Part 14

No. 8.—Admitted 1783.

No statement on record. He was a respectable country Clergyman: his friends say he was a hard student, neglecting exercise, and all attention to himself or his health, and which had, for some time previous to the attack of derangement, been in a very precarious state—the attack was very sudden and violent.

He has a leprous eruption, which has continued since the time of his admission until now, without any very perceptibly abatement. He was formerly the most furious maniac amongst the old incurable cases, though less strikingly peculiar in his appearance and manners than the one last described. During the paroxysms of his greatest fury, he appeared like one whose mind, from excruciating pain and dreadful mental provocation, was wrought up to the highest pitch of passion and revenge; so that he would, as though he had the object of his malignity before him, be incessantly repeating, through whole nights and days, some single phrase, such as, “damn’d dog,” with a sort of suppressed barking, roaring furiousness, even until he foamed at the mouth, and his face was black with passion.

He was most violent when the eruption appeared least on the external surface. When his mind was more at ease, he would play like a little child for whole days together, with the merest trifle, such as a piece of string or paper. At these times, when given any thing he likes, he has something singularly fascinating in his smile.

For this eruption, many things had been administered, without any permanent advantage. Solution of nitric acid, about three years ago, {152} appeared to have, for a time, a good effect; the eruption became somewhat less, and the mind less violent: but this might arise from the debilitating effects, rather than the radical removal of the cause of his disease. After this, the solution of nitrate of potash, had a good effect both on his mind and the disease of his skin, without reducing or debilitating his system. He has lived, for this last twelve months, on vegetable diet, and he is apparently better; but this may be a fallacious appearance, since his vital energies appear to be sinking.

OBSERVATION VI.

It has been said, by the late Dr. Jenner, and some others, that cutaneous disorders are common to the insane. I should think they are not very common. {153} This is the only case that I have seen, where the two have continued to exist together. Whether it was the original cause of his mental malady, I have not been able to ascertain, but it is certain, it aggravated it. That mania, in some instances, follows the disappearance of eruptions, ulcers, and other local diseases, particularly with females, is satisfactorily established; but in many instances, other causes co-operate.

In cases of dementia, arising apparently from continued pressure on the brain, the surface, from the general bad habit of the system, is liable to sores, boils, and ulcerations. This cannot be called a cutaneous disease; it is rather a symptom of the diseased state of the brain, than itself the cause of insanity. Glandular swellings, however, seem to have a more direct connection; but still they appear rather before, than after the alienation has taken place. In a few cases, I have noticed slight eruptions during recent paroxysms, and in two or three, immediately previous to their convalescent state. Had such appearances occurred more frequently, I should gladly have regarded them as favourable prognostics; but they might arise from strong medicines, their state of confinement, or they might be mere accidental coincidences. There are many instances of cures by accidental injuries, {154a} as well as by the accession of consumption and other physical diseases.

Here I leave the question for the present, till I come to some cases, where, according to the theory of such a connection subsisting, (which I believe is the case in a few instances,) the tartarized antimonial ointment has been applied; {154b} but I confess, that there is no part of my experience in which my sanguine expectations of cure, after a certain duration of the disease, on this principle of counteraction, have been more disappointed. In the early stages of insanity, it is decidedly the most valuable principle in our practice.

No. 9.—Admitted 1793.

No statement on record, that gives any satisfactory information. She was a respectable farmer’s wife, and her insanity was occasioned by her husband’s heavy losses of cattle. Her first symptom was throwing her little infant at the feet of the parish officers, saying, “there, take it.” {155} She often repeats, with a very moaning sound, and tears, “God rest thy soul, poor old mare.” She will be easily known, when I say, she is a poor, moaning, miserable looking imbecile, constantly sitting cowering in a corner, always crying for tobacco. She was one of those who were kept naked in loose straw, and hence her inclination to undress herself, her dirty habits, and her peculiar mode of sitting: indeed, formerly, throughout the house, the lowest and worst patients had no seats allowed them.

No. 10.—Admitted 1793.

Nothing recorded of this case. It is said, that when young, he was severely kicked by a horse. There is now a considerable indentation just above his left ear.

His mind, though extremely childish, is altogether in a torpid state, for the most part quiet and good-natured; but sometimes, when more excited, he exhibits a love of mischief, generally very childishly, but sometimes more seriously so. {156a} His temperament is phlegmatic, and he has a heavy, dull look. He has been for years employed in the garden.

No. 11.—Admitted 1793.

