened thirty hours after death.
CASE V.
W. P. a young man, aged twenty-five, was admitted into the hospital,
September 26th, 1795. He had been disordered five months, and had
experienced a similar attack six years before. The disease was brought on
by excessive drinking. He was in a very furious state, in consequence of
which he was constantly confined. He very seldom slept—during the greater
part of the night he was singing, or swearing, or holding conversations
with persons he imagined to be about him: sometimes he would rattle the
chain with which he was confined, for several hours together, and tore
every thing to pieces within his reach. In the beginning of November, the
violence of his disorder subsided for two or three days, but afterwards
returned; and on the 10th he died compleatly exhausted by his
exertions.—Upon opening the head the pericranium was found firmly
attached; the pia mater was inflamed, though not to any very considerable
degree; the tunica arachnoidea in some places was slightly shot with
blood; the membranes of the brain, and its convolutions, when these were
removed, were of a brown, or brownish straw colour. There was no water in
any of the cavities of the brain, nor any particular congestion of blood
in its substance—the consistence of which was natural. He was opened
twenty hours after death.
CASE VI.
B. H. was an incurable patient, who had been confined in the house from
the year 1788, and for some years before that time in a private madhouse.
He was about sixty years of age—had formerly been in the habit of
intoxicating himself. His character was strongly marked by pride,
irascibility, and malevolence. During the four last years of his life, he
was confined for attempting to commit some violence on one of the
officers of the house. After this, he was seldom heard to speak; yet he
manifested his evil disposition by every species of dumb insult. Latterly
he grew suspicious, and would sometimes tell the keeper that his victuals
were poisoned. About the beginning of December he was taken ill with a
cough, attended with copious expectoration. Being then asked respecting
his complaints, he said, he had a violent pain across the stomach, which
arose from his navel string at his birth having been tied too short. He
never spoke afterwards, though frequently importuned to describe his
complaints. He died December 24, 1795.
Upon dividing the integuments of the head, the pericranium was found
scarcely to adhere to the scull. On the right parietal bone there was a
large blotch, as if the bone had been inflamed: there were others on
different parts of the bone, but considerably smaller. The glandulæ
Pacchioni were uncommonly large: the tunica arachnoidea in many places
wanted the natural transparency of that membrane: there was a large
determination of blood to the substance of the brain: the ventricles
contained about three ounces of water: the consistence of the brain was
natural. He was opened two days after death.
CASE VII.
A. M. a woman, aged twenty-seven, was admitted into the hospital, August
15, 1795; she had then been eleven weeks disordered. Religious enthusiasm,
and a too frequent attendance on conventicles, were stated to have
occasioned her complaint. She was in a very miserable and unhappy
condition, and terrified by the most alarming apprehensions for the
salvation of her soul. Towards the latter end of September, she appeared
in a convalescent state, and continued tolerably well until the middle of
November, when she began to relapse.
The return of her disorder commenced with loss of sleep. She alternately
sang, and cried the greatest part of the night. She conceived her inside
full of the most loathsome vermin, and often felt the sensation as if they
were crawling into her throat. She was suddenly seized with a strong and
unconquerable determination to destroy herself; became very sensible of
her malady, and said, that God had inflicted this punishment on her, from
having (at some former part of her life) said the Lord’s Prayer backwards.
She continued some time in a restless and forlorn state; at one moment
expecting the devil to seize upon her and tear her to pieces; in the next,
wondering that she was not instigated to commit violence on the persons
about her. On January 12, 1796, she died suddenly. She was opened twelve
hours after death. The thoracic and abdominal viscera were perfectly
healthy.
Upon examining the contents of the cranium, the pia mater was considerably
inflamed, and an extravasated blotch, about the size of a shilling, was
seen upon that membrane, near the middle of the right lobe of the
cerebrum. There was no water between the membranes, nor in the ventricles,
but a general determination of blood to the contents of the cranium. The
medullary substance, when cut into, was full of bloody points. The
consistence of the brain was natural.
CASE VIII.
M. W. a very tall and thin woman, forty-four years of age, was admitted
into the hospital, September 19, 1795. Her disorder was of six months
standing, and eight years before she had also had an attack of this
disease. The cause assigned to have brought it on, the last time, was the
loss of some property, the disease having shortly followed that
circumstance.—The constant tenor of her discourse was, that she should
live but a short time. She seemed anxiously to wish for her dissolution,
but had no thoughts of accomplishing her own destruction. In the course of
a few weeks she began to imagine, that some malevolent person had given
her mercury with an intention to destroy her. She was constantly shewing
her teeth, which had decayed naturally, as if this effect had been
produced by that medicine: at last she insisted, that mercurial
preparations were mingled in the food and medicines which were
administered to her. Her appetite was voracious, notwithstanding this
belief. She had a continual thirst, and drank very large quantities of
cold water.
On January 14, 1796, she had an apoplectic fit, well marked by stertor,
loss of voluntary motion, and insensibility to stimuli. On the following
day she died. She was opened two days after death. There was a remarkable
accumulation of blood in the veins of the dura and pia mater; the
substance of the brain was loaded with blood. When the medullary substance
was cut into, blood oozed from it; and, upon squeezing it, a greater
quantity could be forced out. On the pia mater covering the right lobe of
the cerebrum, were some slight extravasations of blood. The ventricles
contained no water; on the plexus choroides were some vesicles of the size
of coriander-seeds, filled with a yellow fluid. The pericranium adhered
firmly to the scull. The consistence of the brain was firmer than usual.
CASE IX.
E. D. a woman, aged thirty-six, was admitted into the hospital, February
20, 1795; she had then been disordered four months. Her insanity came on a
few days after having been delivered. She had also laboured under a
similar attack seven years before, which, like the present, supervened
upon the birth of a child. Under the impression that she ought to be
hanged, she destroyed her infant, with the view of meeting with that
punishment. When she came into the house, she was very sensible of the
crime she had committed, and felt the most poignant affliction for the
act. For about a month she continued to amend: after which time she became
more thoughtful, and frequently spoke about the child: great anxiety and
restlessness succeeded. In this state she remained until April 23, when
her tongue became thickly furred, the skin parched, her eyes inflamed and
glassy, and her pulse quick. She now talked incoherently; and, towards the
evening, merely muttered to herself. She died on the following day
comatose.
She was opened about twenty-four hours after death. The scull was thick,
the pericranium scarcely adhered to the bone, the dura mater was also but
slightly attached to its internal surface. There was a large quantity of
water between the dura mater and tunica arachnoidea; this latter membrane
was much thickened, and was of a milky white appearance. Between the
tunica arachnoidea and pia mater, there was a considerable accumulation of
water. The veins of the pia mater were particularly turgid. About three
ounces of water were contained in the lateral ventricles: the veins of the
membrane lining these cavities were remarkably large and turgid with
blood. When the medullary substance of the cerebrum and cerebellum was cut
into, there appeared a great number of bloody points. The brain was of its
natural consistence.
CASE X.
