# Demographic info and clinical notes

History and clinical notes:
History: Officers who bring patient know but little of his history.  Certificate states that disease is gradually increasing; was brought to Hospt in restraint; conversation incoherent.
Feb 20, 1901.  No improvement; is restrained and at times violent, appetite good.
Aug 12.  Quiet for 3 months past, eats and sleeps well.  On one occasion simulated death to frighten attendant.  Talks very little, is clean and orderly, desires to wear restraints, which he is still do.  (sic)
Apr 15, 1902.  No change.  Vaccinated today.
Sep 22, 1903.  No change.  
Apr 4, 1932.  Died in hospital.


On certificate of:
Drs. John P. Waples and Evan G. Shortlidge

History and clinical notes:
History: Has been nervous for years and about a year ago she began to have delusions; believed that people were going to take her life.  She is very much depressed and worries all the time; sleeps poorly at night.
Feb 1, 1901.  Has not improved.  Has a poor appetite, seldom has a good night’s rest.  Says she is going to die and that we are trying to kill her; that the food is poisoned.  Keeps by herself most of the time and does not wish to associate with any one [ill.] carry on a conversation.
Feb 11.  Was visited by husband today who removed her on parole against the advice of the Supt.
May 13, 1901.  Discharged improved.
Note attached: Standard form, dated Feb 11, 1901.  “I, [name redacted], has this day removed (name redacted) my wife from the Del. State Hospital at Farnhurst against the advice of the Supt and do hereby exonerate the Trustees of the said institution should the said [name redacted] do harm to herself or others or commit any depredations that are interdicted by law.”  Signed [name redacted].


History and clinical notes:
History: First symptoms were first noticed 2 weeks ago, 4 weeks after birth of child.  Got up too soon after birth of child and did not get on very well.  Was not able to do her work.  Two weeks ago began to talk foolishly and incoherent.  Has gradually got worse until lately when she swears and curses and is hard to control.  Does not sleep very well and eats but little although she has taken milk; drinks a great deal of water.  She has lost flesh and strength. (Father says patient was up on second day after birth of child and did a day’s washing).  Patient large-framed, strong woman.  Was covered with vermin and very dirty.  Eyes markedly suffused and very bright – pupils dilated, respond poorly; cheeks flushed.  [Ill.] on mouth, tongue coated.  Skin dry and harsh.  Pulse accelerated.  Had to be kept in bed with hands and feet restrained, very violent, thrashed around, tried to bite attendants, etc.  Slept poorly.  Took nourishment badly; fed by tube until 23rd, then [ill.] to obstruction in naso-pharynx; this was discontinued and food was given her by spoonful at frequent intervals.  During the night talked and laughed, quieter during the day.  When restraint removed, masturbated excessively, pushed off clothing, drew herself up in bed and was in every way very restless.  On the 24th attack of heart failure at 11 a.m., pulseless and very weak.  Reacted after Tr. Digitalis [ill.] x, Spt Ammon Aromat ℥ (ounce) ii whiskey ℥ (ounce) ii and hypodermic of strychnine sulph 1/30 and etc.  Hot water [ill.] [ill. – looks like ‘sinaprisus’] etc.  Following this took nourishment a little better.  Disturbed a good deal by collection of mucous in throat and nose.  With exception large bronchi lungs clear (exam. owing to restlessness of patient incomplete).  Bichloride douches which were being administered daily were discontinued as patient was menstruating. Clysinas (?) to keep bowels open.  Also saline enemas (four oz. at a time) given three times daily.
Feb 3, 1901.  Another attack; called to patient, found her almost pulseless, heart action feeble and irregular.  Breathing sighing.  Extremities cold, eyes sunken and anxious.  Reacted after 2 hours work and administration of Strych Sulph gr 1/60; Digitalin 1/100; Nitroglycerine 1/100; Strych Sulph 1/30 gr. Strop 1/250 gr – Aromat Ammon ℥ (ounce) ii and Whiskey ℥ (ounce) ii in water teaspoonsful at a time every few minutes.  Hypodermic of whiskey.  Patient swallows with difficulty; obstruction in throat and Cayer (?) bronchi seems extending; auscultation over lungs revealed only harsh breathing.  Percussion note clear all over grad (?) reacted.  At 2 p.m. last rites of Catholic Church administered.  Following this, patient grew stronger; took little nourishment every little while during the afternoon.  Beef juice malt, milk and whiskey being alternated.  Strych Sulph 1/60 every 6 hours.
Feb 5.  Fed by [ill.] twice in the morning, retained very little, at night did not regurgitate food.  [Ill.] milk, 3 eggs. ℥ (ounce) ii whiskey and ℥ (ounce) ii of meat juice.  All through day patient seemed brighter, was restless and fought attendants.
Feb 6.  Drank food herself through the day; seemed stronger, recognized physician and nurses, seemed milder and more amenable to requirements.  Bowels moved copiously following enema, 8 p.m. R ear commenced to run – considerable quantity creamy white fluid.
Feb 7, 1901.  Seemed stronger.  Asked for coffee, given some, seemed to relish it.  Enema at noon followed by good evacuation.  Quiet and apparently lucid.  At 2:45 doctor called, found patient dusky blue color.  Respirations labored.  55 per min.  Pulse rapid – weak – dicrotic mucous nothing in throat and over chest anteriorly numerous rales heard.  Percussion note anteriorly clear.  Patient appears conscious at first, muttered a little in Polish, same treatment as before, but failed to react.  Ammonia and [ill.] nitrite inhalations of no avail.  Patient could not swallow to [ill.] to hypodermics.  Gradually grew worse and died at 5 p.m. in presence of Drs. and nurses.  See urinalysis for albumin and casts.

