quiet,
obtain
man,?till about the 3rd instant, when he could sleep, and first began to have strange delusions of
retired no
in hell and among devils. He became very talkative and eccentric, and his hallucinations increased in strength daily, till the whole of the previous night he was alarmingly boisterous, and made use of the most obscene and blaspheHis mous language in spite of all efforts to quieten him. wife states that since his last febrile attack he had only 2 pints of beer a day (?). and that his appetite had increased largely. As he himself afterwards confessed, he has had some private family matters preying on his mind, and these, capped with some recent occurrences, had completely upset him. He has never had apoplexy, nor delirium tremens. Present condition, 8th December.?On admission his behaviour was violent and boisterous,?shouting, talking and singing a lot of nonsense well interspersed with the use of obscene abuse. At first would not allow of his temperature being taken, but we managed a couple of hours later to take 93*2?. 'He sat up in bed the most part of this day ceaselessly swaying his body backwards and forwards, energetically talking, singing, or shouting, even when engaged at his meals, which he takes in quite an absent, mechanical manner, though with apparent avidity. His appearance is that of a tall, spare man, rather delicate. His face is a little flushed ; and his eyes, which are very. restless, are large, staring, sharp, and clear, and of a peculiarly brilliant expression which is very striking, but there is no vacancy of look. He has no tremors nor horrors. There are no sudden startings, or exhibitions of fear His tongue is white and dry, and his bowels are or dread. confined. Has most awful hallucinations : at one time believing himself God, damning to eternal flames his Colonel, officers, and comrades ; at another, considering it the Judgment day, waving his orderlies to the right and left, and delivering his blessings to the first and his curses to the second accordingly. On certain occasions he was Jesus Christ dead for the world and going to rise on the third day ; at others, throwing off his bed-clothes and gazing at himself, he would gravely declare he was "in the family-way'; that he was " the Blessed Virgin going to giye birth to the child Jesus in the stable at Bethlehem, on Good Friday," on which occasion he would compel Colonel P- an(^ Sergeant F. to kneel down and adore him, and " make apologies" to him. These latter seemed to be his longest delusions, and he imparted them freely, not only to every new-comer, but over and over again untiringly to those in charge of him, whom he as frequently damned as devils to hell, to fill up the intervals. He can usually recognise and name those around him, but is always incongruously mixing them up with "hell" and " the devils." He was isolated ; 2 orderlies were placed over him ; and he was to have Beef-tea diet. 3ss ?f chloral was given at bed-time, to be repeated in an hour if not asleep.
being
_
Subsequent progress: Second day.?Took both draughts, but had no sleep whatever. Was restless throughout the night. Bowels are still confined. Delusions about the same as yesterday ; still launching out in the most foul and profane abuse. Became extremely violent during the and
A CASE OF ACUTE MANIA. By P. W.
O'Gormau, Sub-Medical Department.
Where is the man," says Esquirol, "who would dare to flatter himself that he had observed and could describe all the symptoms of mania, even in a single case. The maniac is a Proteus, who, assuming all forms, escapes the observation of the most practised and watchful eye."?T. II. Tanner. Previous history.?W. B., (2nd-5th Fusiliers), aged 29, service 7 years, 11 months in India, was brought into the Agra Station Hospital, escorted by 4 men, at 5-30 A. M. on the 8tli December 1881, in the belief that he was mad. From accounts derived from his wife and comrades the following history was obtained. It appears that ever since his marriage, now about 6 months, he had been pretty freely indulging in beer and spirits ; that on the 25th November, i.e. 14 days ago, on returning from a cricket match, he had an attack of ague ushered in with vomiting ; and from that day had complained of feeling queer and out of sorts,?being easily disturbed and annoyed, though he had usually been a very
day, starting suddenly from bed, knocked over his attendant and, running past, escaped with a clear bound over the fourfoot hospital wall, on the other side of which he lay down on the approach of his orderlies, who conveyed him back. His left arm was found bruised a good deal, otherwise unhurt. Took his food fairly well. Is very abusive and boisterous, and has to be held down. During these struggles in bed h e has a painfully animal-like appearance, with glaring eyeballs, clenched teeth, parted lips, and panting breath. Four orderlies took charge of him with strict injunctions to use but quiet restraint and avoid every harsh treatment. To his diet were added 2 extra pints of Beef-tea and 2 of chicken-tea. ^ iii Haust. Senna? Co., procured one stool, which he passed with his urine in bed-clothes. In the evening with very great difficulty a warm bath was administered, cold water being poured on his head the while ; after which 3 ss Liq. Morphiie hyd. was given, and repeated in two hours. Third day.?The opiates had no effect : this is supposed to be the 9th day without sleep (?)? weaker and quieter than last evening, though still violent and restless, and even endeavouring to throw off the coverings which served the more easily to secure him in bed. The same delusions as yesterday. Took his nourishment fairly well during the day. Slept for 2 hours ia the evening, awaking with a start. Be_
October 2,
1882.]
