Mr. B—, an accountant æt. 37, was admitted into this hospital on February 6th, 1900, suffering from epileptic mania. That there was insanity or other diseases of the nervous system in his family history was denied, but his brother was said to be very eccentric and to take too much to drink. There was also a suspicion that another brother died of some mental or nervous disease. The patient was married at 21, and his wife had had four children—no miscarriages; the eldest and third are alive and in good health, æt. respectively 16 and 12; the second died at ½ years and the fourth at four months, both in convulsions. He was always excitable and masterful, and latterly had been very quarrelsome; he had always been a sober, steady, hard-working man and a good and kind husband and father. He had built up a good business as an accountant and estate agent. He had had good bodily health generally until five years ago, when he had an ischio-rectal abscess followed by a fistula, which was cured by operation. When he was a boy a brick fell on his head and caused a contused wound, the scar of which is about one and a half inches long on the left side behind, and in which he often had a stabbing pain. He had his first fit when he was 22 years of age, and for some years had them every fourteen to twenty-one days. In a fit he usually turned round and fell down, was unconscious for about an hour, slept about ten minutes, and was then all right. Twelve years ago he was assaulted and knocked down. He was picked up insensible and bleeding from his mouth, nose, and ears; his eyes were “bloodshot” for some time afterwards; he was unconscious for three days, then resumed his business. Since this accident he suffered from very severe headaches, and the fits gradually grew longer in duration and more frequent, until at the time of his admission he had them daily, and sometimes several on one day. Often during the fits latterly he had passed water and occasionally faeces. He had left internal strabismus. There was no syphilis. This was the first attack of mania, and was of a week's duration. For the previous six or eight weeks he had been excited, quarrelsome, and extravagant, but had attended to his business. He had threatened suicide, and to kill his wife. On his admission he was in a state of epileptic mania, talked continuously, complained of everything, said his food was poisoned, accused his wife and daughter of immorality, and was very emotional. He said he had intense pain in his head and was sure there was something seriously wrong with it. The urine contained neither albumen nor sugar. The excitement passed off quickly and he was discharged recovered on the 21st. He had several epileptic attacks during his stay. He was admitted again on January 23rd, 1901, with very similar symptoms. During the time he was at home he had not been able to do much work. When the acute excitement passed off, which it did in a few days, it was found that he had loss of memory and was somewhat demented. In addition to the epileptic attacks, which were very frequent and in which he wetted himself, he had fits which simulated epileptic fits; he fell down carefully and did not wet himself. The delusions persisted, and he was always complaining. In April he said he was going blind, and on examination optic neuritis was discovered. The urine at this time had a specific gravity of 1022, no albumen, no sugar. The optic neuritis rapidly went on to atrophy, and by June he was quite blind. On the evening of July 20th he was heard snoring loudly, and was found unconscious, sitting in his chair. He could not be roused; the temperature was 102°. Next morning he had regained consciousness; the temperature was 102°, the pulse 100, full and bounding, and the skin bathed in perspiration. In the evening he was drowsy but could be roused, answered when spoken to, and put out his tongue when asked to do so. The temperature was 105.8°, the pulse rapid, and the perspiration still very profuse. About six o'clock next morning (July 22nd) he again became comatose, and remained so until he died at 8.15 a.m. A post-mortem examination was made next day by Mr. P. G. Mould. There appeared to be nothing abnormal about the skull, and there was no sign that it had been fractured. The brain weighed 69 ounces, and was sent to the Pathological Laboratory at the Owens College for examination.
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