Final disposition:
Died of complications following childbirth

Additional notes:
Probably an infection from childbirth.  Could not find anyone else of this name or variations on the spelling -- no husband Frank, no child.  Death certificate says she died 2/6/1901 of oedema of lungs as a complication of puerperal mania


History and clinical notes:
History: Officers who bring patient know nothing of history.  Certificate states that the disease is of 2 weeks standing.  That the patient has had syphilis and that this is the probable cause.  At times is violent.  Patient has a hesitating speech.  Tendon reflex not absent.
Apr 3, 1901.  Removed today by wife.
Apr 3, 1901.  Discharged unimproved.


History and clinical notes:
History: Father died in this institution.  Patient lost 2 children 5 years ago (twin boys), worried a great deal about it, imagined that Dr. Hitch killed them.  Delusions only appeared about 1 year ago.  Has threatened to kill different people because “they are working on [ill. – looks like ‘feice’] with electricity and has repeatedly threatened to injure people around him.  At times he is very melancholy and will not speak for a month or two and then breaks out in violence.  Reads the Bible a great deal since he lost his children; previous to that time was an infidel.  Disease is increasing.  Had steadily losing flesh and strength.  Appetite has been fair.  Sleeps fairly well at night, although there are times when he is very restless and walks the floor.
May 16, 1901.  Believes [ill.] McMullin Joseph and McGonigle are his enemies and when any one speaks loudly it goes through him like electricity.  Says there are good and bad spirits in him, which seem to wander over the world and when they come near bad people in groups he feels as if he were being pulled backwards.  Claims to sleep and feel well.  Is very slow in his reflexes.  Has a dreamy ‘mystic’ appearance.  Is in fair physical condition.  Quiet and tractable.
Jun 20.  Fulfillment period of 4 years ended today.  Is now Jesus Christ and can walk about.  
Jun 25.  Attempted to strike Mr. McMullin today because he was asked to do something.  Transferred to Ward VI.  Says the Spirit makes the pupils (of eyes) large or small by drawing on them.
Feb 1, 1902.  Is going to be King of America.  Gave us all positions.  Is quite hysterical in actions.
Mar 15.  Says he is not going to be King.
Apr 15.  Quiet and cleanly, moves slowly.  Much preoccupied.  Vaccinated today.
Apr 20.  Good take.
Jul 30.  In good physical condition, but mentally the same.
Jul 12, 1903.  Good worker about the ward.  Talks little.  Emotional, crying frequently.  General health good.
Aug 20.  No change in condition.  Voracious appetite.
Jul 11, 1907.  Removed to TB today.
Aug 2.  Failing rapidly, refuses nourishment.
Aug 10, 1907.  Died.  Phthisis Pulmonalis.


