Hugh Hughes (507)

Admission Details for Patient: Hugh Hughes (507)

Gender: Male Age: 71
Marital Status: Married Religion: Congregationalist
Occupation: Hay Merchant
Address: Upper Bangor, Carnarvonshire

Date of Admission: May 17, 1890
Date of Death: September 27, 1890
Cause of Death: Acute melancholia/morbus cordis

Disease: Melancholia (sub acute)
Supposed Cause: Heredity/Previous attacks

Medical Certificate:
1. He expressed his belief that he was doomed to eternal punishment. A few days ago he was on his legs and starting in great excitement to go to the Abode of the Eternally Doomed. He also told me that he was certain of the fact because he had had one intimation from the county and a message from heaven informing him of his doom.

2. His nephew, Hugh Hughes, coach builder, Llangefni, Anglesey, tells me that last night he took off his waistcoat and throwing it away from him said "Give that to my old friend Robert Jones for I am going to hell". His next door neighbour, Grace Davies, tells me that on Monday night last she saw him tear his clothes while shouting "I am going to hell". I certify etc. and my reasons are: There is some danger of the said H. Hughes becoming violent. Rees Rowland Jones, Bangor.

Approximate duration of present attack: 6 weeks

Number of Previous Attacks: 0

Number of Previous Admissions: 0

Number of Subsequent Admissions: 0

Total Number of Admissions: 1

Relatives affected:

Epileptic: No

Suicidal: No

Dangerous: Yes

Clean Habit: Yes

Food Refusal: No

Sleep Habit: Badly

Destructive Habit: Yes

Disposition: -

Education: -

Physical/Mental State at Examination: Health moderate. Morbus Cordis.

Current Diagnosis: Severe Depressive Episode (F32.3)

Case Notes

1890 (the dates are obscured by death certificate) - Patient is a tall respectable looking old man and is suffering from melancholia at times bordering upon the acute. Yesterday evening he became very excited, tore his trousers to pieces and pulled off his clothes as he said he was dead and his clothes were burning.

Was also under the impression that he was to be put to death and prayed to be allowed to live another day and says he has done wrong in neglecting the poor and should have given them hundreds

of pounds etc.

Becomes violent and will strike at once. Well nourished. Cardiac action strong but intermittent - no valvular lesion at present discernible.

- Condition variable, at one time quiet at another excited and restless. Is often afraid we are going to kill him and begs us to let him live till morning etc.

Fainted today after becoming excited.

Has a systolic murmur at apex and prob. Cardiac dilation.

- Will not take the med. prescribed him as he says it is no use. An obstinate and unreasonable old fellow.

- Today more than usually restless, called to him this afternoon. Had made a rush for window and cut the top of his head with the intent, he said, of ending himself. Had previously attempted to get a razor from an attendant. Put him in Padded Room. Strong clothing etc.

and to be inspected every half hour.

C(aution) Card issued.

July 10 - The acute excitement has passed off and he is now quieter. Refuses food persistently and has to be hand fed.

Very deluded.

Thinks his wife is dead. That his clothes do not belong to him. That he has committed unpardonable sins. Aug 15 - Very miserable. Varies much at one time quiet at another restless. Takes food well one day, refuses next. Sept 20 - Has seen his wife. Will not believe it is her. Has become very thin.

Has been confined to bed during last few days and his lungs, esp the left, show signs of congestion.

This together with the heart disease upon which it is consequent is a most unfavourable symptom. Can be induced to take but little food and any attempt to feed him forcibly is so invariably followed by symptoms of an alarming nature that it has had to be desisted from.

25 - Has become very feeble. Left lung much congested with several large patches of consolidation. Will take nothing but a little brandy and water or milk and there is no change in his mental condition. Died.

Medications/Treatments: Padded Room. Strong clothing. (Suicide attempt)