A MIRROR OF HOSPITAL PRACTICE.
came extremely violent and furious, making fierce snaps with his teeth at cup or spoon held near his mouth, thus all drinks offered him, and ferociously clutching wasting the pillow and bed-clothes with his teeth, or violently and ceaselessly dashing his head up and down against the pillow. Skin hot; pulse full and frequent. Brandy jss every 2nd hour to be given alternately with a mixture of grs. x each of Chloral and Bromide so long as awake. In the evening he quietly suffered his hair to be cut away, and seemed to like the operation. Cold water was applied to the head and sinapisms to the legs below the
knees.
Fourth day.?No sleep. Was very troublesome and dangerall last night ; tore most of his clothing, which had to be removed, except his coverings. This morning his skin is cool ; pulse full, soft, and regular. Tongue moist and clean. Pupils normal. Was raving and furious all day, requiring constant control and watching. In the evening was very restless, and still kept jerking his head up and down on the pillow and striking the bed on each side with his hands for long periods together. Wont take his nourishment, spits it out of his mouth or snaps at the cup. The brandy was omitted in the evening. Chloral 3 ss and Pot. Bromide grs. x at bed-time, to be repeated in an hour if needed. If still no effect within two hours, the Chloral and Bromide mixture to be continued as before. Fifth day.?Slept the whole night (about 6 hours) after the first draught : a remarkable change this morning. Is very much quieter and more subdued. Turns about restlessly in bed from side to side, but persistently keeps his eyes firmly closed without speaking to any one, or answering or heeding questions in the slightest degree : had he been quite alone he could not have taken less notice of those about him. He remained very quiet for the greater part of the day, but towards evening became more restless and a little talkative. " When spoken to, expresses himself ironically, giving very knowing" replies, and winds up by endeavouring to spit on the questioner. Took his food very well. Passed some urine. He was to receive no medicine unless he became furious or talkative, when the Chloral and Bromide mixture was to be given. At bed-timo the chloral draught was administered. Sixth day? Slept in doses for the greater part of the night. Is much better in appearance this morning, and though still violent and restless, is very much weaker, requiring less forcible control. Is very suspicious of every new comer (medical attendant), whose movements he vigilantly follows with his eyes and head, attempting to spit on him if he approach too near. Passed stool and urine in bed-clothes. Cold to head was now omitted ; other treatment as yesterday. Draught at bed-time if necessary. Seventh day.?Slept without draught a good part of the night. Very quiet to-day : won't speak or pay any lieed to questions ; but in the afternoon became rather restless and talkative. Took his food well. Very quiet and merry in the evening: "''keeping time" with his head and energetically whistling Garry Owen" (incorrectly) without in the least noticing any one although being turned about and.raised out of bed for the purpose of removing soiled linen. Won't notice questions. Two pints of milk added to his diet. \ iii Senna mixture. Repeat draught at bed-time. Eighth day.?Slept at night. About the same as yesterday. Purgative did not operate, so tried him with a drop of Croton oil 011 sugar, but his suspicions being aroused he immediately spat it out again. As the sacro-gluteal region shewed signs of congestion, Tannin and Spirit lotion was to be applied. Draught H. S. Ninth day.?Slept at intervals during night. Appears much better this morning: has less of that maniacal glare, and general appearance, is much improved. Has a severe abrasion on both legs from kicking, to which zinc ointment was to be applied. Spat out the Croton oil though twice attempted to be given disguised in lemonade. Has been much more sensible and rational to-day, and exhibited a most marked change in his. for the first time, asking for the urinal to pass water in. Is very suspicious and vigilant, and replies to " queries in a very " dry" and knowing" way. Treatment continued. Tenth day.?Slept well last night. Is much better. The delusions of " hell" and the devils returned to him this morning, but were of a much more subdued kind. In the evening became more rational, and could recognise his attendants. His replies, when spoken to, are much quieter ous
237
and more to the point though given in the still cunninjr Asked for food himself to-day, which he took well without any wilful mischievous Bowels were wastage. moved. Called for bed-pan and urinal in case of his every use of them ; but getting into a pet on the last occasion threw them at his orderly and broke the former. Eleventh day.?Xo delusions to-day. Pulse, which he barely allowed to be felt, was full, soft and regular ; skin cool and moist. Reasoning powers improving in every way Conversed with the priest and read his prayer book to-day. Took food well. Demanded why he was not allowed oat of bed to sit in chair for a couple of hours, jeerin?-ly deridinoany excuse. Is very suspicious of his over whom he keeps a sharp eye, and starts whenever a " hand is stretched towards him. Gives very cute" and " dry" replies, and refuses point blank to put out his tongue His diet was changed to low pudding, and 2 extra e?gs added Twelfth day.?Slept very well last night. There is a most remarkable change to-day. Is quite rational and sensible this morning for the first time; but feels very weak and much exhausted and tired. Fully realises and understands his present condition, and clearly remembers every occurrence throughout his illness, for his disrespect during which he begs forgiveness. Is much subdued and quietened, though still somewhat vigilant and suspicious. Took his meals very well. Passed one stool. The ulcerations on both le?-s ointment was continued. extending. The zinc Draught H. S Thirteenth day? Much better. In his perfect Feels Speaks quite rationally. very weak ; limbs are numbed and aching ; feels sore all over. No hallucinations, illusions Was up incLair for 2 or 3 hours or starting dreams. ; says ho feels better for it. No headache. Had one stool. Herpetic on has lips. Tongue sore, protruded with eruption appeared difficulty tremulously and only partially, and twisting from side to side ; says he can t put it out further ; it is and clean though somewhat dry. Two orderlies were sent away was diet His and an changed, addition of fresh to-day. vegetables allowed. Poultices were applied to the feet. Fourteenth day.?Slept only in doses. Is not so well this morning. Bowels purged freely. Remained very unwell all day. No sleep ; is very restless, and tossing in bed from side to side. Did not take food so well. Skin very hot full and frequent. and pungent; manner.
medical?attendants?
senses.*
pafe
pulse
Morning temperature
98-2? ; evening 102-6?. Diaphoretic mixture every 2nd hour to be given, and night draught if needed. set in Reactionary pyrexia accompanied with the usual restlessness, delirium, headache, photophobia and intolerance of sound. The temperature rose to 105? on the 4th day of fever, when phlebitis of the left leg set in, the limb swelling much and the courses of the veins exhibiting distinct bluish traces, chiefly of the Saphenic vein, which was also painful and tender to the touch. The knee and ankle were also much inflamed, and over the latter a small abscess formed and had to be opened. This lasted about a fortin^ht the temperature usually ranging 102?, and gradually sinking after the 4th day. On this day his left hand became somewhat numbed and he could not grasp with it as strongly as with the right. This, however, was gradually overcome as he regained his normal health. For some months after though quite recovered, he was still detained in hospital as a safe measure to obviate a relapse till proper arrangements could be made for his transfer to Europe. And when I last eaw him in June he had not only much improved in health, but had even grown quite stout.
pink?
?
