76

Epileptic, Suicidal, or Dangerous ? No - ? - Yes.

Form of Disorder Certified,

Address of nearest known Relative, } Mrs Ann Harriet Mitchell, 5 Woodhill, Portishead

Date	History and Progress of Case
July 25th	Medical Certificate - (a) Incessant talking, giving orders incessantly to those around him to send telegrams, talks of his great wealth - spending lavishly tho’ ____ _____ - threatened to dismiss me if I did not assist him - carrying out various impossible projects - compelled me to write out absurd agreements. (b)Mrs Edward Mitchell, wife of the above, informs me that he has given orders to and set to work painters and carpenters where nothing required doing - then he has within the last four days spent much money - ordered goods not wanted, paying ten pounds for useless things. Elizabeth Mitchell (daughter) tells me he is buying all the property adjoining his house and going to live in tents and is establishing a business in the Scilly Isles!
	State on admission:- Physically Patient is very emaciated - the skin lying in folds over his abdomen. Superficial vein very prominent. He wears a truss for an old impaired hernia. Hair and beard grey - tongue clear - teeth good. Eyes dark blue - pupils round - react to light. Heart fairly strong - reduplicated 1st sound, & aortic 2nd somewhat accentuated. Lungs appear healthy - Abdominal veins ? healthy - a small tumour to be felt over stomach. Urine 1020, no abnormal sugar. Knee joints - unequal - not diminished. Weight on admission only 7 st. 10!
	Mentally - Exulted for the most part promised money lavishly to those who will do his bidding and threatening those who disobey with -Swinging -. He frequently asks me to send telegraphs to his friends about trivial matters. At times he is querulous and cries like a child at a trifle. He is often noisy and on two consecutive nights after admission had to be removed to a single room. He refused food at first - but now taken his milk, eggs and whisky. TBL
July 26th	Patient weak physically - taken food pretty well. Would not take food this evening - says I insulted him and that he will have me deprived of my uniform. Always quarrelling with patients near. Ordered to be kept in separate room in no. 6. TBL
July 28th	Requires to be humoured in his diet - taken eggs, milk - whisky - but refused meat. He is always giving orders - sometimes he asks me to send for so & so ‘as a favour’ while he threatens me in the same breath to punish me in some way if refused. He retains no recollection of unfulfilled promises made to him. TBL.
July 30th	Complains of a dull pain over epigastria - not much tenderness on pressure- TBL
Aug 4th	Tried to escape from the airing court today. TBL
Aug 9th	Is taking Sulphaned qui XV at bedtime - for insomnia. Delusion that he is a millionaire still very exulted.
Aug 25th	Eats and Sleeps better, much quieter - TBL
Sept 4th	He gained 8lbs. Quieter in manner but still has exulted ideas. TBL
Sept 23rd	Is brighter and converses more rationally than he used to. TBL
Oct 5th	Again attempted to escape from airing court. Put in asylum clothes. TBL.
Oct 24th	The tumour in cardine end of stomach remains about same size - no pain and no vomiting. He takes a long time over his meals and says he cannot swallow quickly. TBL
Nov 4th	Is losing weight in spite of extra food and stimulants. TBL.
Dec 30th	Emaciated - is with difficulty got to take sufficient nourishment.
Jan 6th	Confined to bed - weaker. TBL. Wife informed of his illness.
Jan 10th	Sinking - still exulted mentally. TBL.
Jan 11th	Died at 6.15 this morning. See P.M. book folio 112.