C. M. a man, forty years of age, was admitted into the hospital, December
26, 1795. It was stated, that he had been disordered two months previously
to his having been received as a patient. His friends were unacquainted
with any cause, which was likely to have induced the disease. During the
time he was in the house he seemed sulky, or rather stupid. He never asked
any questions, and if spoken to, either replied shortly, or turned away
without giving any answer. He scarcely appeared to take notice of any
thing which was going forward, and if told to do any little office
generally forgot what he was going about, before he had advanced half a
dozen steps. He remained in this state until the beginning of May, 1796,
when his legs became œdematous, and his abdomen swollen. He grew very
feeble and helpless, and died rather suddenly, May 19th. He was opened
about forty-eight hours after death. The pericranium and dura mater
adhered firmly to the scull; in many places there was an opake whiteness
of the tunica arachnoidea. About four ounces of water were found in the
ventricles. The plexus choroides were uncommonly pale. The medullary
substance afforded hardly any bloody points when cut into. The consistence
of the brain I cannot describe better than by saying, it was doughy.
CASE XI.
S. M. a man, thirty-six years of age, was admitted as an incurable patient
in the year 1790. Of the former history of his complaint I have no
information. As his habits, which frequently came under my observation,
were of a singular nature, it may not here be improper to relate
them.—Having at some period of his confinement been mischievously
disposed, and, in consequence, put under coercion, he never afterwards
found himself comfortable when at liberty. When he rose in the morning he
went immediately to the room where he was usually confined, and placed
himself in a particular corner, until the keeper came to secure him. If
he found any other patient had pre-occupied his situation, he became very
outrageous, and generally forced them to leave it. When he had been
confined, for which he appeared anxious, as he bore any delay with little
temper, he employed himself throughout the remainder of the day, by
tramping or shuffling his feet. He was constantly muttering to himself, of
which scarcely one word in a sentence was intelligible. When an audible
expression escaped him it was commonly an imprecation. If a stranger
visited him, he always asked for tobacco, but seldom repeated his
solicitation. He devoured his food with avidity, and always muttered as he
ate.
In the month of July, 1796, he was seized with a diarrhœa, which
afterwards terminated in dysentery. This continued, notwithstanding the
employment of every medicine usually given in such a case, until his
death, which took place on September 23, of the same year. He was opened
twelve hours after death. The scull was unusually thin; the glandulæ
Pacchioni were large and numerous: there was a very general determination
of blood to the brain: the medullary substance, when cut, shewed an
abundance of bloody points: the lateral ventricles contained about four
ounces of water: the consistence of the brain was natural.
CASE XII.
E. R. was a woman, to all appearance about eighty years of age, but of
whose history, before she came into the hospital, it has not been in my
power to acquire any satisfactory intelligence. She was an incurable
patient, and had been admitted on that establishment in February, 1782.
During the time I had an opportunity of observing her, she continued in
the same state: she appeared feeble and childish. During the course of the
day, she sat in a particular part of the common-room, from which she never
stirred. Her appetite was tolerably good, but it was requisite to feed
her. Except she was particularly urged to speak she never talked. As the
summer declined she grew weaker, and died October 19, 1796, apparently
worn out. She was opened two days after death. The scull was particularly
thin; the pericranium adhered firmly to the bone, and the scull-cap was
with difficulty separated from the dura mater. There was a very large
quantity of water between the membranes of the brain: the glandulæ
Pacchioni were uncommonly large: the tunica arachnoidea was in many
places blotched and streaked with opacities: when the medullary substance
of the brain was cut into, it was every where bloody; and blood could be
pressed from it, as from a sponge. There were some large hydatids on the
plexus choroides: in the ventricles about a tea spoonful of water was
observed: the consistence of the brain was particularly firm, but it could
not be called elastic. There were no symptoms of general dropsy.
CASE XIII.
J. D. a man, thirty-five years of age, was admitted into the hospital in
October, 1796. He was a person of good education, and had been regularly
brought up to medicine, which he had practised in this town for several
years. It was stated by his friends, that, about two years before, he had
suffered a similar attack, which continued six months: but it appears
from the observations of some medical persons, that he never perfectly
recovered from it, although he returned to the exercise of his profession.
A laborious attention to business, and great apprehensions of the want of
success, were assigned as causes of his malady. In the beginning of the
year 1796 the disease recurred, and became so violent that it was
necessary to confine him.
At the time he was received into Bethlem hospital, he was in an unquiet
state, got little or no sleep, and was constantly speaking loudly: in
general he was worse towards evening. He appeared little sensible of
external objects: his exclamations were of the most incoherent nature.
During the time he was a patient he was thrice cupped on the scalp. After
each operation, he became rational to a certain degree; but these
intervals were of a short continuance, as he relapsed in the course of a
few hours. The scalp, particularly at the posterior part of the head, was
so loose that a considerable quantity of it could be gathered up by the
hand.[9] The violence of his exertions at last exhausted him, and on
December 11, he died. He was opened about twenty-four hours after death.
There was a large quantity of water between the dura mater and tunica
arachnoidea, and also between this latter membrane and the pia mater. The
tunica arachnoidea was thickened and opake; the vessels of the pia mater
were loaded with blood: when the medullary substance was cut into, it was
very abundant in bloody points: about three ounces of water were contained
in the lateral ventricles: the plexus choroides were remarkably turgid
with blood: a quantity of water was found in the theca vertebralis: the
consistence of the brain was natural.
CASE XIV.
J. C. a man, aged sixty-one, was admitted into the hospital September 17,
1796. It was stated, that he had been disordered ten months. He had for
thirty years kept a public house, and had for some time been in the habit
of getting intoxicated. His memory was considerably impaired:
circumstances were so feebly impressed on his mind, that he was unable to
give any account of the preceding day. He appeared perfectly reconciled to
his situation, and conducted himself with order and propriety. As he
seldom spoke but when interrogated, it was not possible to collect his
opinions. In this quiet state he continued about two months, when he
became more thoughtful and abstracted, walked about with a quick step, and
frequently started, as if suddenly interrupted. He was next seized with
trembling, appeared anxious to be released from his confinement: conceived
at one time that his house was filled with company; at another that
different people had gone off without paying him, and that he should be
arrested for sums of money which he owed. Under this constant alarm and
disquietude he continued about a week, when he became sullen, and refused
his food. When importuned to take nourishment, he said it was ridiculous
to offer it to him, as he had no mouth to eat it: though forced to take
it, he continued in the same opinion; and when food was put into his
mouth, insisted that a wound had been made in his throat, in order to
force it into his stomach. The next day he complained of violent pain in
his head, and in a few minutes afterwards died. He was opened twelve hours
after death. There was a large quantity of water between the tunica
arachnoidea and pia mater; the latter membrane was much suffused with
blood, and many of its vessels were considerably enlarged: the lateral
ventricles contained at least six ounces of water: the brain was very
firm.
CASE XV.
J. A. a man, forty-two years of age, was first admitted into the house on
June 27, 1795. His disease came on suddenly whilst he was working in a
garden, on a very hot day, without any covering to his head. He had some
years before travelled with a gentleman over a great part of Europe: his
ideas ran particularly on what he had seen abroad; sometimes he conceived
himself the king of Denmark, at other times the king of France. Although
naturally dull and wanting common education, he professed himself a master
of all the dead and living languages; but his most intimate acquaintance
was with the old French: and he was persuaded he had some faint
recollection of coming over to this country with William the Conqueror.
His temper was very irritable, and he was disposed to quarrel with every
body about him. After he had continued ten months in the hospital, he
became tranquil, relinquished his absurdities, and was discharged well in
June 1796. He went into the country with his wife to settle some domestic
affairs, and in about six weeks afterwards relapsed. He was re-admitted
into the hospital August 13th.