History and clinical notes:
History: Officers who bring patient know nothing of history.  Certificate states that disease is of two weeks standing, gradually increasing, of emotional character, religious.  Patient says that people talk to her all the time and want to prevent her communicating with the Lord.  Just wants to lie down and be alone.  Does not want to eat; could give very little information herself.  Stopped working after the New Year.  Wanted to save her soul; did not want everyone to bother her.  Wanted the Lord for herself and did not wish to give anyone else any of his time.  On the ward patient went quietly to bed, drank glass of milk, answered a few questions when persistently asked, but as shortly and irrevelantly (irrelevantly) as she could.  Said she knew the reason she was asked questions was that everyone wanted to make out she was insane but she was not.  Said she had never been an ‘osmary girl’ (?? – perhaps ‘ornery’); had attended Revival meetings, etc.  One sister living (in) Philadelphia.
Feb 11.  Patient has slept quietly since admission.  During the days sits most of the time on a bench with head bent, gazing in front of her; occasionally jumps up and walks up and down the ward; once in a while stands still and jumps up and down on her toes a dozen times or more, as high as she can, muttering to herself all the time.  Patient somewhat negative, only answers questions when one insists; since yesterday has refused to eat.  Fed this morning by tube; never talks to other patients, does not work or show any interest in her surroundings, occasionally shows fight when attendants want her to go to meals.
Feb 19.  After three feedings, patient went to table to eat; for past week has been more approachable, works on the ward willingly; does not talk so much about the Lord; says she knows that she had too much religion and feels better now.  Visited on the 16th by a cousin who said that last fall [patient] had a severe attack of illness and that she prayed and sang with her until [patient] ‘got religion’.  Since then has been peculiar, talking about the Lord, etc. 
Mar 8.  Has been working on ward periodically very well; eats and sleeps properly.  At times has periods of depression and mutters to herself.  Sits idly on bench staring ahead of her or else wanders up and down hall.  These attacks last a day or so only.
Jul 30, 1902.  Mentally and physically unchanged.
May 2, 1904.  Condition about the same.  Works on ward occasionally.  Health good.
Nov 14.  Mentally and physically the same.
Jun 5, 1905.  Remains about the same.  Works on ward.  Eats well.
Feb 20, 1906.  Physical condition fairly good.
Jun 6, 1909.  Patient very stupid; being treated for otitis media.
Sep 22.  Complains of pain in head, discharge of blood from left ear; passed blood in urine.  Exam. heart rapid and feeble, pulse 136, temp. 103.  Skin clammy, moans in sleep.  Lies with head drawn to left side, no appetite, pupils dilated, patient delirious.
Sep 23.  Condition same, considerable quantity blood and pus passed from ear.
Sep 25.  Patient unconscious, blood still oozing from ear.
Sep 25, 1909.  Died 1:30 p.m., cerebral abscess secondary to purulent otitis media.

Final disposition:
Died of cerebral abscess secondary to otitis media.  Buried at DHS #177.


