William Evans (2448)

Admission Details for Patient: William Evans (2448)

Gender: Male Age: 64
Marital Status: Widowed Religion: Church of England
Occupation: Car driver
Address: Llandrillo, Carnarvonshire

Date of Admission: May 8, 1875
Date of Death: June 25, 1875
Cause of Death: Scirrhus of Liver/Dropsy

Disease: Mania
Supposed Cause: Hard drinking/Domestic affliction

Medical Certificate:
He forms false ideas about the culture of land and says there are people ploughing up crops sown on the same day and resowing them again before night and forms false ideas of a similar nature about matters connected with farming. By his daughter Margaret Evans: He roams about and wants to go to his old home thinking he still lives there. Asks what has become of his deceased wife. Thomas Davies LRCP Edin. MRCS Engl.

Approximate duration of present attack: About 4 months

Number of Previous Attacks: 0

Number of Previous Admissions: 0

Number of Subsequent Admissions: 0

Total Number of Admissions: 1

Relatives affected:

Epileptic: Uncertain

Suicidal: No

Dangerous: No

Clean Habit:

Food Refusal: No, eats well

Sleep Habit:

Destructive Habit: No

Disposition: A hard drinker and not accustomed to work

Education: Fair

Physical/Mental State at Examination: Feeble health. Tall and stout. Phlegmatic temperament. Very stout, flabby muscles, large fibrous tumour on hip. Eats well, tongue clean, bowels open, tremor of tongue on protrusion. Heart's impulse feeble. First sound abrupt and weak. Arteries atheromatous. Resonance on percussion, inspiration somewhat loud and prolonged, emphysema. Examined urine and free from albumen. Very quiet and obedient on admission. Could not reply sensibly to any question. After his bath seemed quite happy and contented, smiling when talked to and conversing freely but incoherently. Does not know where he is. Fancies himself at his farm and states that there is a fair tomorrow at Conway where he has several cattle to dispose of. His feet and ankles are oedematous. About two years ago his wife died which greatly preyed upon his mind. They had been at one time very well to do, keeping a large hotel, but he took to excessive drinking which resulted in poverty. Very weak on his legs and tottering a good deal in walking. Drank a bowlful of beef tea soon after admission. Placed in No 9 ward.

Current Diagnosis: Delirium (F05.9)

Case Notes

1875 May 9 - Slept well last night and partakes freely of nutriment. Calm but has delusions, wishing to go out in order to look after the farm. May 11 - Sleeps and eats well.

Seemed aware this morning that he was in the Asylum but soon after fancied himself by the River Conway and expressed great surprise that the boat was not there to take him over. Cleanly in his habits.

May 18 - As incoherent as ever and full of delusions.

Said that last night he went as far as Conway and returned this morning.

Gets a glass of beer daily.

Oedema still continues, otherwise in fair bodily health.

June 10 - Getting dirty in his habits, lost control over his bladder.

Exceedingly feeble and unable to stand without support.

Mental state merging into dementia.

June 20 - Getting more and more feeble. Bedsores are forming on the buttocks.

Placed in bed in No 9 on horseshoe water cushion.

Has been taking bread and milk for breakfast and supper for weeks past.

June 23 - This morning was suddenly seized with vomiting.

He ejected a large quantity of inky fluid, probably decomposed bile.

On examination the liver appears to be greatly reduced in size.

The right hypochondrial region being resonant on percussion and the hepatic organ cannot be felt on palpitation.

He was for some time in a state of syncope with cold extremities and covered with a clammy perspiration.

Given some Chloric Ether and Dilute Hydrocyanic Acid with wine. In this attack left pupil was for a short time greatly dilated while the right was unaffected.

He was insensible for about 2 hours.

Towards evening he revived and he talked and smiled as usual.

June 24 - No return of vomiting.

June 25 - This morning about 7.30 he had another attack of vomiting ejecting the same inky coloured liquid.

Insensible.

Breathing became shallow accompanied by the throat rattle. Extremities cold with profuse sweating.

He never rallied and died at twenty minutes past 11am. The anasarca had been gradually increasing within the last few weeks.

Medications/Treatments: Chloric Ether and Dilute Hydrocyanic Acid with wine td, Horseshoe water cushion