May 13,1854  Age 34 Blacksmith [?] Thick,stout and muscular. He left his employment-trade-about a year ago without assigning any very definite reasons and has pottered about since that time, fishing more than doing any other work, but not accomplishing much in that line of business.Occasionally within a few months he has been disposed to drink [?] when it happened to be in his way. Was never [?] much [?] for company or companions neither had he obviously avoided them till within the last year. Now he wishes to be entirely alone. Within a few weeks he has fears that the whole family were coming to want. Has been continually racking his brain to ascertain how or from what  source they could be supplied with many of the necessaries of life. Night before last he declared they had but a small quantity of wood and did not see how they could possibly get any more, but after the family were asleep he got up and brought into the  yard a large quantity of sails [??] from a neighbor's [?].His friends brought him over securely handcuffed fearing they might have trouble with him. He looked so formidable that he was once taken to the solitary.
 May 14, After having been bathed and dressed a little-all the conducting (himself) with propriety-he looks so much better that he was allowed to come into the lower gallery.
 May 15,got into a fight with another patient who, the attendant thinks provoked him and got a black eye and an abrasion on his nose and a shallow wound of the upper eyelid. He is also found to be filthy-urinating and defecating in his pantaloons and spitting on the floor without the slightest compunction. Removed to solitary. Appetite good. Is taciturn-sometimes answering questions briefly and sometimes irrelevantly. Sits on the settee a large part of the time, generally getting his feet up, occupying the room of two or three persons.
 May 18,No change in his condition or appearance.Is disposed to strike other patients without any provocation, defiles his room and person day and night.
 May 22,Has been kept in confinement, was let out into the hall this morning and soon began to tear off the window screens.  Is always good natured and pleasant enough when we are talking with him. Appetite good. Has not shown any disposition to attack his attendant.
 May 26,He has just struck another patient, and is probably unsafe to be in the hall a moment without having some restraint.
 June 15, Has constantly worn the restraints [?] since last date. His filthy habits filthy habits have been in a measure corrected, His mental manifestations are abut the same. His attendant took him out to parlor[?] yesterday without the restraints; and at a moment when the attendant's back was turned he dashed into the woods, but was overtaken before he had gone a mile.
 July 1, No change since last date, Sleeps well and seems to be in excellent bodily health.
 July 10,Is occasionally visited by his friends, but is does not appear to make much impression on him.
 August 20, Has been in the same state of mind since last date; good natured and pleasant all the time;but his deportment is characterized by such a reckless indifference and don't care sort of manner that we do not consider him safe without the restraints. Is perfectly quiet about the and does not appear at all opposed to wearing them. Seldom makes any inquiries about friends. Mind rather incoherent. Has had two attacks of diarrhea which  were speedily checked by a few drops of laudanum.
 Sept. 11, soon after last note it was deemed expedient to leave him without restraint, and to change him from the solitary to the I.W.9.[?] This evidence of confidence on our part was well received by the patient, and strong attempts at self control were manifested, His dress soon began to attract his attention and care and his manners steadily improved--He was presently sent to the U.W.9. where he still continues one of the best behaved and properly disposed patient in that Hall. Father and mother were to see him today. Will take him home (if he continues to convalesce) the next time they come.
 Oct. 20, It was hope that this patient could be permitted to remain here, some time longer, that his complete [?] might be established -The father however has today removed him, impatient for his services. Patient may not relapse, but is impossible to feel no anxiety.
 Dec.1, Committed suicide soon after discharge.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Apr.29, 1854, Married: Agent for some western railroad. Has had impaired health and depression of spirits for some months past, Three or four weeks ago on his way to New York he got considerably excited and was obliged to go home. Since that time he has suffered acute depression of spirits and been unable to attend to any business.
 May 4,Had him suspected of some suicidal propensity before he was admitted and we have therefore assigned an attendant for him at night Does not sleep very well. Tho some each night, appetite rather small, regular. His mind is a good deal distressed, and he thinks he is [?] for this world and therefore is preparing for next by reading the bible diligently.Has a sad serious countenance and does not smile. Has been out to [?],[?] in the hall considerable.
 June 1, His condition remains about the same as at last date. His attendant thinks he does not sleep quite so well. Reads the bible constantly. Does a moderate amount of groaning and sighing. Rx Morphia 1/4 gr. morning & night.
