In an asylum one not uncommonly sees cases of weak-mindedness consequent on apoplectic fits, but it is not very common for one to have an opportunity of watching the effects of mental disorganization associated with changes which ultimately lead to apoplexy. In the subjoined case I had an opportunity of seeing constantly for some months a gentleman who finally died with severe apoplectic fits. He was a man whom I had known for years, and therefore I was better able to judge of any intellectual and other change which occurred in him. He was married, and 55 years of age, of a gouty habit, one who had lived well, eaten largely, and enjoyed life, but had never been intemperate. He had never suffered from any severe constitutional disease, and up to the last year of his life had been remarkable for his constant work and general ability—a man of considerably more than the usual amount of intellectual force and inventiveness. When first called to see him he was suffering from sleeplessness, and some neuralgic pains, fixing themselves chiefly in his eye-balls, so that he tried various kinds of spectacles, and consulted many medical men, because he thought there was some trouble associated with his eyes. I was unable to make out any hallucinations of any kind at that time, his one complaint being that of persistent sleeplessness. About the same time he became irritable, and his servants were constantly being changed. He was unable to keep his coachman, and therefore suppressed his carriage. He became emotional, and his memory failed. After these symptoms had existed for some weeks, the sleeplessness continuing, hallucinations of hearing became marked, so that on several occasions he got up at night, believing a bell had rung, and his wife was unable to persuade him that no bell had sounded at all. He became troublesome in consequence of these hallucinations, which troubled him most at night in the way of bell-ringing; but during the day he had other annoyances, which he said were due to his unusual keenness of hearing, so that he declared that he could hear his servants in the kitchen talking, this being impossible. He was recommended for these symptoms to try a change, and he went down to the Isle of Wight, where for a time he seemed better. He always seemed benefited during a change, but very rapidly relapsed on his return home. On one or two railway journeys he caused annoyance and trouble to his travelling companion by the worry he made because he fancied he heard a Westinghouse break attached to the railway carriage. He stopped at each of the stations on the line, and demanded to see the station-master, whom he told that he would not have the Westinghouse break fixed on to the wheel of his carriage while it was in rapid motion. Nothing would persuade him but that some break was attached to his carriage, and was causing a most unpleasant jarring sound. When his companion told him that no such sound was audible, he became angered at contradiction, and prostrated himself on the floor to listen to it the more readily. Change, with some rest, and talks about the possibility of its being due to hallucination, did him good for a time. He had a change to the sea-side, but after this, the sleep being rather better, and he rather less emotional and irritable, he became loquacious, and excessively fond of talking of his own worries and ailments, his memory remaining weak. He now developed hallucinations of smell, and became a complete nuisance to all his family and friends; he would accept none of their statements that these stinks were subjective, but said that there was always some smell of smoke, and that he believed that in his household they were constantly cooking and burning what they were cooking, and it was a disgrace that this should be allowed to take place. He said it was not only his nose that was affected, but also his eyes, and that his eyes smarted and were uneasy in consequence of this smell. At one time he was so convinced about these smells being real, that he even abused friends into whose houses he went for having the same want of method in cooking that he found in his own house, and had almost got the idea that there was a general conspiracy to annoy and worry him. At times these sensations varied, so that besides those of smoke and cooking, he also had smells as from drains. During the whole of this time he was losing flesh, and becoming weaker. The symptoms kept very much in the condition which I have last described, till one day he had an apoplectic fit, affecting the left side. The convulsions were extremely severe. He never regained consciousness, but died within a week.
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