History and clinical notes:
History: Has been drinking heavily for more than a year; only confessed to doing so in Aug ’00.  Has been in the habit of leaving home for days and weeks at a time; on his return can give no account of himself.  Money which he took with him all spent and he is always in more or less of a dazed condition for some time.  Has not worked for over a year; appears nervous and excitable.  Says he has pains in his head all the time.  Wife said they had been married 16 years and that up to a year ago last November that he was always sober and industrious.  Was cheated out of considerable money then and it seemed to prey on his mind.  Habits up to that time good in all respects.  Patient’s father was a heavy drinker; died of ‘stroke’ at age of 73 years.  Patient’s mother still living, perfectly well now, a few years ago was insane for a few years.  Age at present 70 years.  Other than typhoid fever as a young man and repeated attacks of [ill. – looks like ‘quincy’], patient has always been healthy.  During the past year has been treated for nervousness, etc. by Drs. Patterson, Bereus, and others.  Yesterday was the 7th time he absented himself from home.  Came back in intoxicated, dazed condition and confessed to use of Absinthe as well as Alcohol, expressed desire to be treated and was brought to Hospt. today by his wife very nervous and complains of pains in head and contusions of left eye, coordination slightly impaired, tongue tremulous, speech thick, appetite has been better since he drinks than before.  Does not sleep well at times.  First absence from home Nov 1, 1899, 4 weeks; 2nd March 20-Apr 7; 3rd Aug 27-Sep 4; 5th Dec 12-17; 6th Jan 6-9, 1901; 7th Jan 21-29th.  During intervals he is at home he will attempt to work, but cannot.  Gets nervous, walks up and down some and finally says he has some errand or other to attend to that takes him out.
Feb 23, 1901.  So much improved that he was allowed to go home with his wife.  Discharged.

Additional notes:
Mother was insane for a few years, some time previously.  Died 8/12/1907 of accidental poisoning.


History and clinical notes:
History: First symptoms of mental deterioration was noticed about 2 years ago, characteristic of senility; wandered away and did not know where he was.  For past six months has been very hard to care for – wandered about at night and was at times destructive.  His relations were too poor to care for him longer.  Has usually a good appetite but seldom rests well at night.  Five weeks ago his wife died, but patient never realized it, nor has he asked for her for some months.  
Jan 21, 1901.  Slept but little last night and destroyed some of his bed clothes, wanders around aimlessly.
Apr 16, 1902.  Demented; recognized no one; must be tied to bed at night.  In fair health, occasionally has boils or will scratch back badly.  Vaccinated today.
Aug 30, 1902.  Circulation poor, nose cold, extremities often cold and cyanosed.  Is unable to retain solid food.
Aug 31.  In bed.  Very weak.
Sep 2, 1902.  Unconscious.  Died this morning.

Additional notes:
"Relations were too poor to care for him any longer."


History and clinical notes:
History: Has been drinking since last Thursday, he is very nervous and delirious and untidy.  This is third attack in 9 months.
Feb 22, 1901.  Much improved, talks coherent, eating very good and sleeps well.
Feb 23.  Still improving.
Feb 25.  Allowed to go home this a.m.
May 13, 1901.  Discharged.


History and clinical notes:
History: Had La Grippe 4 years ago and mind has been affected every since; gradually getting worse, wanders from home and friends were afraid that he would be injured; at times he is very helpless.
Feb 26, 1901.  Certificate did not arrive until this a.m.
May 1.  Has steadily grown more feeble.  Has to be dressed and undressed by nurse.  Articulation affected so much that he cannot be understood.  Heart action very irregular.
Jun 1.  No change; cannot walk without assistance; breathing very difficult at times.
Jun 30.  Became very weak this evening, could hardly breathe; weather has been extremely hot.  Temperature only 99.  Heart’s action irregular.  Ice bags applied to head and sponged off with alcohol.  Strychnia and cardiac stimulants given hypodermically.  In a few hours was much better.
Jul 7.  Has been dressed every day and placed in a rocking chair in cool part of hall.  Dr. Hancker saw patient at 5 p.m. and was about the same as previous notes, except that he has steadily grown more feeble since June 1st.  At 6:30 p.m. Mr. Brennan and Mr. McGonigle, attendants on ward, spoke to patient and Mr. McGonigle went to dining room to get patient supper.  Returned at 6:35 and found patient had died in the interim, apparently without pain.
Jul 7, 1901.  Died, organic disease of the heart.  6:35 p.m.


