Part 5 (1/2)
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 appet.i.te 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 quant.i.ty 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 x.x.xII.
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 x.x.xIII.
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 quant.i.ty 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 oedematous 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 x.x.xIV.
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 a.s.sign any circ.u.mstances, which preceded his disorder, as a cause of his disease. He had a large tumor on the throat which extended backward to the neck, princ.i.p.ally 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 appet.i.te 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 quant.i.ty of very foetid purulent matter.
This is the only instance of a gangrenous state of the brain which has fallen under my observation.
CASE x.x.xV.
T. C. This person had remained many years in the hospital on the incurable establishment. He had been a schoolmaster at Warrington in Lancas.h.i.+re, 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.”
_Ma.s.singer'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 pa.s.sion, 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 a.s.sistance. 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 circ.u.mstance with peculiar triumph, and his countenance (the most cunning and malignant I ever beheld) became highly animated at the conclusion of the story.