Admission Details for Patient: Jeremiah Owen (2424)
Gender: Male Age: 39
Marital Status: Single Religion: Calvinist Methodist
Occupation: Copper Miner
Address: Llaneilian, Anglesey
Date of Admission: February 6, 1875
Date of Death: December 28, 1895
Cause of Death: Pulm.Phthisis/Exhaustion
Disease: Chronic Mania
Supposed Cause: Supposed fever at America
I asked several questions and he refused to answer any. He was reading his Bible and he would not take away his eyes from it. He had an anxious distracted expression of his countenance. Robert Williams tells me he has been to America and returned 2 years ago, and he has not been in a sane state of mind since. A few weeks ago, he said he was very anxious to see his mother buried (earth placed over her) and that he is determined to destroy her. He was a member of the Chapel and at a private meeting he rose and said that the leaders did not behave towards him as they ought and that he would have to leave the chapel or his work. He says his mother is the cause of all his troubles in America, in Yorkshire, in the Chapel, and in his present employment. Carries a gun and his mother is afraid of him. Thos. Hughes, Amlwch
Approximate duration of present attack: 2 years
Number of Previous Attacks: 0
Number of Previous Admissions: 0
Number of Subsequent Admissions: 0
Total Number of Admissions: 1
Physical/Mental State at Examination: Free from bruises. Medium height, sparely built, wiry looking. Nervous temperament. Manacled. Tongue trembles slightly. Pulse 92. Slight dullness at right apex, breathing has rustling character on left side. Right hand puffed. Patient states it has been in cold weather several winters. He is rather depressed in appearance, speaks slowly but volubly, memory apparently good. (Pupils dilated). Coherent and no excitement of manner till he speaks and then he evidently feels deeply. Says he has led a fast life till last few years. Sleeps badly, no hallucinations. Believes he has been treated badly, that he tried to live as a Christian but found it impossible to live without hating people, that his mother interfered with his endeavours to be godly, that he should rather see her buried than that she should continue so, that the Chapel people treated him unfairly and set people to try to prevent him. Says he is not unhappy but that people set upon him so.
Current Diagnosis: Severe Depressive Episode (F32.2)
1875 Mar 18 - Improved and goes out to work in the fields. 25 - Greatly improved since last report and works still in the fields. Very religious, somewhat excited, pupils unequal, bodily health good.
Apr 5 - Examined his lungs. Probable deposit of crude tubercle.
Roughness of inspiration, murmur on left side with slight bronchophony.
Chest not very resonant on percussion.
On right in sub-clavicular and mammary regions a want of resonance.
Mental condition in status quo.
Somewhat churlish in his manner.
Pupils still unequal. Working willingly in the fields.
June 4 - Some improvement. Says that he has a failure in his head and that he cannot help it and that he hopes to get well here. Not so churlish in his manner.
July 28 - No improvement. Does not speak unless spoken to when he answers readily. Very industrious, no delusions, has not had a single epileptic attack since admission. (Sept 1876 to December 1878 - Notes indicate little change).
1879 Jan - Has given up all work and does nothing now but read all day. Rarely talks. In good health.
Aug - Will not work. Will only read all day with uplifted eyebrows and an expression of great piety. Will not speak. 1880 Jan 28 - Today he is almost affable when spoken to. Still reading but not so much.
Apr 20 - Reading hard again. Expression more serious and despondent.
Sept 16 - Reading hard. Expression very anxious.
Face pale, health moderate. 1881July 3 - Does nothing but read the prayer book.
Intelligence small. Nov 11 - Helps at times in cleaning the wards.
1882 Feb 16 - Is losing flesh.
Apr 19 - Health deteriorating.
Depressed and very religious.
His face is full of wrinkles and wears an intensely pious expression.
1883 Aug 20 - Escaped this morning at 9 and was retaken at 10.
1884 Nov 1 - A chronic maniac of a quiet and harmless nature.
(July 1885 to Jan 1889 - Notes indicate little change).
1889 Mar 19 - Found him in bed this morning and on left foot a sinus behind internal malleolus.
Discharge very foul and there appears to be exposed bone at extremity of sinus.
Made a counter opening, inserted a drainage tube and dressed.
Says that he has had much pain and swelling in the part for the last fortnight.
It is probable that there is dead bone present which will have to be removed.
Mar 22 - Lying quietly in bed.
Discharge less foul. Tongue coated.
Poor appetite and is with great difficulty got to take enough food to maintain life, much less to combat the existing morbid condition, and it is useless pressing him for he is obstinacy itself.
Apr 6 - No attempt at healing and the probe still reveals diseased bone. Therefore this afternoon anaesthetised patient and cut down upon the internal malleolus. Gouged away a large quantity of diseased bone.
Packed with lint in carbolized oil.
Bandaged and put in bed, the operation being perfectly bloodless. Apr Apr 7 - Dressed today. The plug very foul. No fever. Apr 9 - Dress daily. Says he is easier and freer from pain than he has been for weeks and his appetite has marvellously improved, eats everything given him. Sleeping well and takes an iron mixture. Apr 16 - Wound granulating up.
Looks better than he has done for weeks but there is evidently more mischief brewing.
The ankle is swelling and becoming painful likewise the tarsus.
The astragalus is probably also implicated.
May 10 - Gets up daily. Consid. discharge but is putting on flesh rapidly.
July 1 - Is now in status quo.
Foot much swollen and there is evidently extensive disease of tarsal bones which can only be remedied by removal. Oct 7 - No change. 1890 Feb 19 - Has not been doing so well during the last couple of months. Foot painful. Loss of sleep and appetite. Will remove the same and he wishes it. Indeed he will not have many more months if left to himself.
Feb 25 - The Supt giving ether removed his leg today at junction of lower and middle third. Full antiseptic precautions and dressings.
Stood operation well.
Feb 26 - Dressed stump this morning, looking well and temp. normal. Mar 4 - Dressed again, healing kindly, temp. never higher than 99.4.
Appetite improving and expressing himself as feeling eversomuch better.
Mar 9 - Dressed, removing tube and some sutures and almost healed throughout.
Mar 23 - Got him up today. An excellent stump and will carry an artificial leg well and painlessly.
Health much improved in every way.
Aug 11 - Will shortly get him an artificial leg.
1891 June 1 - Gets about on crutches easily. (Notes from July 1892 to May 1894 indicate no mental change).
1895 June 1- Has been suffering from a strumous abscess of neck for some weeks. Dec 28 - Died today of exhaustion, the abscess in the neck continued discharging and he gradually began to lose flesh.
Was given extras, would not take Cod Liver Oil*, and was sent to bed where he steadily and slowly went downhill in spite of all that was done for him. The old tubercular process in his lungs having broken out afresh.
Mentally he was exactly the same, as stubborn as ever.
Medications/Treatments: Carbolised oil dressings
Amputation of leg under ether*
The first recorded successful operation in North West Wales using ether had been carried out at the Penrhyn Quarry Hospital in April 1847: This was an amputation of the leg performed by Mr H A Roberts in the presence of Surgeons Churchill, Pring and Richards. "The patient, previous to the operation, inhaled the vapour of the ether for the space of four minutes, when it was apparent that he was fully under its influence."
This was only three months after the discovery of ether had reached London and the local press provided glowing reports on its use: "It cannot be too widely known what a blessing this wonderful discovery is." (in O V Jones, The Progress of Medicine: A history of the Caernarfon and Anglesey Infirmary 1809-1948, 1984).
Cod Liver Oil (Ol. Morrhuae) was commonly used as a treatment for phthisical patients at the asylum.