On certificate of:
Drs. James L. France and J.B. Steele (?)

History and clinical notes:
History: Complains of rheumatism and pains in his head.  States that women are sending for him all the time and write him postal cards to call and have been at it for the past 14 years.  Says he has plenty of money, and owns a livery stable and various other things; has a tremulous tongue and many other symptoms of paresis.
Aug 1, 1901.  Marked tremor of voice, fibrillary twitching of facial muscles and tongue.  Very demented, is quiet and cleanly, eats and sleeps well.
Dec 15.  Still more demented and stupid.
Dec 26.  Untidy and restless, slight swelling of right side of face.  Temp 101, pulse 120, respirations 18.  Refuses to eat.
Dec 29.  Is about again but often refuses food, cries when made to eat.
Jan 5, 1902.  Is in bed again, very stupid.  T.P.R. normal.  Eats poorly.  Is untidy.
Jan 7.  No improvement or change.
Jan 12.  Continues in bed.  Eats and sleeps fairly well.  Very demented.
Jan 18.  No change.
Jan 19.  Out of bed.
Apr 16.  In bed for six weeks past.  At times noisy.
May 2, 1902.  Has been failing rapidly of late; patient nourishment badly; died this a.m. 10 o’clock from gradual exhaustion of general paresis.


On certificate of:
Drs. J. Paul Lukens and James L. Nance (?)

History and clinical notes:
History: Officer who brings patient knows nothing of history.  Patient somewhat excitable – anxious to talk, is violent at times.
Mar 8, 1901.  Very talkative, restless, occasionally singing, says she wants to do just as everyone wants her to, does not see why people lied to her in bringing her here.  Everyone is her ‘dear friend.’  Says the reason she went and asked police protection was that a man has been following her on a bicycle for a number of days; that she was not well, but certainly not insane.  On the 3rd was so excited that she had to be transferred to (Ward) 5 and restrained for the day.  Then returned to B and since has been better and more amenable to discipline.
Jul 30, 1902.  Since admission patient has been in stationary condition.  Great worker on ward; anxious to help; if anything, has to restrained from working.  At the same time she complains that the attendants make a slave of her – that she has all the work to do, that they are lazy, but they treat her badly.  That they beat and abuse the patients, that she wants to do right but she cannot in this h---- (hell) of a place.  The one moment she is fawning all over the doctors, the next berating them as thieves, liars, etc. at the top of her voice and with great rapidity.  Her voice is of a peculiarly penetrating rasping character that it grates on one’s nerves.  This she seems to realize and when excited or angered there is no stopping the [ill.] that flows of vile language.  She also has a complete vocabulary and uses it extensively.  Patient is obliged to live on back ward as she became too obnoxious in the manner she greeted everyone passing through B Ward that her transfer was necessary.  Her acquaintance in Delaware was extensive and her memory [ill.] more than ordinarily good; the result was she buttonholed everyone with whom she came in contact.  Once in a great while her excitement is sufficient to cause her transfer to Ward 3 for the time being.  If she likes an attendant etc. there is nothing she won’t do to help them.  If she does not there is nothing she leaves unsaid.  Her memory of people and faces is excellent; for past events etc. not quite so good.  She is a great church woman, being able to recite whole pages of the services, but her manner in attending church is so pronounced and her answers too loud that she disturbs the others.  [Ill.] is only allowed to go occasionally.
Jun 1, 1903.  Very abusive and violent at times.  Talks incessantly at the top of her voice.  Disturbs the entire ward.  Sedations frequently necessary.
Jul 30.  For past week, patient has complained of headache and backache with T. 100-104, P. 90-100, R. 20-25.  Constipation.  No rash, no splenic enlargement.  Enteric fever suspected and verified by Widal test.
Aug 20.  Patient better.  Temp ran an atypical course.  No rash or palpable splenic enlargement at any time.  Sitting up some now.  (see p. 155)
Sep 23, 1903.  Has completely recovered from Typhoid.  During the course of and the recovery from the fever she was quiet and tractable, but now is again noisy and at times violent.
Feb 19, 1904.  Uses very foul language, is quarrelsome and unruly.  Losing flesh, but otherwise in good physical condition.
Mar 16, 1904.  Rapidly losing flesh and strength.  Breath very foul. Mental condition unchanged.  Coughs and expectorates profusely, sputum examined, no tubercle bacilli found.  Patient sent to bed and put on milk diet.
May 2.  Patient better, growing thinner.  Eats well.  Is up and about ward, sometimes works.
Nov 14.  Physically well, has wild outbursts of passion very frequently.
Jun 5, 1905.  Patient vulgar and noisy, great nuisance on ward, physical condition somewhat better.
Nov 20, 1907.  Physical condition, much emaciated.  Eats well.  Mental condition unchanged.
Sep 20, 1909.  Physically [ill. – looks like ‘rarlur’] good; mentally no change.  A good worker.
Apr 5, 1929.  Died