\
/
obtain
man,?till about the 3rd instant, when he could sleep, and first began to have strange delusions of
retired no
in hell and among devils. He became very talkative and eccentric, and his hallucinations increased in strength daily, till the whole of the previous night he was alarmingly boisterous, and made use of the most obscene and blaspheHis mous language in spite of all efforts to quieten him. wife states that since his last febrile attack he had only 2 pints of beer a day (?). and that his appetite had increased largely. As he himself afterwards confessed, he has had some private family matters preying on his mind, and these, capped with some recent occurrences, had completely upset him. He has never had apoplexy, nor delirium tremens. Present condition, 8th December.?On admission his behaviour was violent and boisterous,?shouting, talking and singing a lot of nonsense well interspersed with the use of obscene abuse. At first would not allow of his temperature being taken, but we managed a couple of hours later to take 93*2?. 'He sat up in bed the most part of this day ceaselessly swaying his body backwards and forwards, energetically talking, singing, or shouting, even when engaged at his meals, which he takes in quite an absent, mechanical manner, though with apparent avidity. His appearance is that of a tall, spare man, rather delicate. His face is a little flushed ; and his eyes, which are very. restless, are large, staring, sharp, and clear, and of a peculiarly brilliant expression which is very striking, but there is no vacancy of look. He has no tremors nor horrors. There are no sudden startings, or exhibitions of fear His tongue is white and dry, and his bowels are or dread. confined. Has most awful hallucinations : at one time believing himself God, damning to eternal flames his Colonel, officers, and comrades ; at another, considering it the Judgment day, waving his orderlies to the right and left, and delivering his blessings to the first and his curses to the second accordingly. On certain occasions he was Jesus Christ dead for the world and going to rise on the third day ; at others, throwing off his bed-clothes and gazing at himself, he would gravely declare he was "in the family-way'; that he was " the Blessed Virgin going to giye birth to the child Jesus in the stable at Bethlehem, on Good Friday," on which occasion he would compel Colonel P- an(^ Sergeant F. to kneel down and adore him, and " make apologies" to him. These latter seemed to be his longest delusions, and he imparted them freely, not only to every new-comer, but over and over again untiringly to those in charge of him, whom he as frequently damned as devils to hell, to fill up the intervals. He can usually recognise and name those around him, but is always incongruously mixing them up with "hell" and " the devils." He was isolated ; 2 orderlies were placed over him ; and he was to have Beef-tea diet. 3ss ?f chloral was given at bed-time, to be repeated in an hour if not asleep.
being
_
Subsequent progress: Second day.?Took both draughts, but had no sleep whatever. Was restless throughout the night. Bowels are still confined. Delusions about the same as yesterday ; still launching out in the most foul and profane abuse. Became extremely violent during the and
A CASE OF ACUTE MANIA. By P. W.
O'Gormau, Sub-Medical Department.
Where is the man," says Esquirol, "who would dare to flatter himself that he had observed and could describe all the symptoms of mania, even in a single case. The maniac is a Proteus, who, assuming all forms, escapes the observation of the most practised and watchful eye."?T. II. Tanner. Previous history.?W. B., (2nd-5th Fusiliers), aged 29, service 7 years, 11 months in India, was brought into the Agra Station Hospital, escorted by 4 men, at 5-30 A. M. on the 8tli December 1881, in the belief that he was mad. From accounts derived from his wife and comrades the following history was obtained. It appears that ever since his marriage, now about 6 months, he had been pretty freely indulging in beer and spirits ; that on the 25th November, i.e. 14 days ago, on returning from a cricket match, he had an attack of ague ushered in with vomiting ; and from that day had complained of feeling queer and out of sorts,?being easily disturbed and annoyed, though he had usually been a very
day, starting suddenly from bed, knocked over his attendant and, running past, escaped with a clear bound over the fourfoot hospital wall, on the other side of which he lay down on the approach of his orderlies, who conveyed him back. His left arm was found bruised a good deal, otherwise unhurt. Took his food fairly well. Is very abusive and boisterous, and has to be held down. During these struggles in bed h e has a painfully animal-like appearance, with glaring eyeballs, clenched teeth, parted lips, and panting breath. Four orderlies took charge of him with strict injunctions to use but quiet restraint and avoid every harsh treatment. To his diet were added 2 extra pints of Beef-tea and 2 of chicken-tea. ^ iii Haust. Senna? Co., procured one stool, which he passed with his urine in bed-clothes. In the evening with very great difficulty a warm bath was administered, cold water being poured on his head the while ; after which 3 ss Liq. Morphiie hyd. was given, and repeated in two hours. Third day.?The opiates had no effect : this is supposed to be the 9th day without sleep (?)? weaker and quieter than last evening, though still violent and restless, and even endeavouring to throw off the coverings which served the more easily to secure him in bed. The same delusions as yesterday. Took his nourishment fairly well during the day. Slept for 2 hours ia the evening, awaking with a start. Be_
October 2,
1882.]