Nothing on record. I have been informed, that he was a well-sinker, and that his insanity was the consequence of a rheumatic fever. No one, except a complete idiot, can be in a more stupidly stagnant state of mind; he scarcely notices any thing, and never speaks unless spoken to, and then his answers are merely monosyllables. About once in twelve months, a slight exhibition of excitement shows itself in a sort of ill-tempered obstinate fit, {156b} but which soon subsides, especially with the aid of sulphate of magnesia. He is, together with No. 10, constantly employed in the garden.

OBSERVATION VII.

The observation which suggests itself on No. 10 and 11, is, that from such facts as these, it is very evident, there can scarcely be an old pauper patient in such a state as wholly incapacitates him from being brought, with a little trouble, into habits of useful employment.

As stupid men are generally less diverted from an object which once engages their attention, than men of greater capacity; so it is with these poor automata; if the first difficulty be but once overcome, that of acquiring the habit of working, there is no fear; but they will proceed in it more steadily than those who feel that they have a right to consult their own choice. They cannot be tempted, nor do they possess the power of giving their energies a new direction; and hence, as habit gathers strength, we may depend on them as on our time-pieces. If amusements and employment are good for these, how much better for those who are not past the hope of recovery; it may change the object of their thoughts, and gradually turn them to one of a less dangerous nature. I shall have some very interesting cures, partly attributable to this principle, to state in due course; in the mean time we perceive, that if even they are past the hope of recovery, they are kept in a better and more healthful state; and what is more, it diffuses a satisfactory feeling through the whole system, and they are made happier than they would be by a life of idleness.

No. 12.—Admitted 1797.

Nothing on record; and I have failed in my efforts to obtain any information of her previous history. It is said, that her relations are respectable; yet her residence here is paid for by a parish in London. She has long been, together with No. 7, the most useful and hardworking person in the house. In the midst of her work, she will often scold and swear with vehemence, but no one knows about what, or against whom; and though her voice is loud and shrill, no one regards it, saying, “Oh! it is only poor M. W.” Yet she is very kind-hearted and friendly, giving away her own meat, especially to those who are ill; and when prevented from doing so, will throw it away with indignation. She would gladly starve herself to feed others; and always asserts, when a patient dies, “that they died for want of something to eat.” She used to practice this singular fancy, that of frightening the devil away, by taking a sweeping brush with her to bed; but now, a tin pint serves the same purpose. She is a tall, meagre-looking woman.

No. 13.—Admitted 1798.

No statement of this case; but it is said that, in the first instance, he was very violent. His mind is now in a fixed imbecile state, and exhibits no alteration, except the slight changes which mere alterations of our spirits produce; when he is more easily provoked—talks, laughs, and sings more, or holds conversations with persons dead or absent; sometimes scolds them, fancying they tease him in some strange manner, which he calls “triangling;” but it is impossible to ascertain what ideas he affixes to the word; he is a very quiet, good-natured man, a general favourite, and is usefully employed by the attendants in the house. {159}

No. 14.—Admitted 1799.

No statement of her case; and I have failed in obtaining any very satisfactory information about her.

It is said, that she gradually became insane, after the death of her only boy, named “Charles,” (who was the natural son of Sir —:) this is probably true, as she now imagines that Charles is constantly with her—sleeps with her—that she feeds him at her meals—carries him about in a corner of her apron—nurses him—and talks to him with delight and maternal fondness. She often fancies, too, that she has been confined, and has got more children. {160}

Her appearance and manners are exceedingly polite, pleasing, and affectionate; she is attentive to others, in all those little nameless etiquettes of life, which, when regulated by truth, constitute the innocent fascination of a kind-hearted and well-bred character; and it is so with her: every one doats upon her as upon a favourite child. She never fails to tell me, if I have been out during dinner-time, when she next meets me, “you have not got your dinner, go and get it immediately;” and yet left to herself, she is wholly taken up with scolding some imaginary beings who annoy her, get into her throat, head, back, &c., run her through with swords, and do a thousand other strange and cruel things to her. Every evening she has a long scolding, with a tone three-fourths of anger and one-fourth affection, with some men who plague her in her bed and in her bed-room, and continue to do so till her attendant comes, sometimes at her call, to drive them away. Is this the lingering last impression made on her mind by her seducer? In the midst of her scolding she will often swear in a strange under tone of voice; and when accused, she says it is some other person, frequently Jack Swales. Her conversation is so exceedingly extravagant and varied, that it is impossible, except by the most lengthened description, to convey to others any adequate conception of it. Names of dukes, kings, queens, pipes of wine, sums of money, estates, &c., are as common to her as household words; yet strange as all this is, it seems to have some connexion with her past life, having formerly held a situation in a family of consequence. Her former situation and disposition are hinted at by these reminiscences, which are delightful traits of what she has been.

No. 15.—Admitted 1799.—Aged 50.