R J (9545)

Admission Details for Patient: R J (9545)

Gender: Male Age: 58
Marital Status: Married Religion: Wesleyan Methodist
Occupation: Farm labourer
Address: Aberdaron, Carnarvonshire

Date of Admission: November 18, 1920
Date of Discharge: February 22, 1921
Discharge Category: Recovered

Disease: (Sub acute mania)
Supposed Cause: None stated

Medical Certificate:
Stated he had been administered some poison by persons in the cowshed on Sunday nights. Stated he had been in heaven. Talks incoherently. Refuses food at times. Wants to rid the place of certain men. He becomes very violent. Hears voices. Mrs J, Aberdaron, his wife, stated that he has been depressed for the last week or more and states that certain men intend doing him harm. He has smashed the front door at his house and Ty Newydd Inn, Aberdaron. Dr Lloyd W Hughes, Bottwnog, 17th Nov 1920.

Approximate duration of present attack: 1 week

Number of Previous Attacks: 0

Number of Previous Admissions: 0

Number of Subsequent Admissions: 1

Total Number of Admissions: 2

Relatives affected: His cousins

Epileptic: No

Suicidal: No

Dangerous: Threatening

Clean Habit:

Food Refusal:

Sleep Habit:

Destructive Habit:

Disposition:

Education:

Physical/Mental State at Examination: Good health and condition. Fractured left femur with shortening. His appearance is wild and he has delusions of poisoning. There is shortening of his left leg due to an old fractured femur. He is very noisy and uncontrollable on anyone's approach, thinking he is going to be done to death.

Current Diagnosis: Manic episode (F30)

Case Notes

1920 Nov 24 (copy) - Suffering from sub acute Mania.

Since admission he has been very noisy and restless and throwing himself about.

His conversation is most rambling and disconnected.

He sings and shouts hymns and is most obstinate in taking his food. States that people are trying to poison him.

Good health and condition but he has a bruise on the left side of his chest and one of his ribs is fractured. The patient cannot give any account as to how hi injured his side, it is possible it was done before admission.

25 - His maniacal attack is now at its height.

He had administered to him half a gram of Morphia - no effect.

Two hours later half a gram of hyoscine - no effect.

The only drugs that give him a few hours sleep are Paraldehyde and Chloral.

This morning he cut the ulnar border of rt forearm on pane.

Stitched up - no anaesthetic.

He has very marked peripheral analgesia in all limbs.

Temp = 103.

Dec 2 - His mania still continues but has been on the wane since 25th.

His cuts have become septic due to his continually removing dressing and his violence.

More confused and foolish than at the height of the attack even.

Has to get sleeping draught nearly every night. Exhausted.

9 - Somewhat quieter.

Stays pretty well in bed now. Confused and suspicious. Rambling and irrelevant in his talk.

16 - He has been a good deal more manageable for the last week and has now been transferred to Sick Ward sideroom.

He is confused and incoherent, talks to himself most of the time, sometimes takes his food, sometimes refuses it.

18 - I have got him up for a while today.

Behaves himself well in his new surroundings so far. Has been on milk all the time.

25 - Improving steadily and rapidly now.

Cuts now healed.

Beginning to get a gleam of insight into his condition during the past 5 weeks and now on full diet which he does handsome justice to.

1921 Jan 1 - Steadily regaining his "status quo".

Cheerful and affable.

Insight now nearly complete.

12 - Keeps on improving. One day while talking to me he volunteered the interesting clinical observation that he "heard everything" when he was at the height of his excitement (he is rather a deaf man now when normal - familial deafness it appears).

21- Discharged on trial.

Medications/Treatments: Morphia, Hyoscine, Paraldehyde, Chloral

Additional Notes

Readmission:

10th February 1934 (No. 12157, C620) admitted with Mania.

The Medical Certificate reads:

Talks wildly and incoherently.

He is very obstreperous, and talks of killing himself and other members of family.

He also states that the food is being poisoned.

Mrs Jones, his wife, states that he is very restless and threatening. He refuses food saying that it has been poisoned.

R J had a cerebral haemorrhage and died in the asylum a fortnight later on 23rd February 1934.