J. D. a man, thirty-five years of age, was admitted into the hospital in
October, 1796. He was a person of good education, and had been regularly
brought up to medicine, which he had practised in this town for several
years. It was stated by his friends, that, about two years before, he had
suffered a similar attack, which continued six months: but it appears
from the observations of some medical persons, that he never perfectly
recovered from it, although he returned to the exercise of his profession.
A laborious attention to business, and great apprehensions of the want of
success, were assigned as causes of his malady. In the beginning of the
year 1796 the disease recurred, and became so violent that it was
necessary to confine him.
At the time he was received into Bethlem hospital, he was in an unquiet
state, got little or no sleep, and was constantly speaking loudly: in
general he was worse towards evening. He appeared little sensible of
external objects: his exclamations were of the most incoherent nature.
During the time he was a patient he was thrice cupped on the scalp. After
each operation, he became rational to a certain degree; but these
intervals were of a short continuance, as he relapsed in the course of a
few hours. The scalp, particularly at the posterior part of the head, was
so loose that a considerable quantity of it could be gathered up by the
hand.[9] The violence of his exertions at last exhausted him, and on
December 11, he died. He was opened about twenty-four hours after death.
There was a large quantity of water between the dura mater and tunica
arachnoidea, and also between this latter membrane and the pia mater. The
tunica arachnoidea was thickened and opake; the vessels of the pia mater
were loaded with blood: when the medullary substance was cut into, it was
very abundant in bloody points: about three ounces of water were contained
in the lateral ventricles: the plexus choroides were remarkably turgid
with blood: a quantity of water was found in the theca vertebralis: the
consistence of the brain was natural.