October 12. At 10 P.M. patient suddenly started up, and in a frightened manner asked, several times, “Was not the doctor in the room just now?” only the nurse having been present. Until 12 P.M. he laid in bed quietly without speaking; he afterward raised himself up and screamed out, in great excitement, “Who is that big fellow in the next room? He is so tall that he cannot get through the door! And now he is getting taller still. Now there are several of them; they are ghosts!” His voice was trembling, his extremities in constant convulsive movements. He was quieted, but only with great difficulty. Again and again he raised himself and anxiously looked at the door. Temperature, 38.5° C. (101.3° F.). In the morning the patient addressed the superintendent, as he entered, as follows: “Ah, good morning, dear Emily. I am very glad you are coming!” While saying so he was lying down quietly. Now and then he raised his head slightly and looked at the wall for a time, as if observing something, and his lips were moving as if he was talking to somebody. In the course of the day he vomited considerably, several times. Patient feels very weak, the speech is unintelligible, the tremor has increased. He entered into a short conversation, and thinks himself better than yesterday. Although very tired he cannot get to sleep. Pulse was strong throughout the day. Auscultation and percussion of the lungs and heart showed a normal condition. The bladder was empty and no urine was passed until 5 P.M. Several relaxed motions.
October 13. Toward midnight patient suddenly raised himself up, looked around, stretched his hands, as if frightened, and called out in a trembling voice, “What do you want? There is the—the ghost!” The voice next morning was hoarse, hesitating, unintelligible, devoid of sound. The features looked worn. During the whole of the day there was diarrhœa and vomiting. An injection of food into the bowels was given (after Leube).
October 14. Patient has slept for only a quarter of an hour in the night. The other part of the time he was dozing; vomited four times, and had four relaxed motions. At 5 A.M. he called out to those watching him during the night, “Come along, come along, quick, quick!” He gradually lost consciousness, did not move upon being called. Pulse 40, very small, hardly to be felt; respiration gasping, slow. Hippocratic face. Injected one-fourth of a grain of morphia. Pulse and respiration soon became regular, and he regained his consciousness. There was no vomiting during the day. The voice is still gone, the features worn. Toward the evening the patient had an injection of food (Leube) of sixteen and a half ounces. Great prostration. Skin moist and hot.
October 15. Patient had no sleep, but lay quietly in bed until about 2 A.M., when there was vomiting, oppression, moaning, clonic contractions of the muscles of the face and extremities. Pulse strong.
October 16. He had three relaxed motions, vomiting and bleeding of the nose during the night. During daytime patient felt well.
October 17. Patient has had no sleep during the night, but was quiet; vomiting and diarrhœa. In the day feeling of great weakness. Appetite good.
October 18. No sleep, patient feels thoroughly knocked up. In the afternoon he slept for a short time.
From this time the patient’s condition was satisfactory. He slept at first for three hours, afterward for five hours, at last during the whole of the night; the appetite increased considerably, the disposition was changed. He left the Institution on November 21st.
Urine.—The specific gravity of the urine vacillated between 1.019 and 1.029. A precipitation with alkaline solution of sulphate of copper was noticeable only occasionally.
The patient, whom I saw six months after his discharge, has had no relapse.