No. 8.—Admitted 1783.
No statement on record. He was a respectable country Clergyman: his friends say he was a hard student, neglecting exercise, and all attention to himself or his health, and which had, for some time previous to the attack of derangement, been in a very precarious state—the attack was very sudden and violent.
He has a leprous eruption, which has continued since the time of his admission until now, without any very perceptibly abatement. He was formerly the most furious maniac amongst the old incurable cases, though less strikingly peculiar in his appearance and manners than the one last described. During the paroxysms of his greatest fury, he appeared like one whose mind, from excruciating pain and dreadful mental provocation, was wrought up to the highest pitch of passion and revenge; so that he would, as though he had the object of his malignity before him, be incessantly repeating, through whole nights and days, some single phrase, such as, “damn’d dog,” with a sort of suppressed barking, roaring furiousness, even until he foamed at the mouth, and his face was black with passion.
He was most violent when the eruption appeared least on the external surface. When his mind was more at ease, he would play like a little child for whole days together, with the merest trifle, such as a piece of string or paper. At these times, when given any thing he likes, he has something singularly fascinating in his smile.
For this eruption, many things had been administered, without any permanent advantage. Solution of nitric acid, about three years ago, [152] appeared to have, for a time, a good effect; the eruption became somewhat less, and the mind less violent: but this might arise from the debilitating effects, rather than the radical removal of the cause of his disease. After this, the solution of nitrate of potash, had a good effect both on his mind and the disease of his skin, without reducing or debilitating his system. He has lived, for this last twelve months, on vegetable diet, and he is apparently better; but this may be a fallacious appearance, since his vital energies appear to be sinking.
OBSERVATION VI.
It has been said, by the late Dr. Jenner, and some others, that cutaneous disorders are common to the insane. I should think they are not very common. [153] This is the only case that I have seen, where the two have continued to exist together. Whether it was the original cause of his mental malady, I have not been able to ascertain, but it is certain, it aggravated it. That mania, in some instances, follows the disappearance of eruptions, ulcers, and other local diseases, particularly with females, is satisfactorily established; but in many instances, other causes co-operate.
In cases of dementia, arising apparently from continued pressure on the brain, the surface, from the general bad habit of the system, is liable to sores, boils, and ulcerations. This cannot be called a cutaneous disease; it is rather a symptom of the diseased state of the brain, than itself the cause of insanity. Glandular swellings, however, seem to have a more direct connection; but still they appear rather before, than after the alienation has taken place. In a few cases, I have noticed slight eruptions during recent paroxysms, and in two or three, immediately previous to their convalescent state. Had such appearances occurred more frequently, I should gladly have regarded them as favourable prognostics; but they might arise from strong medicines, their state of confinement, or they might be mere accidental coincidences. There are many instances of cures by accidental injuries, [154a] as well as by the accession of consumption and other physical diseases.
Here I leave the question for the present, till I come to some cases, where, according to the theory of such a connection subsisting, (which I believe is the case in a few instances,) the tartarized antimonial ointment has been applied; [154b] but I confess, that there is no part of my experience in which my sanguine expectations of cure, after a certain duration of the disease, on this principle of counteraction, have been more disappointed. In the early stages of insanity, it is decidedly the most valuable principle in our practice.