History and clinical notes:
History: Left here July 13, 1899, was fairly well until about last Christmas, when he began to neglect his work and wandered from home.  For past month or six weeks has been carrying pistols and guns and has threatened to kill any one that comes near him.  Is in fairly good general health.
May 10, 1901.  Has been violent since last admission and often under restraint.  Is vindictive, quarrelsome.
Jun 15.  Restraint off most of time.  Occasionally will play with spittoon contents.  
Aug 15.  Quiet except at times at night; cleanly; no restraint.  Very incoherent.
Apr 16, 1902.  Incoherent, demented.  Quiet, cleanly, helpful, vaccinated yesterday.
Jul 30.  No change.
Jan, 1919.  No improvement in patient’s mental condition, physically getting worse; suffering badly from chronic interstitial nephritis.
Feb 22, 1920.  Patient died this morning at 6 a.m. of chronic interstitial nephritis (3 years).


On certificate of:
Drs. Francis L. Durrilap (?) and J.W. Delbitt (?)

History and clinical notes:
History: Patient had apoplexy in August and has been paralyzed; on right side, since mind is feeble; is very nervous and falls very often, perfectly harmless.
Mar 12, 1901.  Has been in bed since admission.  Has not been able to take solid food, has to be fed with liquid nourishment.  Has all symptoms of general paresis.
Mar 18.  Patient is unconscious today; has not been able to swallow since yesterday.  Cannot last very long; friends were notified.  Failed rapidly and died 9:30 p.m. on March 18, 1901 of general paresis.


On certificate of:
Drs. John P. Wales and Evan G. Shortlidge

History and clinical notes:
History: Has been admitted a number of times for drink; is nervous and excitable.
May 13, 1901.  Discharged recovered.