A MIRROR OF HOSPITAL PRACTICE.
came extremely violent and furious, making fierce snaps with his teeth at cup or spoon held near his mouth, thus all drinks offered him, and ferociously clutching wasting the pillow and bed-clothes with his teeth, or violently and ceaselessly dashing his head up and down against the pillow. Skin hot; pulse full and frequent. Brandy jss every 2nd hour to be given alternately with a mixture of grs. x each of Chloral and Bromide so long as awake. In the evening he quietly suffered his hair to be cut away, and seemed to like the operation. Cold water was applied to the head and sinapisms to the legs below the
knees.
Fourth day.?No sleep. Was very troublesome and dangerall last night ; tore most of his clothing, which had to be removed, except his coverings. This morning his skin is cool ; pulse full, soft, and regular. Tongue moist and clean. Pupils normal. Was raving and furious all day, requiring constant control and watching. In the evening was very restless, and still kept jerking his head up and down on the pillow and striking the bed on each side with his hands for long periods together. Wont take his nourishment, spits it out of his mouth or snaps at the cup. The brandy was omitted in the evening. Chloral 3 ss and Pot. Bromide grs. x at bed-time, to be repeated in an hour if needed. If still no effect within two hours, the Chloral and Bromide mixture to be continued as before. Fifth day.?Slept the whole night (about 6 hours) after the first draught : a remarkable change this morning. Is very much quieter and more subdued. Turns about restlessly in bed from side to side, but persistently keeps his eyes firmly closed without speaking to any one, or answering or heeding questions in the slightest degree : had he been quite alone he could not have taken less notice of those about him. He remained very quiet for the greater part of the day, but towards evening became more restless and a little talkative. " When spoken to, expresses himself ironically, giving very knowing" replies, and winds up by endeavouring to spit on the questioner. Took his food very well. Passed some urine. He was to receive no medicine unless he became furious or talkative, when the Chloral and Bromide mixture was to be given. At bed-timo the chloral draught was administered. Sixth day? Slept in doses for the greater part of the night. Is much better in appearance this morning, and though still violent and restless, is very much weaker, requiring less forcible control. Is very suspicious of every new comer (medical attendant), whose movements he vigilantly follows with his eyes and head, attempting to spit on him if he approach too near. Passed stool and urine in bed-clothes. Cold to head was now omitted ; other treatment as yesterday. Draught at bed-time if necessary. Seventh day.?Slept without draught a good part of the night. Very quiet to-day : won't speak or pay any lieed to questions ; but in the afternoon became rather restless and talkative. Took his food well. Very quiet and merry in the evening: "''keeping time" with his head and energetically whistling Garry Owen" (incorrectly) without in the least noticing any one although being turned about and.raised out of bed for the purpose of removing soiled linen. Won't notice questions. Two pints of milk added to his diet. \ iii Senna mixture. Repeat draught at bed-time. Eighth day.?Slept at night. About the same as yesterday. Purgative did not operate, so tried him with a drop of Croton oil 011 sugar, but his suspicions being aroused he immediately spat it out again. As the sacro-gluteal region shewed signs of congestion, Tannin and Spirit lotion was to be applied. Draught H. S. Ninth day.?Slept at intervals during night. Appears much better this morning: has less of that maniacal glare, and general appearance, is much improved. Has a severe abrasion on both legs from kicking, to which zinc ointment was to be applied. Spat out the Croton oil though twice attempted to be given disguised in lemonade. Has been much more sensible and rational to-day, and exhibited a most marked change in his. for the first time, asking for the urinal to pass water in. Is very suspicious and vigilant, and replies to " queries in a very " dry" and knowing" way. Treatment continued. Tenth day.?Slept well last night. Is much better. The delusions of " hell" and the devils returned to him this morning, but were of a much more subdued kind. In the evening became more rational, and could recognise his attendants. His replies, when spoken to, are much quieter ous