He now evidently had a paralytic affection; his speech was inarticulate,
and his mouth drawn aside. He shortly became stupid, his legs swelled, and
afterwards ulcerated: at length his appetite failed him; he became
emaciated, and died December 27th, of the same year. The head was opened
twenty hours after death. There was a greater quantity of water between
the different membranes of the brain than has ever occurred to me. The
tunica arachnoidea was generally opake and very much thickened: the pia
mater was loaded with blood, and the veins of that membrane were
particularly enlarged. On the forepart of the right hemisphere of the
brain, when stripped of its membranes, there was a blotch, of a brown
colour, several shades darker than the rest of the cortical substance: the
ventricles were much enlarged, and contained, by estimation, at least six
ounces of water. The veins in these cavities were particularly turgid.
The consistence of the brain was firmer than usual.
CASE XVI.
J. H. a man, aged forty-two, was admitted into the house on April 12,
1794. He had then been disordered two months: it was a family disease on
his father’s side. Having manifested a mischievous disposition to some of
his relations, he was continued in the hospital upon the incurable
establishment. His temper was naturally violent, and he was easily
provoked. As long as he was kept to any employment he conducted himself
tolerably well; but when unoccupied, would walk about in a hurried and
distracted manner, throwing out the most horrid threats and imprecations.
He would often appear to be holding conversations: but these conferences
always terminated in a violent quarrel between the imaginary being and
himself. He constantly supposed unfriendly people were placed in different
parts of the house to torment and annoy him. However violently he might be
contesting any subject with these supposed enemies, if directed by the
keepers to render them any assistance, he immediately gave up the dispute
and went with alacrity. As he slept but little, the greatest part of the
night was spent in a very noisy and riotous manner. In this state he
continued until April 1796, when he was attacked with a paralytic
affection, which deprived him of the use of the left side. His
articulation was now hardly intelligible; he became childish, got
gradually weaker, and died December 28, 1796. He was opened twenty-four
hours after death. There was a general opacity of the tunica arachnoidea,
and a small quantity of water between that membrane and the pia mater:
the ventricles were much enlarged and contained a considerable quantity of
water, by estimation, four ounces; the consistence of the brain was
natural.
CASE XVII.
M. G. a woman, about fifty years of age, had been admitted on the
incurable establishment in July 1785. She had for some years before been
in a disordered state, and was considered as a dangerous patient. Her
temper was violent; and if interrupted in her usual habits, she became
very furious. Like many others among the incurables, she was an insulated
being: she never spoke except when disturbed. Her greatest delight
appeared to be in getting into some corner to sleep; and the interval
between breakfast and dinner, was usually past in this manner. At other
times she was generally committing some petty mischief, such as slyly
breaking a window, dirtying the rooms of the other patients, or purloining
their provisions. She had been for some months in a weak and declining
state, but would never give any account of her disorder. On January 5,
1797, she died, apparently worn out. The head was opened three days after
death. The pericranium adhered but slightly to the scull, nor was the dura
mater firmly attached. There was water between the membranes of the brain;
and the want of transparency of the tunica arachnoidea, indicated marks of
former inflammation. The posterior part of the hemispheres of the brain
was of a brownish colour. In this case there was a considerable appearance
of air in the veins; the medullary substance, when cut, was full of bloody
points: the lateral ventricles were small, but filled with water: the
plexus choroides were loaded with vesicles of a much larger size than
usual: the consistence of the brain was natural.
CASE XVIII.
S. T. a woman, aged fifty-seven, was admitted into the house, January 14,
1797. It was stated by her friends, that she had been disordered eight
months: they were unacquainted with any cause, which might have induced
the disease. She had evidently suffered a paralytic attack, which
considerably affected her speech, and occasioned her to walk lame with the
right leg. As she avoided all conversation, it was not possible to collect
any further account of her case. Three days after her admission, she had
another paralytic stroke, which deprived her entirely of the use of the
right side. Two days afterwards she died. She was opened forty-eight hours
after death. There was a small quantity of water between the tunica
arachnoidea and pia mater, and a number of opake spots on the former
membrane. On the pia mater, covering the posterior part of the left
hemisphere of the brain, there was an extravasated blotch, about the size
of a shilling: the medullary substance was unusually loaded with blood:
the lateral ventricles were large, but did not contain much water: the
consistence of the brain was very soft.
CASE XIX.
W. C. a man, aged sixty-three, was admitted into the hospital, January 21,
1797. The persons, who attended at his admission, deposed, that he had
been disordered five months; that he never had been insane before, and
that the disease came on shortly after the death of his son. He was in a
very anxious and miserable state. No persuasion could induce him to take
nourishment; and it was with extreme difficulty that any food could be
forced upon him. He paced about with an hurried step; was often suddenly
struck with the idea of having important business to adjust in some
distant place, and which would not admit of a moment’s delay. Presently
after, he would conceive his house to be on fire, and would hastily
endeavour to rescue his property from the flames. Then he would fancy that
his son was drowning, that he had twice sunk: he was prepared to plunge
into the river to save him, as he floated for the last time: every moment
appeared an hour until he rose. In this miserable state he continued till
the 27th, when, with great perturbation, he suddenly ran into his room,
threw himself on the bed, and in a few minutes expired. The head was
opened twenty-four hours after death. The pericranium was but slightly
adherent to the scull: the tunica arachnoidea, particularly where the
hemispheres meet, was of a milky whiteness. Between this membrane, which
was somewhat thickened, and the pia mater, there was a very large
collection of water: the pia mater was inflamed: the veins of this
membrane were enlarged beyond what I had ever before observed: there was a
striking appearance of air in the veins: the medullary substance of the
brain, when cut into, bled freely, and seemed spongy from the number and
enlargement of its vessels: in the ventricles, which were of a natural
capacity, there was about half an ounce of water: the brain was of a
healthy consistence.
CASE XX.
M. L. a woman, aged thirty-eight, was admitted into the house, June 11,
1796. From the information of the people who had attended her, it
appeared, that she had been disordered six weeks, and that the disease
took place shortly after the death of her husband. At the first attack she
was violent, but she soon became more calm. She conceived that the
overseers of the parish, to which she belonged, meditated her destruction:
afterwards she supposed them deeply enamoured of her, and that they were
to decide their claims by a battle. During the time she continued in the
hospital she was perfectly quiet, although very much deranged. She fancied
that a young man, for whom she had formerly entertained a partiality, but
who had been dead some years, appeared frequently at her bed-side, in a
state of putrefaction, which left an abominable stench in her room. Soon
after she grew suspicious, and became apprehensive of evil intentions in
the people about her. She would frequently watch at her door, and, when
asked the reason, replied that she was fully aware of a design, which had
been formed, to put her secretly to death.—Under the influence of these
opinions she continued to her death, which took place on February 8, 1797,
in consequence of a violent rheumatic fever. She was opened twelve hours
after death. There were two opake spots on the tunica arachnoidea: the pia
mater was slightly inflamed: there was a general congestion of blood to
the whole contents of the cranium: the consistence of the brain did not
differ from what is found in a healthy state.
CASE XXI.