 July 1, Is a little improved-- a little more cheerful and sociable-- a little more interested in worldly affairs-- in better spirits generally. Does not read his bible so attentively and constantly. Often assists the attendant in his duties about the gallery.Has not slept with an attendant for two weeks.
 Aug. 12, Mental condition scarcely changed since last date generally goes out on walk when others go without appearing to be much interested in the matter and returns without any apparent desire to further [?]any different direction. Often expresses his conviction in a very melancholy tone of voice that he can [?] be any better that he is "wholly lost," that everything is a "hell" to him. Cannot be induced to write to his wife. Was attacked with diarrhea last night ...[several notes about his bowels follow over the next two weeks]
 August 29,Has no diarrhoea and but little appetite tho his strength is considerable and he gets up and off his bed freely and without help. Is exceedingly cross and ill natured and does not now make any apology for it [?] and strikes at his attendant and those who have anything to do for him and loads them with the most opprobrious epithets he can command and threatens to kill [?] spits all over his room out of pure malice resists all his medicine but mine.
 Sept. 3, His irritability and ill humored disposition continue in full force, and he is only [?] with his vile language. Among other things asks only me persist in doctoring a dead man.
 Sept. 4, The resistance offered by the patient to medication, more than neutralizes the good therefrom--all medicine discontinued--[?].
 Sept. 6, [bowel problems] requests something for sleep--the laudanum is repeated
 Sept. 7,Patient has had no passage since last note-- Has been today rather more quiet than usual; not making a noise unless disturbed-- I not so abusive-- seems to have rather more confidence. Has taken Beef tea and crackers and milk today. No tinct of Opium since this morning Skin moist and warm--pulse 84 nearly natural Head not too warm--pupisl normal--complains of no physical pain--lungs[?]clear--extremities warm
 Sept. 8, Under the influence of 1/4 gr of Morphine he rested quietly last night. Is this morning considerably more composed --talks rationally as far as encouraged...
 Sept. 9, Patient continues quiet--Is no longer abusive...morphine tonight.
 Sept. 11,Patient seems to be slowly improving...morphine at night...an evacuation from the bowels is anxiously awaited for. Is not abusive, and appears to cherish a little hope of his ultimate recovery.
 Sept. 12, This evening patient is very quiet...having had no evacuation since the 6th...his digestive organs begin to show some degree of irritation...enema--night draught as usual...
 Sept. 15,Still gaining--Seems to have no delusions--acknowledges he was under hallucinations when he abused those who sought to aid him--...has a bad taste in mouth--Is more hopeful and much more considerate of those about him. Is still in bed...
 Sept. 17, ...Delusions not apparent, speaks of his hallucinations as such, and is hopeful of ultimate recovery...Still in bed--"Will get up in a few days"
 Sept. 19,Has been up and ...dressed this morning.Slept well last night, appetite returning...
 Sept. 27,While the mental health of this patient seems daily progressing toward complete sanity, an obstinate constipation oppresses him....
 Oct. 19, The rapid and decided convalescence of this patient continued without interruption to this date. ...He looks back with a very pretty feeling of gratitude to the times when he was ill. His wife came to see him today and he went home with her.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Oct 6, 1854,28 years old, A colored servant woman living in the family of Mr. J. of  Y.... she inherits the disease from her maternal grandmother. Always of a nervous temperament, the death of her husband occurring some months since, prior to considerable agitation which, though at first not incapacitating her from service, has been lately increased by trouble in relation to her husband's estate--The mother of four children her physical health has been ordinarily good, though now and then her mind has been a little excited by things of but little consequence--She has a brother insane--Is brought here in a camisole. Is noisy at night--singing and pounding upon the [?] --no disposition to mend or to destroy in any way self or other things Hallucinations spiritual in their general character--disposition rather [?] Manner apathetic.
 Patient complains of headache two weeks ago, but the first external manifestation of an insanity demanding restraint occurred on Sunday last (5 days ago)
 Oct.10 Patient having been much excited since admission has been in seclusion. Having destroyed her bed & clothing she stands in her room with no covering but a blanket thrown over her shoulders Rx Morphine.