237
and more to the point though given in the still cunninjr Asked for food himself to-day, which he took well without any wilful mischievous Bowels were wastage. moved. Called for bed-pan and urinal in case of his every use of them ; but getting into a pet on the last occasion threw them at his orderly and broke the former. Eleventh day.?Xo delusions to-day. Pulse, which he barely allowed to be felt, was full, soft and regular ; skin cool and moist. Reasoning powers improving in every way Conversed with the priest and read his prayer book to-day. Took food well. Demanded why he was not allowed oat of bed to sit in chair for a couple of hours, jeerin?-ly deridinoany excuse. Is very suspicious of his over whom he keeps a sharp eye, and starts whenever a " hand is stretched towards him. Gives very cute" and " dry" replies, and refuses point blank to put out his tongue His diet was changed to low pudding, and 2 extra e?gs added Twelfth day.?Slept very well last night. There is a most remarkable change to-day. Is quite rational and sensible this morning for the first time; but feels very weak and much exhausted and tired. Fully realises and understands his present condition, and clearly remembers every occurrence throughout his illness, for his disrespect during which he begs forgiveness. Is much subdued and quietened, though still somewhat vigilant and suspicious. Took his meals very well. Passed one stool. The ulcerations on both le?-s ointment was continued. extending. The zinc Draught H. S Thirteenth day? Much better. In his perfect Feels Speaks quite rationally. very weak ; limbs are numbed and aching ; feels sore all over. No hallucinations, illusions Was up incLair for 2 or 3 hours or starting dreams. ; says ho feels better for it. No headache. Had one stool. Herpetic on has lips. Tongue sore, protruded with eruption appeared difficulty tremulously and only partially, and twisting from side to side ; says he can t put it out further ; it is and clean though somewhat dry. Two orderlies were sent away was diet His and an changed, addition of fresh to-day. vegetables allowed. Poultices were applied to the feet. Fourteenth day.?Slept only in doses. Is not so well this morning. Bowels purged freely. Remained very unwell all day. No sleep ; is very restless, and tossing in bed from side to side. Did not take food so well. Skin very hot full and frequent. and pungent; manner.
medical?attendants?
senses.*
pafe
pulse
Morning temperature
98-2? ; evening 102-6?. Diaphoretic mixture every 2nd hour to be given, and night draught if needed. set in Reactionary pyrexia accompanied with the usual restlessness, delirium, headache, photophobia and intolerance of sound. The temperature rose to 105? on the 4th day of fever, when phlebitis of the left leg set in, the limb swelling much and the courses of the veins exhibiting distinct bluish traces, chiefly of the Saphenic vein, which was also painful and tender to the touch. The knee and ankle were also much inflamed, and over the latter a small abscess formed and had to be opened. This lasted about a fortin^ht the temperature usually ranging 102?, and gradually sinking after the 4th day. On this day his left hand became somewhat numbed and he could not grasp with it as strongly as with the right. This, however, was gradually overcome as he regained his normal health. For some months after though quite recovered, he was still detained in hospital as a safe measure to obviate a relapse till proper arrangements could be made for his transfer to Europe. And when I last eaw him in June he had not only much improved in health, but had even grown quite stout.
pink?
?
\
/