H. C. a woman, of about sixty-five years of age, had been admitted on the
incurable establishment in the year 1788. I have not been able to collect
any particulars of her former history. During the time I had an
opportunity of seeing her, she continued in a very violent and irritable
state: it was her custom to abuse every one who came near her. The
greatest part of the day was passed in cursing the persons she saw about
her; and when no one was near, she usually muttered some blasphemy to
herself. She died of a fever on February 19, 1797, on the fourth day after
the attack. She was opened two days after death. The tunica arachnoidea
was, in many parts, without its natural transparency: the pia mater was
generally suffused with blood, and its vessels were enlarged: the
consistence of the brain was firm.
CASE XXII.
J. C. a man, aged fifty, was admitted into the hospital, August 6, 1796.
It was stated that he had been disordered about three weeks, and that the
disease had been induced by too great attention to business, and the want
of sufficient rest. About four years before, he had been a patient, and
was discharged uncured. He was an artful and designing man, and with great
ingenuity once effected his escape from the hospital. His time was mostly
passed in childish amusements, such as tearing pieces of paper and
sticking them on the walls of his room, collecting rubbish and assorting
it. However, when he conceived himself unobserved, he was intriguing with
other patients, and instructing them in the means, by which they might
escape. Of his disorder he seemed highly sensible, and appeared to approve
so much of his confinement, that when his friends wished to have him
released, he opposed it, except it should meet with my approbation;
telling them, in my presence, that, although he might appear well to them,
the medical people of the house were alone capable of judging of the
actual state of his mind; yet I afterwards discovered, that he had
instigated them to procure his enlargement, by a relation of the grossest
falshoods and most unjust complaints. In April 1797, he was permitted to
have a month’s leave of absence, as he appeared tolerably well, and wished
to maintain his family by his industry. For above three weeks of this
time, he conducted himself in a very rational and orderly manner. The day
preceding that, on which he was to have returned thanks, he appeared
gloomy and suspicious, and felt a disinclination for work. The night was
passed in a restless manner, but in the morning he seemed better, and
proposed coming to the hospital to obtain his discharge. His wife having
been absent for a few minutes from the room, found him, on her return,
with his throat cut. He was re-admitted as a patient, and expressed great
sorrow and penitence for what he had done; and said that it was committed
in a moment of rashness and despair. After a long and minute examination,
he bewrayed nothing incoherent in his discourse. His wound, from which it
was stated that he had lost a large quantity of blood, was attended to by
Mr. Crowther, the surgeon to the hospital. Every day he became more
dispirited, and at last refused to speak. He died May 29th, about ten days
after his re-admission. His head was opened two days after death. There
were some slight opacities of the tunica arachnoidea, and the pia mater
was a little inflamed: the other parts of the brain were in an healthy
state, and its consistence natural.
CASE XXIII.
E. L. was a man, about seventy-eight years of age; had been admitted on
the incurable establishment, January 3, 1767. By report, I have understood
that he was formerly in the navy, and that his insanity was caused by a
disappointment of some promotion which he expected. It was also said, that
he was troublesome to some persons high in office, which rendered it
necessary that he should be confined. At one time he imagined himself to
be the king, and insisted on his crown. During the time I had an
opportunity of knowing him, he conducted himself in a very gentlemanly
manner. His disposition was remarkably placid, and I never remember him to
have uttered an unkind or hasty expression. With the other patients he
seldom held any conversation. His chief amusement was reading, and writing
letters to the people of the house. Of his books he was by no means
choice; he appeared to derive as much amusement from an old catalogue as
from the most entertaining performance. His writings always contained
directions for his release from confinement; and he never omitted his high
titles of God’s King, Holy Ghost, Admiral, and Physician. He died June 13,
1797, worn out with age. He was opened two days after death. The scull was
thick and porous. There was a large quantity of water between the
different membranes. The tunica arachnoidea was particularly opake: the
veins seemed to contain air: in the medullary substance the vessels were
very copious and much enlarged: the lateral ventricles contained two
ounces of pellucid water: the consistence of the brain was natural.
It has been stated, by a gentleman of great accuracy, and whose situation
affords him abundant opportunity of acquiring a knowledge of diseased
appearances, that the fluid of hydrocephalus appears to be of the same
nature with the water which is found in dropsy of the thorax and
abdomen.[10] That this is generally the case, there can be no doubt, from
the respectable testimony of the author of the Morbid Anatomy: but in
three instances, where I submitted this fluid to experiment, it was
incoagulable by acids and by heat; in all of them its consistence was not
altered even by boiling. There was, however, a cloudiness produced; and,
after the liquor had stood some time, a slight deposition of animal
matter took place, which, prior to the application of heat or mineral
acids, had been dissolved in the fluid. This liquor tinged green the
vegetable blues; produced a copious deposition with nitrat of silver; and,
on evaporation, afforded cubic crystals (nitrat of soda). From this
examination it was inferred, that the water of the brain, collected in
maniacal cases, contained a quantity of uncombined alkali and some common
salt. What other substances may enter into its composition, from want of
sufficient opportunity, I have not been enabled to determine.
CASE XXIV.
S. W. a woman, thirty-five years of age, was admitted into the hospital,
June 3, 1797. It was stated that she had been one month disordered, and
had never experienced any prior affection of the same kind. The disease
was said to have been produced by misfortunes which had attended her
family, and from frequent quarrels with those who composed it. She was in
a truly melancholic state; she was lost to all the comforts of this life,
and conceived herself abandoned for ever by God. She refused all food and
medicines. In this wretched condition she continued until July 29th, when
she lost the use of her right side. On the 30th she became lethargic, and
continued so until her death, which happened on August the 3d. She was
opened two days after death. There was a large collection of water between
the different membranes of the brain, amounting at least to four ounces:
the pia mater was very much inflamed, and was separable from the
convolutions of the brain with unusual facility: the medullary substance
was abundantly loaded with bloody points: the consistence of the brain
was remarkably firm.
CASE XXV.
D. W. a man, about fifty-eight years of age, had been admitted upon the
incurable establishment in 1789. He was of a violent and mischievous
disposition, and had nearly killed one of the keepers at a private mad
house previously to his admission into the hospital. At all times he was
equally deranged respecting his opinions, although he was occasionally
more quiet and tractable: these intervals were extremely irregular as to
their duration and period of return. He was of a very constipated habit,
and required large doses of cathartic medicines to procure stools. On
August 3, 1797, he was in a very furious state; complained of costiveness,
for which he took his ordinary quantity of opening physic, which operated
as usual. On the same day he ate his dinner with a good appetite; but
about six o’clock in the evening he was struck with hemiplegia, which
deprived him completely of the use of his left side. He lay insensible of
what passed about him, muttered constantly to himself, and appeared to be
keeping up a kind of conversation. The pulse was feeble, but not oppressed
or intermitting. He never had any stertor. He continued in this state
until the 12th, when he died. He was opened twelve hours after death.
There was some water between the tunica arachnoidea and pia mater: the
former membrane was opake in many places; bearing the marks of former
inflammation: in the veins of the membranes of the brain there was a
considerable appearance of air, and they were likewise particularly
charged with blood: the vessels of the medullary substance were numerous
and enlarged. On opening the right lateral ventricle, which was much
distended, it was found filled with dark and grumous blood; some had also
escaped into the left, but in quantity inconsiderable when compared with
what was contained in the other: the consistence of the brain was very
soft.
CASE XXVI.
J. S. a man, forty-four years of age, was received into the hospital, June
24, 1797. He had been disordered nine months previous to his admission.
