R. B. This man had been many years an incurable patient, and it was
supposed that jealousy of his wife had been the cause of his madness,
although it appeared from very respectable testimony that he had no real
grounds for such suspicion. During eight years, (the period he was subject
to my observation,) he was mostly in a very furious state, and obliged to
be strictly confined. His mischeivous disposition was manifested on every
occasion; he would hurl the bowl, in which his food was served, against
those who passed his cell; and when his hands were secured he would kick,
bite, or throw his head into the stomachs of those who came near him. He
entertained a constant aversion to his keeper, whom he suspected to be
connected with his wife. His life was miserably divided between furious
paroxysms and melancholic languor, and there was great uncertainty in the
duration of these states. He has been known to continue ten months in the
highest degree of violence, and relapse into the same state after a few
days passed in tranquil depression. There was one circumstance which never
failed to produce a relapse, however quietly he might have conducted
himself, this was a visit from any of his family, and a very striking
instance occurred. From May, 1799, to September, 1800, he had every
appearance of being perfectly recovered: he was, in consequence, allowed
additional comforts, and treated as a convalescent. At this time he was
visited by his son, who, after many hours conversation with him, was
persuaded that he had perfectly recovered his intellects; and he expressed
himself astonished at his father's accurate recollection of particulars
which might be supposed to have been obliterated from his mind. This
dutiful visit and affectionate intercourse produced unpleasant
consequences. The numerous enquiries which the patient had made, furnished
him with materials for reflexion. On the departure of his son he began to
detect mismanagement in his affairs, and improprieties in the conduct of
his family: he was very talkative, and became impatient to return home.
The following day he had a wildness in his eyes, spoke fast, and appeared
busy: before the evening he was so irritable and disobedient that it
became necessary to confine him. From this time he continued in the most
furious condition, singing and vociferating the greatest part of the
night, until January 2d, 1801, when he became suddenly calm, complained of
extreme debility, and said he should die in a few hours. He gave very
proper answers to the questions which were asked him, but complained of
the fatigue which talking induced. On the next morning he expired. He was
sixty-eight years of age. The head was opened two days after his death.
The tunica arachnoidea was in many places opake, and considerably
thickened. There was a small quantity of limpid water between this
membrane and the pia mater. When the medullary substance was cut into,
there oozed from many points a quantity of dark blood, indeed the whole
head was loaded with venous blood. The lateral ventricles were
considerably enlarged and filled with water--four ounces were collected.
The internal carotid arteries were much enlarged, and when divided, did
not collapse, but remained open, as arteries in the other parts of the
body. The consistence of the brain was doughy.