76

ANNUAL REPORT OF THE MANAGERS

Woman, age forty-seven; married; native of New York; no insane relations; patient usually enjoyed good health until about a year before admission, when she lost in flesh and became wakeful, due to overwork; for a year was gloomy and despondent; lost all interest in her household duties; said everything was wrong about her house; became suspicious; said she was to be poisoned; cried and moaned much of the time; talked often of suicide; in attempting it, took one ounce of laudanum, which she vomited as soon as swallowed; at another time, hung herself behind a door in a hoop skirt; was detected and then closely watched; for some time carried a butcher knife, and at night placed it under her pillow with the knowledge of her friends; on admission, was melancholy; seemed to realize that she was sick, and confessed that she was insane; she slept well the following night and in the morning was cheerful; talked freely of her condition, and expressed herself well satisfied that she was brought to the asylum; in the afternoon of the same day spoke of the disgrace of suicide, and said "but for my husband, I would have been dead long ago; she retired as usual in an associate dormitory the following night, and seemed quite cheerful; at about nine P. M., complained of slight colic, which was soon relieved; at one and three A. M., the following morning, the night watch found her sleeping; at four A. M., she got out of bed and walked a few times up and down the room, waking some of the patients and conversing with them; she then retired and the patients went to sleep; at five A. M., again visited by night watch, when she found life extinct, but body warm; at once reported to physicians; on examination, her hands were bloody, night dress thoroughly saturated with blood;

the hair mattrass and straw tick contained clotted blood, and a pool under the bed; in the bed was found a small piece of the rim of an earthern vessel, about one by one and a half inches in size, with one very sharp edge; this was covered with blood; on the floor was two other pieces of freshly broken earthenware, which, with the first piece, fitted exactly the broken space in the chamber under her bed; during all this, none of the patients were awaked; the body was colorless; two cuts were found in groin, parallel to a line drawn from the anterior superior spinous process of the crest of the ilium, to a point two inches below the symphisis pubis; each were four inches in length, and at the deepest point one and a quarter inches, dividing the femoral artery completely on the left side, and cutting a small opening in the femoral, on the right side; on the right side, there were four small cuts besides the deep one; there were also numerous scratches in left elbow joint; the husband subsequently stated that he had frequently noticed her reading a school book on anatomy and physiology.

Woman, aged 39; married, no children, good habits; native of Ireland. She was always a hard-working woman and enjoyed good health, with the exception of an attack of muscular rheumatism. In August last had a fit; could not speak for a few minutes afterward; complained of numbness of hands and feet; about four weeks before coming to the asylum, had another fit, with loss of speech; after this she grew feeble in mind, became dull and sleepy, was indifferent and forgetful; frequently put only bread on the table; complained of headache soon after the last fit; after the the third fit became helpless and speechless, but retained consciousness; after this was noisy and maniacal, at

times singing, laughing, crying; her appetite was good, but she lost in flesh; on admission was talkative and noisy; hesitancy and thickness in speech, so that at times she could with difficulty be understood; talked like a person intoxicated; also marked complacency of countenance; said she was well and never enjoyed better health; gait unsteady; no change in pupils; was frequently maniacal and destructive, at other times laughing, crying or singing; her appetitite was good and she usually slept well; the paretic attacks were frequent, and her speech became more disturbed. For a week previous to her death had paralysis of right side, which continued; deglutition was difficult; passed her excrement in bed; she gradually failed, and died paralyzed five months after admission.

Autopsy. Skull-cap normal; dura mater adherent to skullcap; subarachnoid serous effusion; meningeal vessels distended with blood; on surface of left hemisphere were two blood clots. Right hemisphere was much larger than the left, and all the convolutions were softened; left hemisphere was harder than usual, and gray matter very thin. Left lobe of cerebellum softened, right lobe indurated; pons variolii and medulla soft.

Woman, age 48, single, good habits, native of New York; patient usually enjoyed good health till attack of insanity in 1845. In 1847 was admitted to the asylum; she had always been a nervous, excitable person, and considered eccentric; resided alone, because of her peculiar behavior no one would live with her; on admission was quiet, in fair flesh, showed evidences of having been insane for some time, was idle and retiring, irritable and seclusive for some years afterward; interested herself in sewing most of the time; developed delusions that she owned the asylum and was married; was usually

quiet, and continued in her ordinary health until about two years preceding her death, when she began to grow more feeble both in mind and body; she dabbled in water and was childish, working over her dresses very frequently. From this time she required constant care as a feeble old woman, but retained her delusions. After complaining of headache during the day she died suddenly in the evening.

Autopsy. Skull-cap thin, dura mater firmly adherent at vevtex; between dura mater and skull-cap, at the upper part of right parietal bone, a recent blood clot measuring two inches in length by one in breadth; vessels in frontal region pale and contained only serum-considerable subarachnoid effusion.

Thorax.-Old pleuritic adhesions binding right lung to walls of the chest, upper lobe of right lung contained a small abscess filled with pus.

Woman, age 50, widow, seven children, no hereditary tendency to insanity. Patient was said to have been insane for four weeks; nothing further was known of the case by the officer who accompanied her to the asylum. In office presented all the symptoms of general paresis; twitchings at the angles of the mouth, tremulousness of the tongue, hesitancy of speech, and unsteadiness of gait; her pupils were of unequal size; had delusions of wealth, said she owned the whole world; was serene, placid, and seemed to be perfectly happy; was thin in flesh, and complained of headache. For some days after admission she continued quiet; very feeble in both mind and body; had to be dressed and undressed; was stupid; ate fairly and usually slept well; two months after had a paretic seizure; from this time lost complete control of her sphincter; pupils contracted, tongue more tremulous, and increased hesitancy in speech, with great difficulty in protruding the tongue; had a

number of paretic seizures during the last two months. Died paralyzed four months after admission.

Autopsy-Skull-cap normal. Dura mater adherent to arachnoid. Convolutions of cerebrum atrophied and softened; gray matter very thin; a number of apoplectic clots at junction of lower cervical and upper dorsal; vertebræ adherent to sheath of spinal cord.

Thorax.-About six ounces of serum in right pleural cavity; a number of calcareous deposits in right lung.

Woman, age 48; widow, two children; good habits; native of Massachusetts. Insanity not hereditary. Patient was unwell for about six years; suffered from headaches and umbilical hernia; at one time was very fleshy, weighing 300 pounds. The tumor, which was the size of a goose egg, became smaller about a year before admission, and a fistulous opening appeared which discharged constantly a muco-purulent matter. Symptoms of insanity developed about two months before coming to the asylum; was talkative, excited and incoherent in speech, suspicious of her friends and family, ate irregularly and was wakeful at night; threatened to kill her children. This was her condition on admission. She gradually grew feeble and was put to bed. Fistulous opening discharged fæcal matter and was offensive. On the fourteenth day after admission had a severe epileptic fit, and, on the day following, had three more. She took liquid food in small quantity and usually slept well. About two weeks after had another severe epileptic fit and became maniacal and violent. Choroid plexus contained large cysts; pineal gland large and pale; vessels of the circle of melis atheromatous. Weight of brain forty-three and onehalf ounces.