His insanity was attributed to a violent quarrel, which had taken place
with a young woman, to whom he was attached, as he shortly afterwards
became sullen and melancholy.
During the time he remained in the house he seldom spoke, and wandered
about like a forlorn person. Sometimes he would suddenly stop, and keep
his eyes fixed on an object, and continue to stare at it for more than an
hour together. Afterwards he became stupid, hung down his head, and
drivelled like an ideot. At length he grew feeble and emaciated, his legs
were swollen and œdematous, and on September 13th, after eating his
dinner, he crawled to his room, where he was found dead about an hour
afterwards. He was opened two days after death. The tunica arachnoidea had
a milky whiteness, and was thickened. There was a considerable quantity of
water between that membrane and the pia mater, which latter was loaded
with blood: the lateral ventricles were very much enlarged, and contained,
by estimation, about six ounces of transparent fluid: the brain was of its
natural consistence.
CASE XXVII.
T. W. a man, thirty-eight years of age, was admitted into the house, May
16, 1795. He had then been disordered a year. His disease was stated to
have arisen, from his having been defrauded, by two of his near relations,
of some property, which he had accumulated by servitude. Having remained
in the hospital the usual time of trial for cure, he was afterwards
continued on the incurable establishment, in consequence of a strong
determination he had always shewn, to be revenged on those people who had
disposed of his property, and a declared intention of destroying himself.
He was in a very miserable state, conceived that he had offended God, and
that his soul was burning in Hell. Notwithstanding he was haunted with
these dreadful imaginations, he acted with propriety upon most occasions.
He took delight in rendering any assistance in his power to the people
about the house, and waited on those who were sick, with a kindness that
made him generally esteemed. At some period of his life he had acquired an
unfortunate propensity to gaming, and whenever he had collected a few
pence, he ventured them at cards. His losses were borne with very little
philosophy, and the devil was always accused of some unfair interposition.
On September 14, 1797, he appeared jaundiced, the yellowness daily
increased, and his depression of mind was more tormenting than ever. From
the time he was first attacked by the jaundice he had a strong
presentiment that he should die. Although he took the medicines which were
ordered, as a mark of attention to those who prescribed them, he was
firmly persuaded they could be of no service. The horror and anxiety he
felt, was, he said, sufficient to kill him, independantly of the jaundice.
On the 20th he was drowsy, and on the following day died comatose. He was
opened twenty-four hours after death. In some places the tunica
arachnoidea was slightly opake: the pia mater was inflamed; and in the
ventricles were found about two tea-spoons full of water tinged deeply
yellow, and the vesicles of the plexus choroides were of the same colour:
to the whole contents of the cranium there was a considerable congestion
of blood: the consistence of the brain was natural: the liver was sound:
the gall-bladder very much thickened, and contained a stone of the
mulberry appearance, of a white colour. Another stone was also found in
the duodenum.
CASE XXVIII.
R. B. a man, sixty-four years of age, was admitted into the hospital,
September 2, 1797. He had then been disordered three months. It was also
stated, that he had suffered an attack of this disease seven years before,
which then continued about two months. His disorder had, both times, been
occasioned by drinking spirituous liquors to excess. He was a person of
liberal education, and had been occasionally employed as usher in a
school, and at other times as a librarian and amanuensis. When admitted he
was very noisy, and importunately talkative. During the greatest part of
the day he was reciting passages from the Greek and Roman poets, or
talking of his own literary importance. He became so troublesome to the
other madmen, who were sufficiently occupied with their own speculations,
that they avoided, and excluded him from the common room; so that he was,
at last, reduced to the mortifying situation of being the sole auditor of
his own compositions.
He conceived himself very nearly related to Anacreon, and possessed of the
peculiar vein of that poet. He also fancied that he had discovered the
longitude; and was very urgent for his liberation from the hospital, that
he might claim the reward, to which his discovery was intitled. At length
he formed schemes to pay off the national debt: these, however, so much
bewildered him that his disorder became more violent than ever, and he was
in consequence obliged to be confined to his room. He now, after he had
remained two months in the house, was more noisy than before, and had
little sleep. These exertions very much reduced him.
In the beginning of January, 1798, his conceptions were less distinct, and
although his talkativeness continued, he was unable to conclude a single
sentence. When he began to speak, his attention was diverted by the first
object which caught his eye, or by any sound that struck him. On the 5th
he merely muttered; on the 7th he lost the use of his right side, and
became stupid and taciturn. In this state he continued until the 14th,
when he had another fit; after which he remained comatose and insensible.
On the following day he died. He was opened thirty-six hours after death.
The pericranium adhered very loosely to the scull: the tunica arachnoidea
was generally opake, and suffused with a brownish hue: a large quantity of
water was contained between it and the pia mater: the contents of the
cranium were unusually destitute of blood: there was a considerable
quantity of water (perhaps four ounces) in the lateral ventricles, which
were much enlarged: the consistence of the brain was very soft.
CASE XXIX.
E. T. a man, aged thirty years, was admitted a patient, July 23, 1796. The
persons who attended, related, that he had been disordered eleven months,
and that his insanity shortly supervened to a violent fever. It also
appeared, from subsequent enquiries, that his mother had been affected
with madness.
He was a very violent and mischievous patient, and possessed of great
bodily strength and activity. Although confined, he contrived several
times during the night to tear up the flooring of his cell; and had also
detached the wainscot to a considerable extent, and loosened a number of
bricks in the wall. When a new patient was admitted, he generally enticed
him into his room, on pretence of being an old acquaintance, and, as soon
as he came within his reach, immediately tore his clothes to pieces. He
was extremely dexterous with his feet, and frequently took off the hats of
those who were near him with his toes, and destroyed them with his teeth.
After he had dined he generally bit to pieces a thick wooden bowl, in
which his food was served, on the principle of sharpening his teeth
against the next meal. He once bit out the testicles of a living cat,
because the animal was attached to some person who had offended him. Of
his disorder he appeared to be very sensible; and after he had done any
mischief, always blamed the keepers for not securing him so, as to have
prevented it. After he had continued a year in the hospital he was
retained as an incurable patient. He died February 17, 1798, in
consequence of a tumor of the neck. He was opened two days after death.
The tunica arachnoidea was generally opake, and of a milky whiteness: the
vessels of the pia mater were turgid, and its veins contained a quantity
of air; about an ounce of water was contained in the lateral ventricles:
the consistence of the brain was unusually firm, and possessed of
considerable elasticity: it is the only instance of this nature which has
fallen under my observation.
CASE XXX.
T. G. a man, about fifty-five years of age, was admitted into the
hospital, January 20, 1798. It was stated, that he had been disordered a
year and half, and that his madness arose from repeated intoxication.
Having set fire to several hay-stacks, and committed frequent depredations
on the neighbouring farmers, it had been found necessary to confine him in
the county goal. His behaviour in this situation marked the cunning and
malignity of his mind, so that he was always attempting some mischief
either by violence or stratagem.
When brought to the hospital he conducted himself with propriety and
order, and appeared to be in a state of recovery. On the second of May he
was attacked with a diarrhœa which daily encreased, notwithstanding the
medicines employed for its removal. His mind became violently agitated
from the commencement of the diarrhœa, and it was found proper to
secure him. On the 8th, dysenteric symptoms appeared, which continued to
the 13th, when he died.
Appearances on Dissection.
