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.