Name of Patient.

Mary Emily Wickham

Age.

29 years

Admitted.

May 28, 1893

Residence at or immediately previous to date.

The Workhouse Infirmary, St. Johns Road, N.

Rank, Profession or Occupation.

Governess

Degree of Education.

Good

Religious Persuasion.

Church of England

Married, Single or Widowed.

Single

Number of Children.

Age of youngest Child.

Whether the first Attack.

Yes

Age on first Attack.

Duration of existing Attack.

6 weeks

How many previous Attacks.

Confined in any Lunatic Asylum.

Where.

When.

And how long.

Supposed cause of Insanity.

Over-study

Exciting.

Predisposing.

Heredity

Whether Suicidal.

Whether dangerous to others, and in what way.

State of Bodily Health.

Fair

Whether of sober habits.

Yes

Relatives afflicted with Insanity.

An Uncle

Urgency Certificate. (if any). a. Facts indicating Insanity observed by myself at the time of Examination, viz.— b. Facts communicated by others.
1st Medical Certificate. J.J. Lough, 1A Colebrooke Road, London. a. Facts indicating Insanity observed by myself at the time of Examination, viz.— She told me “that Alice Hutchins a fair-haired girl was a first cousin of John Bull and was first she tried to kill the last baby that her Brother Henry had was a toy cat and when she went into the room it looked so bad she turned it on its face, she never learned Latin because she never kept a girls school. Her truest friend was John Bull and was 30 years because the Bible told her so. b. Facts communicated by others. On show Arthur Wickham, Sawyer, 1 WestbourneRoad, N. Brother of the alleged lunatic told me her movements for weeks were most erratic. She spent her money foolishly - has been violent and incoherent in her speech and smashed a window. May 27th 1893.
2nd Medical Certificate. C. St. John Wright, Islington Infirmary, St. Johns Road, N. a. Facts indicating Insanity observed by myself at the time of Examination, viz.— She is maniacal. Incessantly shouting, talking in a rambling and at times incoherent manner. She does not answer any question rationally but only laughs and answers irrationally. She is violent and has to be restrained. May 27th 1893. b. Facts communicated by others.
Discharged.	Left the Hospital.	Died.

Relation of Informant to Patient: Brother.

Family History.
Insanity or other Diseases of Nervous System:
Maternal Uncle insane (senile).
Phthsis:   No.
Alcoholism:   Father alcoholic (not probably before birth of patient).
Diabetes:       No.
Other Diseases:
Father fit. Mother acute rheumatism – died from aortic disease.

Previous History.
Neuroses in Patient:
Last few years rather unstable, easily excited or depressed.
Acute Rheumatism or Chorea:   No.
Fits – epileptic or hysterical:   No.
Fits – infantile:   No.
Fevers, &c.:   Scarlet fever and measles at 6.
Syphilis:   No.
Other Diseases:   Chronic ??
Sober:   Yes.
Number and nature of previous attacks:   First.
Injuries or shocks:   No.
Catamenia:   Regular up to 6 months ago, but not regular since.

Present Attack.
Time of earliest symptoms:   Erratic since Christmas.
Nature of earliest symptoms:
Excitable, about six weeks ago left friends without saying anything, arrived at relations house without giving notice of coming. Sleeps little at night but a good deal in the daytime. Food taken well. Three weeks ago became unmanageable and had to be removed to Islington Infirmary. About a fortnight ago smashed a window and injured her hand. Threw herself about, three people could not refrain her. Engaged lodgings, wanted to make money in butter line. Spent 75£ in speculation. Extravagant. Bought things at a Pawn-shop. About four years since she did school work.
Progress of case:
Suicidal or Dangerous (facts):   Struck attendant. Not suicidal.
Tendency to leave home:   Yes. Wanders about.

Hallucinations (observed before admission).
of Sight:
Saw fancy processions. People. Illusions, saw grotesques in peoples dress.
of Hearing:   No.
of Taste:   No.
of Smell:   No.
of Common Sensation:   No.

On Admission.

Presence or Absence of Bruises:   Clean. Sores on hands. Bruised thighs.
Tongue:   Clean.
Palate and Teeth:
Appetite:   Fair.
Bowels:   Regular.
Abdominal Viscera:
Pelvic Viscera:
Catamenia:
Urine:
Heart, Pulse, etc.:   Apparently normal.

Lungs: Apparently normal.

Eyes and Sight:   Good.
Pupils:   Equal – React to light and accommodations.
Ears and Hearing:   Good.
Taste and Smell:
Common Sensation:
Dynamometer:
Handwriting:

Walk: Normal.
Reflexes: Brisk.

Temperature: Normal.

Weight:
Sleep:   Bad.
Dreams:
Reaction to questions:   Bad.
Memory, Recent:   None elicited. Too excited.
Remote:   None elicited. Too excited.
Delusions, Exaltation:   None elicited. Too excited.
Depression:   None elicited. Too excited.
Delusions related to digestion or food:   None elicited. Too excited.
Poison:   None elicited. Too excited.
Obstruction:   None elicited. Too excited.
Hallucinations of Taste and Smell:   None elicited. Too excited.
Hallucinations of Sight:   None elicited. Too excited.
Hallucinations of Hearing:   None elicited. Too excited.
Hallucinations of Common Sensation: None elicited. Too excited.
Suicidal or Homicidal:
Diagnosis:   Acute mania.
Prognosis:   Good.

Patient is a tall woman with fair hair. Talks in a very excited manner, does not answer questions but rambles on incoherently. She throws herself about on the floor, so has been put in a padded room. Keeps laughing to herself. There is great difficulty in getting her to take food, but she can be fed with fluids by means of the feeding cup. She does not know where she is, but remembers being at Islington. She is sleeping very badly usually about 2 hours a night. She throws her bed clothes about but is not destructive. Her general condition appears good.
Jun. 3 – Rather less noisy. Sleeping better and less trouble with her food. Still in padded room.
Jun. 10 – Continues very excited, been moved down stairs. Takes food.
Jun. 18 – No change.
Jun. 27 – Still very excitable. Takes food well.
Jul. 14 – Still incoherent and noisy at times.
Jul. 28 – Is rather better. Has been very noisy and singing.
Aug. 19 – No change.
Sep. 10 – This morning she came up to me to know where she was and asked for her discharge. She said that she was being drugged with arsenic. That the ward was filled with electricity and that it has congested her throat.
Sep. 30 – Varies greatly from day to day. Not so excited.
Oct. 21 – No change.
Dec. 5 – Is now quieter. In the mornings is generally noisy and troublesome. Looks more serious and settled.
1894.
Jan. 26 – Is very lazy and apathetic, lies about on couches all day, takes little interest in anything going on.
Mar. 31 – Talks to herself. Uses unseemly language to herself and to other patients. Sometimes becomes noisy and excited.
May 23 – Discharged uncured.