The head was opened twenty-four hours after death. The pericranium was
loosely attached to the scull, and the dura mater adhered but slightly to
the internal surface of the cranium; there was a considerable quantity of
water between the dura mater and tunica arachnoidea, this latter membrane
(especially where the hemispheres meet) was of a milky whiteness, and
generally so in the course of the veins of the pia mater. The glandulæ
Pacchioni were very large and numerous. Between the tunica arachnoidea and
pia mater there was much water; and from the lateral ventricles, which
were uncommonly enlarged and distended, eight ounces of fluid were
collected: the infundibulum was remarkably large: the membrane lining the
cavity of the lateral ventricles had its veins very turgid: the
consistence of the brain was softer than natural.
The fluid obtained from the brain in this case being very pellucid and
abundant, it was submitted to some chemical tests in order to ascertain
its composition.
An attempt of this kind had been made before; (vide Case 23) the present
may be considered a small addition to our knowledge of this fluid, though
by no means a satisfactory developement of its materials, according to the
severity and precision of modern analysis.[11]
ANALYSIS OF THE FLUID.
| Tincture of Galls, |
|
produced a white precipitate in
moderate quantity. |
| |
| Lime Water, |
|
afforded a considerable quantity
of a white precipitate, which was
redissolved without effervescence
by muriatic acid. |
| |
Solution of Sulphat
of Copper. |
|
A drop of this solution added to
two drams of the brain fluid
tinged it with a pretty deep blue. |
The presence of animal matter is inferred from the deposition produced by
infusion of galls.
The precipitation by lime-water indicates the phosphoric acid.
And it appears from the blue tinge given to the fluid by the sulphat of
copper, that ammonia or some of its combinations was contained.
As it occurred on many former trials, there was no coagulation by heat; a
slight sediment fell, after boiling some minutes.
As this patient remained in the hospital from the middle of January to the
beginning of May, in a state perfectly tranquil, and without the
appearance of disarrangement of mind, it is improbable that a so great
enlargement of the ventricles, and accumulation of water, could have taken
place within the short space of two weeks, it is therefore most likely
that the greatest part of this fluid had been previously collected.
It may be conjectured that a very gradual accumulation of water (although
the quantity be at last considerable) would not affect the sensorium so as
a sudden secretion of fluid; or, that a quantity, which at one time had
occasioned great disturbance, would by habit become less inconvenient.
We are not well informed, but there is reason to believe, that gradual
pressure on the brain, will not occasion those serious symptoms which a
sudden pressure would excite.
CASE XXXI.
H. K. a woman, aged thirty, was admitted into the hospital, October 15,
1796. She had then been mad about four months, and her disorder was stated
to have supervened on the birth of a child. From subsequent enquiry it was
ascertained that her mother had been insane, and that her elder sister
had been similarly affected; but from the best information it did not
appear that her brothers (she had two) had ever been visited with this
calamity.
Previously to her admission she had frequently attempted to destroy
herself, and had also endeavoured to take away the life of her husband. In
the hospital she was extremely violent; supposed her neighbours had
conspired to take away her liberty, and became jealous of her husband: she
was often naming some female of her acquaintance who had artfully ensnared
his affections, and whom he had decked out in her best apparel: she
breathed revenge when she should return home, and seemed much delighted
with the idea of destroying these favourites, when they were dressed for
some excursion with her husband.
She had understood that a year was the extent of time that persons were
detained in the hospital, and conceived she should be liberated when it
had elapsed, to put her menaces into execution. Her disorder being of a
dangerous tendency she was retained in the hospital after the period of
probation. When she found the hope of gratifying her revenge frustrated,
by being kept beyond the time of her expectation, she began to pine away,
her appetite diminished, and a cough, with copious expectoration and
hectic fever supervened. During the whole period of her bodily disease,
she would never acknowledge herself to be ill, and the violence of her
mental disorder was unabated. She died of Phthisis Pulmonalis, April 1st,
1798.
The head was opened twenty four hours after her decease. The tunica
arachnoidea was in many places opake; the pia mater was highly inflamed,
and loaded with blood, and a considerable quantity of water was contained
between it and the former membrane. The ventricles were enlarged, but
contained scarcely any fluid. The other parts of the brain were healthy,
and its consistence was natural.
It is a common opinion, that Phthisis Pulmonalis is frequently suspended
by the supervention of mania; medical books abound with such accounts, and
some persons have supposed it difficult, if not impossible, for these
diseases to co-exist. It is not my intention to dispute the accuracy of
such relations, nor to question the power which Mania may possess in
arresting the progress of Phthisis Pulmonalis, but, to state that the
converse does not obtain; and, that whatever obligations may be due from
Phthisis to Mania, the compliment has not been returned. From my own
experience I can affirm, that insane persons are as liable to Phthisis
Pulmonalis as others, that numbers of them die of that disease; and that I
never saw any abatement of the maniacal symptoms through the progress of
consumption.
CASE XXXII.
J. P. aged 57, was admitted into the hospital, January 19, 1799; he was
stated to have been insane about three weeks, and that his disorder came
on shortly after the death of his master, in whose service he had
continued many years, and to whom he was much attached. He had been in the
hospital three times before, and had each time been discharged well. His
disorder usually recurred every seven or eight years. His father also had
been maniacal about the middle period of life, but never recovered. When
admitted he was very talkative, although his natural character was
reserved. He endeavoured to explain his meaning with superior correctness,
and sought to define every subject, however trifling, with a tedious
minuteness; but, upon religion and politics, the Scylla and Charybdis of
human discussion, he was pertinacious and intollerant. This dictatorial
manner and stubbornness of opinion, not being capable of producing the
relations of peace and amity with other philosophers, equally obstinate,
and whose principles had been matured by long confinement, it became
necessary to shut him up in his cell. During the period of his seclusion,
nothing very incoherent escaped from him; every thing he said was within
the sphere of possibility. His fastidiousness rendered him unhappy: he
acknowledged the food which was brought him to be good, but he conceived
it might have been better. The cathartic medicine, which was administered
to him, he confessed had answered the purpose, but its taste was most
nauseous, and he had never before been so severely griped. He ornamented
his person and apartment in a very whimsical manner: latterly he tore his
clothes because he suspected the taylor had deceived him in the materials.
After this he continued naked until the beginning of March, when he
appeared more composed, and sensible of the state he had been in. On the
morning of the 12th, when the keeper opened his cell, he was speechless;
his mouth drawn to the right side, and so feeble that he could not support
himself. A cathartic medicine was given, and sinapisms were applied to the
feet and legs. In the evening he was much recovered, his speech had
returned, and he was able to move himself. He was visited again at
midnight, when he appeared still better. In the morning it was evident
that he had experienced another attack, his mouth was drawn aside; he was
stupid, and died within half an hour. The head was opened on the
following day. The tunica arachnoidea was in some places slightly opake.
The pia mater was inflamed, but not to any considerable degree. There was
no water between any of the membranes. The ventricles were of a natural
capacity, and did not contain any fluid. There was no extravasation in any
part of the substance of the cerebrum or cerebellum. Excepting the slight
inflammation of the pia mater, the brain had a very healthy appearance;
its consistence was firm; the scull was unusually thick. I regret, from a
promise which had been made to the friends, of inspecting the head only,
that the thoracic and abdominal viscera were not examined.
