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: