Chapter III: Part 3

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 oedematous, 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 diarrhoea which daily encreased, notwithstanding the medicines employed for its removal. His mind became violently agitated from the commencement of the diarrhoea, 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 glandulae 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 A drop of this solution added to
of Copper._ 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 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 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 foetid 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.

CHAP. IV.

CASES OF INSANE CHILDREN.

In the month of March, 1799, a female child, three years and a quarter old, was brought to the hospital for medical advice. She was in good bodily health, and born of sane and undiseased parents. The mother, who attended, stated that her husband's parents and her own had never been in the slightest degree afflicted with mania, but that she had a brother who was born an ideot. She related that her child, until the age of two years and a half, was perfectly well, of ordinary vivacity, and of promising talents; when she was inoculated for the small pox. Severe convulsions ushered in the disease, and a delirium continued during its course. The eruption was of the mild kind, and the child was not marked with the pustules. From the termination of the small-pox to the above date, (nine months) the child continued in an insane state. Previously to the small-pox, she could articulate many words, and use them correctly for the things they signified: but since that time she completely forgot her former acquisitions, nor ever attempted to imitate a significant sound. Whatever she wished to perform, she effected with promptitude and facility. She appeared anxious to possess every thing she saw, and cried if she experienced any disappointment; and on these occasions she would bite, or express her anger by kicking or striking. Her appetite was voracious, and she would devour any thing that was given to her, without discrimination; as fat, raw animal food, or tainted meat. To rake out the fire with her fingers was a favourite amusement, nor was she deterred from having frequently burned them. She passed her urine and faeces in any place without restraint; but she could retain a considerable quantity of the former before she discharged it. Some cathartic remedies were ordered for her, with an emetic occasionally, and she was brought to the hospital every fortnight, but she did not appear in any degree amended. On June 22 she was admitted a patient, and continued in the hospital until the middle of October, when she was attacked with an eruptive fever, and consequently discharged. During this time little progress was made, although considerable pains were bestowed. She became more cunning, and her taste appeared improved. The cathartic medicine, which she drank at first without reluctance, became afterwards highly disgusting, and when she saw the basket which contained it, she endeavoured to escape and hide herself. To particular persons she was friendly, and felt an aversion to others. She was sensible of the authority of the nurse who attended her, and understood by the tone of her voice whether she were pleased or offended. The names of some things she appeared to comprehend, although they were extremely few; when the words, dinner, cakes, orange, and some more were mentioned, she smiled, and appeared in expectation of receiving them. By great attention and perseverance on the part of the nurse, she was brought to evacuate her faeces and urine in a night stool.

After the elapse of three years I was informed that the child had made no intellectual progress.

W. H. a boy, nearly seven years of age, was admitted into the Hospital, June 8th, 1799. His mother, who frequently visited him, related the following particulars respecting his case.--She said that, within a month of being delivered of this child, she was frightened by a man in the street, who rudely put his hand on her abdomen. When the child was born it was subject to startings, and became convulsed on any slight indisposition. When a year old, he suffered much with the measles: and afterwards had a mild kind of inoculated small-pox. At this age she thought the child more lively than usual, and that he slept less than her other children had done. At two years, the mother perceived he could not be controled, and therefore frequently corrected him.

There was a tardiness in the developement of his physical powers. He was fifteen months old before he had a tooth, and unable to go alone at two years and a half: his mind was equally slow; he had arrived at his fourth year before he began to speak; and, when in his fifth, he had not made a greater proficiency in language than generally may be observed in children between two and three years. When admitted into the hospital, he wept at being separated from his mother, but his grief was of very short continuance. He was placed on the female side, and seemed highly delighted with the novelty of the scene: every object excited his curiosity, but he did not pause or dwell on any. He was constantly in action, and rapidly examined the different apartments of the building. To the patients in general he behaved with great insolence--he kicked and spat at them, and distorted his face in derision; but, on the appearance of the nurse, he immediately desisted, and assured her he was a very good boy. Great, but ineffectual, pains were taken, to make him understand the nature of truth,--he could never be brought to confess any mischief he had committed, and always took refuge in the convenient shelter of a lie. In a short time he acquired a striking talent for mimickry, and imitated many of the patients in their insane manners; he generally selected, for his models, those who were confined, as he could practise from such with impunity.

In about three months he had added considerably to his stock of language, but, unluckily, he had selected his expressions from those patients who were addicted to swearing and obscene conversation. To teach him the letters of the alphabet had many times been endeavoured, but always without success; the attempt uniformly disgusted him: he was not to be stimulated by coaxing or coercion; his mind was too excursive, to submit to the painful toil of recording elementary sounds; but it may rather be inferred that he did not possess a sufficient power of attention to become acquainted with arbitrary characters.

He was in good health, his pulse and bowels were regular, and his appetite was keen, but not voracious. One circumstance struck me, as very peculiar, in this boy,--he appeared to have very incorrect ideas of distance: he would frequently stretch out his hand, to grasp objects considerably beyond his reach, but this referred principally to height: he would endeavour to pluck out a nail from the ceiling, or snatch at the moon. In October he became unwell, and, at the mother's request, was discharged from the hospital.