This history has been related to shew, that although the patient died with
those symptoms, which indicate pressure on the brain, as loss of speech,
the mouth being drawn aside, stupor and insensibility; yet the brain did
not afford the same appearances, on dissection, as have been usually
detected in such cases. The following relation is an additional example of
the same fact:
CASE XXXIII.
N. B. He had been many years in the hospital as an incurable patient; his
mother was known to have been maniacal; his two brothers and his sister
have been insane. His eldest son, on taking a very small quantity of
fermented liquor, becomes frantic, and its effects continue much longer
than on persons in general. During this patient’s confinement, he was, as
far as could be ascertained, completely in his senses; this induced the
medical persons of the hospital, on two or three occasions, to give him
leave of absence, that he might return on trial to his wife and family;
but, in a few hours after he came home, he felt uneasy, and found himself
bewitched at all points: the devil and his imps had pre-occupied the best
places in the house; he became very turbulent, and also jealous of his
wife, and was obliged to be returned to the hospital. As he found his home
so beset with difficulties he resolved that he would never enter it again.
During eight years that I was acquainted with him I never discovered the
least insanity in his actions or conversation. He was perfectly sensible
that his intellects were disordered whenever he returned to his family.
His wife and children frequently visited him in Bethlem, and he always
conducted himself affectionately towards them. About 14 months before his
death he laboured under a severe dysentery, which continued six weeks, and
left him in a very reduced state, with œdematous legs, and incipient
dropsy of the abdomen. On his recovery from these symptoms he became
troubled with fits; they appeared to be such as a medical person would
have termed apoplectic. After the attack, no symptoms of paralysis
remained, nor did he experience the fatigue and exhaustion, or fall into a
profound sleep, which usually accompanies Epilepsy. On October 10th, 1802,
being then in a pretty good state of health, he fell down, and expired in
a few minutes. He was about sixty-five years of age. On examination of the
head after death, there was a considerable determination of blood to the
brain; but there was no extravasation of that fluid, nor any collection of
water: the brain and its membranes had a healthy appearance, and its
consistence was natural. The heart was sound, and the abdominal viscera
were not conspicuously diseased.
CASE XXXIV.
J. P. a man, aged thirty, was admitted into the hospital, October 18th,
1800. It was then deposed, by the persons who brought him, that he had
been for eight months in a melancholic state; but they were unable to
assign any circumstances, which preceded his disorder, as a cause of his
disease. He had a large tumor on the throat which extended backward to the
neck, principally on the left side; the increase of this swelling, they
alledged, had much alarmed him, at the commencement of his melancholic
attack. During the time he was the subject of my observation, he was in a
very mopish and stupid state; if spoken to, he would sometimes give a
short answer, but ordinarily he took no notice of those who addressed him.
Some days he would walk slowly in the less frequented part of the
building; frequently he sat down for some hours in a corner. His appetite
was good, he ate the food which was brought him, but never took the
trouble to go for it, when serving out. In this state he continued until
April 2d, when he became more stupid, and could not be made to rise from
his bed. He did not appear to be in any pain, nor was he at all convulsed.
His bowels were regular. On the 5th he became comatose, and on the 9th he
died.
Appearances on Dissection.
There was an excessive determination of blood to the brain, and the pia
mater was highly inflamed. On the inferior part of the middle lobe of the
brain, there was a gangrene of considerable extent, together with a
quantity of very fœtid purulent matter.
This is the only instance of a gangrenous state of the brain which has
fallen under my observation.
CASE XXXV.
T. C. This person had remained many years in the hospital on the incurable
establishment. He had been a schoolmaster at Warrington in Lancashire, and
was a man of acuteness and extensive mathematical learning. As he became
very furious on the attack of his maniacal disorder, he was placed in the
Lunatic Asylum at Manchester, where he killed the person who had the care
of him, by stabbing him in the back with a knife.
The following is the account he gave me of that transaction, and which I
immediately committed to paper; as it conveys a serious and important
lesson to those who are about the persons of the insane.
“He that would govern others, first should be
The master of himself, richly indu’d
With depth of understanding, height of courage.”
Massinger’s Bondman, Act I. Scene 3.
It ought to be more generally understood that a madman seldom forgets the
coercion he has undergone, and that he never forgives an indignity.
“The man whom I stabbed richly deserved it. He behaved to me with great
violence and cruelty, he degraded my nature as a human being; he tied me
down, handcuffed me, and confined my hands much higher than my head, with
a leathern thong: he stretched me on a bed of torture. After some days he
released me. I gave him warning, for I told his wife I would have justice
of him. On her communicating this to him, he came to me in a furious
passion, threw me down, dragg’d me through the court-yard, thumped on my
breast, and confined me in a dark and damp cell. Not liking this
situation, I was induced to play the hypocrite. I pretended extreme sorrow
for having threatened him, and by an affectation of repentance, prevailed
on him to release me. For several days I paid him great attention, and
lent him every assistance. He seemed much pleased with the flattery, and
became very friendly in his behaviour towards me.—Going one day into the
kitchen, where his wife was busied, I saw a knife; (this was too great a
temptation to be resisted;) I concealed it, and carried it about me. For
some time afterwards the same friendly intercourse was maintained between
us; but, as he was one day unlocking his garden door, I seized the
opportunity, and plunged the knife up to the hilt in his back.”—He
always mentioned this circumstance with peculiar triumph, and his
countenance (the most cunning and malignant I ever beheld) became highly
animated at the conclusion of the story.
During the time he was in Bethlem Hospital he most ingeniously formed a
stiletto out of a mop-nail; it was an elaborate contrivance, and had
probably been the work of several months. It was rendered extremely sharp
and polished, by whetting on a small pebble; it was fixed into a handle,
and had a wooden sheath made from the mop-stick. This instrument he
carried in his left breeches pocket, his right hand grasping the hilt. As
I always found him in that posture when I visited him, I suspected he had
some concealed implement of mischief, and therefore employed a
convalescent patient to watch him through the key-hole of his door. This
person saw him with the weapon, and also ascertaining the distance at
which he could use it.
The instrument was taken from him by surprise. When he found he was
prevented from executing his purpose, he roared out the most horrid
imprecations; he cursed the Almighty for creating him, and more especially
for having given him the form of a human being, and he wished to go to
Hell that he might not be disgraced by an association with the Deity.
He had an uniform and implacable aversion to the officers and servants of
the hospital; he said he courted their hatred for their curse was a
blessing. He seldom answered a question but some impiety was contained in
the reply. An indifferent person remarking that it was a bad day, he
immediately retorted, “Sir, did you ever know God make a good one?”
Although the whole of the day, and the greatest part of the night, were
consumed in pouring forth abuse and coining new blasphemies; yet there
were some few patients for whom he professed a friendship, and with whom
he conversed in a mild and civil way: this confidence had been obtained by
the compliments they had addressed to him on the score of his
understanding, of which he entertained a very high opinion. At one time he
conceived himself to be the Messiah, at another, that he was Mr. Adam, the
architect; and that he was shortly to go to America in order to build the
new Jerusalem in Philadelphia.
About six months before his death he complained of pain in his stomach,
and said he felt as if he had no intestines. His appetite diminished, and
he became melancholic.
The scene now began to alter; he had a presentiment that his time in this
world would be short, and he dreaded the change: no hope arose, no
consolation could cheer him; he became daily more emaciated and despairing
until he died, which took place August 27, 1801; he appeared to be about
seventy years of age.