 Oct.11,Last night as her excitement continued, Chloroform in the manner usually prescribed in this hospital was taken in addition to the Morphine and [?] This morning the report is she was quiet during the night and was found sleeping this morning. She is seen to be --on visiting her-- disposed to continue sleeping. & is composed to a good degree--Pulse 85--tongue clean--bowels moved last night--General appearance of patient is rather haggard. has taken little but gruel since admission. Chloroform & Morphine to be repeated this evening.
 Oct.13,Excitement seems to have entirely gone-- She is quietly lying on her bed reading, Appetite variable--Med continued.
 Oct. 19,If allowed to mingle among the other patients she becomes excited--spends much of the time in her rom. There seems no longer to be any indication for the [?] of Chloroform --The morphine however is continued--Books and newspapers are furnished her of which she occasionally makes some use.
 Nov.4,A period of excitement seems approaching. [?] Morph. & Chloroform.
 Nov.5, Patient much excited--medication continued. The Chloroform seems to have less effect than the Morphine.
 Nov.11,Patient's state much excited--is naked and noisy in her room--morphine continued twice or three times daily..
 Nov.21, Three or four nights since an attempt was made to place this patient under the influence of Ether--...failed as the reflex system seems to be too much affected. The respiration lessened in frequency to such an extent as to become alarming [?] was not induced--Patient is now taking Morphine & Chloroform in [?] is much the same.
 Nov. 29, Is gradually growing calmer under the influence of the Morphine-- Seems to have lost considerable of her physical strength.
 Jan.11,1855,Patient has remained with scarcely a noticeable change since last note. most of the time in her room , Her disposition to [?] and to become noisy, has seemed to indicate morphine, on which she has been kept. A string taken from her torn clothes was found one morning tied about one of her nipples in such a manner as to produce srang[?] It was feared the part might slough off but it became ultimately restored. A second attempt to etherize her was made last night. With a little better success than before. The respiration seems [?]affected. She was [?]less noisy during the night.
 Jan.18, Morphine discontinued-- J. has been etherized again since last note. The good effects in her case are hardly to be considered permanent.
 Jan.30,the use of Morphine in this case has been suspended for three weeks. It seems to make but little difference in her manner or with the manifestations of her disease. It has been observed in this case that each morning about 10 am J. has a paroxysm which lasts 1/2 or 3/4 of an hour during which she is very violent. This subsides after a while and she is comparatively quiet until evening.
 Feb.20,The paroxysms above referred to are not so well marked in their periodicity as was at first supposed . J. has been for a fortnight past much more quiet. not destroying anything during that time and [?]ding not a little.She consents to keep her clothes upon herself and speaks quite properly--when addressed.
 June 8, With now and then an attack of violence. with tearing her clothes and what books and newspapers may have been furnished her she has been much as at last note.
 August 31,J. has steadily improved since last note--is now quite well.
 Sept. 7,discharged.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

In 1857 A. T. H Waters wrote that the use of chloroform in mania had 'fallen into disuse.' He speculated that this might have been 'from too much having been anticipated from it, [or] from its having been indiscriminately used'. He makes a case for its use first by in puerperal mania by noting that the mortality in such cases is higher than generally recognized, 22 out of 280 cases that he has reviewed. The danger of 'fatal issue', he argues is due to 'exhaustion of the nervous power and physical depressions which supervene in consequence of the long-continued wakefulness, restlessness, and abstinence from food'. Opium, he agrees, 'occupies the first place ... for the purpose of controlling' mania. In severe forms of mania, however, he 'observed but little benefit' from its use. 'There are cases in which, from continued restlessness and obstinate refusal of the patient to take any thing whatever, opium cannot be administered; and again there are other cases in which, although administered, it produces no good result, but seems rather to increase the mental excitement ... It is, he continues, in such cases as these that we notice the great value of chloroform.' In one case presented by Waters a woman had 'refused all food, had no sleep and was very much excited'. After six days during which she had taken morphia as well as other treatments, 'she was put under chloroform, and an enema of beef-tea was administered whilst she was under its influence. The morphia was omitted. She slept for several hours after the exhibition of the chloroform, and when she awoke was much more quiet, and remained so for two days, during which she took her food' [Waters, 1857, 341-353].

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