On opening the head, the pericranium was scarcely adherent. This membrane
being removed, blood oozed freely from the parietal bones. There was a
large accumulation of water between the dura mater and tunica arachnoidea;
when this was let out the dura mater became flaccid, and seemed to hang
loose on the brain. On the left posterior lobe of the cerebrum there was a
large quantity of a milky fluid, between the tunica arachnoidea and pia
mater, giving the appearance of a vesication; and in that place there was
a depression or cavity formed in the convolutions of the brain. The
convolutions were so strongly and distinctly marked, that they resembled
the intestines of a child. The lateral ventricles were but little
distended, and did not contain much water. The head was not particularly
loaded with blood, nor were the bloody points, in the medullary substance,
very abundant. The brain was of a natural consistence. There was no
disease in the stomach, intestines, or liver. The body was opened about
six hours after his death.
CASE XXXVI.
B. S. a man, generally noticed by those who have visited Bethlem hospital
a few years ago. It was said, that an attachment to a young woman, who
slighted his addresses, was the cause of his becoming insane. He was
considered a very dangerous lunatic, and for many years was confined to
his cell. In this situation he employed himself in the manufacture of
straw baskets and table mats. The desire of money was the leading feature
of his mind, and the whole of his energies were devoted to its
acquisition; nor was he at all scrupulous as to the means, by which he
attained his object. Although repeatedly assured that he would never be
liberated, he disbelieved such information, and was persuaded, when he had
acquired a sum sufficient to purchase a horse and cart, filled with
higler’s ware, that he should be released. The idea of becoming a trader,
on so large a scale, stimulated him to constant occupation. He employed
several lunatic journeymen to plat the straw for him, but they were poorly
rewarded. He generally chose for his workmen such as were chained, and
could not come personally to insist on the reward of their labour. He
commonly pretended that the platting was badly performed, and
consequently unsaleable; sometimes he would protest that he had settled
with them, but that they were too mad to recollect it; and if at any time
he did pay them, it was in bad coin. For many years he was unrivalled in
this trade, and, by every species of fraud, had amassed nearly sufficient
to set his plans afloat: when an unfortunate event took place, which
considerably reduced his capital. He had always a propensity to game,
which, from his skill and dexterity in cheating, was generally attended
with success; but in this science he was once over-matched. An insane
soldier, an ingenious man, became his intimate friend, and finding him
possessed of some money proposed a game at cards. The result was deeply
disastrous to the artificer in straw, who endeavoured to evade the
payment; but his friend stated it to be a debt of honor; and besides he
was a very powerful man, of a stern aspect, and not to be trifled with;
he was therefore compelled to tell down at once the slow accumulation of
several years. It was intended to make the soldier restore the property,
but he, conceiving that he had already derived sufficient benefit from the
hospital, went away in the night, without the formalities of a regular
discharge.
To fill up the measure of his misfortunes, when Hatfield, the maniac who
shot at his Majesty in the theatre, was brought to Bethlem, he, in
conjunction with a contriving cobbler, established a rival manufactory,
which shortly eclipsed the fabric of the old school, and by superior taste
rendered his further exertions unnecessary.
It is natural to suppose, that no great cordiality could exist between
persons, where the prosperity of one had been established on the ruin of
the other. Frequent altercations arose, and much offensive language was
exchanged. At length the patience of the original dealer was exhausted,
and, in collecting his force to give his opponent a blow, he fell down and
instantly expired.—He was about fifty-eight years of age.
Some of his habits and opinions were extremely singular; he believed that
all occurrences were regulated by witches: prosperity was to be attributed
to the good witches having obtained the mastery; and when bad witches
gained the ascendancy, misfortunes arose. When the latter were at work he
supposed himself in possession of a power to frighten and disperse them,
and this was effected by a peculiar noise he made. It is probable he might
have laboured under indigestion, for immediately after he had eaten his
dinner, he sent forth a dreadful howl, which he continued for about ten
minutes: but his great terror was a thunder storm; when this occurred, he
took a very active part, and brought the whole force of his lungs to bear
upon the enemy. A cat was supposed to have a natural antipathy to bad
witches, she could smell them at a distance; for which reason he always
domesticated an animal of that kind to sleep in his cell.
When his head was opened, the dura mater was very easily separable from
the scull; upon puncturing this membrane a considerable quantity of blood
flowed from the opening; and there was a copious extravasation of this
fluid between the membranes of the brain: but the most remarkable
circumstance was, that the tunica arachnoidea was so thickened, that it
exceeded the dura mater on an accurate comparison. The pia mater was
loaded with blood, and its vessels were enlarged. The brain and its
cavities were sound and natural.
CASE XXXVII.
R. B. This man had been many years an incurable patient, and it was
supposed that jealousy of his wife had been the cause of his madness,
although it appeared from very respectable testimony that he had no real
grounds for such suspicion. During eight years, (the period he was subject
to my observation,) he was mostly in a very furious state, and obliged to
be strictly confined. His mischeivous disposition was manifested on every
occasion; he would hurl the bowl, in which his food was served, against
those who passed his cell; and when his hands were secured he would kick,
bite, or throw his head into the stomachs of those who came near him. He
entertained a constant aversion to his keeper, whom he suspected to be
connected with his wife. His life was miserably divided between furious
paroxysms and melancholic languor, and there was great uncertainty in the
duration of these states. He has been known to continue ten months in the
highest degree of violence, and relapse into the same state after a few
days passed in tranquil depression. There was one circumstance which never
failed to produce a relapse, however quietly he might have conducted
himself, this was a visit from any of his family, and a very striking
instance occurred. From May, 1799, to September, 1800, he had every
appearance of being perfectly recovered: he was, in consequence, allowed
additional comforts, and treated as a convalescent. At this time he was
visited by his son, who, after many hours conversation with him, was
persuaded that he had perfectly recovered his intellects; and he expressed
himself astonished at his father’s accurate recollection of particulars
which might be supposed to have been obliterated from his mind. This
dutiful visit and affectionate intercourse produced unpleasant
consequences. The numerous enquiries which the patient had made, furnished
him with materials for reflexion. On the departure of his son he began to
detect mismanagement in his affairs, and improprieties in the conduct of
his family: he was very talkative, and became impatient to return home.
The following day he had a wildness in his eyes, spoke fast, and appeared
busy: before the evening he was so irritable and disobedient that it
became necessary to confine him. From this time he continued in the most
furious condition, singing and vociferating the greatest part of the
night, until January 2d, 1801, when he became suddenly calm, complained of
extreme debility, and said he should die in a few hours. He gave very
proper answers to the questions which were asked him, but complained of
the fatigue which talking induced. On the next morning he expired. He was
sixty-eight years of age. The head was opened two days after his death.
The tunica arachnoidea was in many places opake, and considerably
thickened. There was a small quantity of limpid water between this
membrane and the pia mater. When the medullary substance was cut into,
there oozed from many points a quantity of dark blood, indeed the whole
head was loaded with venous blood. The lateral ventricles were
considerably enlarged and filled with water—four ounces were collected.
The internal carotid arteries were much enlarged, and when divided, did
not collapse, but remained open, as arteries in the other parts of the
body. The consistence of the brain was doughy.
.
[Mod]. It is true that we have now converted the o, into a, and write
the word mad: but mod was anciently employed.