History and clinical notes:
History: None.
Mar 27, 1901.  Visited by friends who have known her for many years; who say she was always insane, mania for stealing anything, terrible temper, flying into a passion at slight provocation.  Three years ago this May threw herself into Brandywine; had a little money saved, supposed to have been stolen from her, grew very despondent and tried to drown herself.  Afterwards [ill.] work for a little while, then steal something and leave.  Afterwards traveled around for awhile; in New Castle Jail for beating her mother.  History of bad treatment, even from a child in part of her family – mother drinks hard; father fell down stairs and killed himself while drunk.  Has history of [ill. – perhaps ‘having’] a child many years ago.  Taken home by this friend who has given her a shelter whenever she needed it.  Used to run around a great deal, with any and everyone.
Jul 30, 1902.  Since admission has been on violent ward, occasionally in restraint for short time, as she has periods of excitement in which she imagines that people are talking about her, saying she is no good, etc.  Her face is suffused, she is very incoherent and confused during these attacks and the least remark will occasion great anger on her part and unless carefully watched and restrained she is apt to strike the patients or fight with the attendants.  She works on the ward at other times a little, but sits chiefly in a rocking chair singing and humming to herself.  She takes great pride in the arrangement of her hair and does it up no end of times a day.  Half the time she only gives one finger to the doctor – at others she is approachable and affable, answering all questions.  Her memory is poor, or else she will not remember, but the [ill.] questioning at various times has failed to elicit much history.
Sep 23, 1903.  Has outbreaks in which she is very violent and restraint is required.  Talk at times is profane and obscene.  Good physical condition.
Feb 19, 1904.  Condition unchanged.
May 2.  Is quiet, except on rare occasions.  She is well physically.
Nov 14.  Very noisy at night.  Is disgustingly obscene in her language.
Jun 5, 1905.  Vulgar and noisy.  Eats and sleeps well.
Feb 20, 1906.  No change in any way.
Nov 20, 1907.  Very much run down physically, very violent at times.
Feb 2, 1924.  Died.


History and clinical notes:
History: Has been attempting to obtain money to buy poison this past week, has been hysterical with husband, hitting him, scolded, etc.  Does not want anyone to come hear her; at other times very demonstrative.  Sleeps well, appetite poor.  Hears buzzing noises in her head; says she is very nervous and fears she is going insane.  Has globus hystericus, nervous indigestion, etc.  At times excitable, again easy to manage.  In this hospital April 24-29, 1900.  Did very well for a while; past three months been getting gradually worse.  In Delaware Hosp. for couple of days; annoyed patients and husband had to remove her.  Patient wants to be treated for trouble in head.  Came willingly with husband; is very fond of children; had to be driven to see her father to say farewell before she came here.  Following day after sexual intercourse always more excitable and nervous.  No bad habits.  When patient was 3 years old, she was run over by horse and carriage, head hurt.  According to father, patient’s condition very similar to her mother’s.  Latter was very excitable and hysterical.  Died in convulsions following miscarriage occasioned by accident to [this daughter – when she was run over by horse and carriage].  During residence in hospital had several hysterical attacks; would throw up her hands and run shrieking down the ward, or cry noisily, saying that no one understood her case.  Invariable acted for the benefit of lookers on – one night summoned the Doctor, had a regular seizure heart ‘cramps’, groans, pain in epigastrium, etc., lay moaning in bed.  Immediately relieved following administration of asafoetida.  At other times was friendly and kindly on the wards; took care of a baby belonging to one of the patients, was smiling and agreeable.  Again would talk in a disagreeable way relative to the other patients.  Would try and get letters mailed by visitors for other patients.  Was very untruthful at times.  Always smiling and fawning on the Doctors.  Afterwards criticizing everything they did severely.  All the time anxious to get out – ‘she was not crazy’ – her people could afford to pay for her in a private hospital.  She was only nervous, would not act that way if they would only try her again.  Removed by husband on parole, April 1, 1901.
May 13, 1901.  Discharged improved.
Note:  same as patient number 40561159.
Note: The “epigastrium” is the upper middle portion of the abdomen, above the navel, directly over and above the stomach; the region of the esophagus.

Additional notes:
Same as 40561159.  Could not track down in online resources.


History and clinical notes:
History: Patient was sick following birth of child; treated for womb trouble at Presbyterian Hospital, better afterwards.  Again became pregnant; at 7 months labor induced – child lived a day and a half, six years ago following (sic).  Since admission has been on Ward A.  At first complained greatly of being unable to walk, wept and moaned at slightest excition (sic).  Claimed she had lost all power over her extremities.  Had one or two semi-hysterical attacks in the night relieved by [ill.] Valerian.  Palpitations, pain in chest, sense of approaching death, etc.  Heart all the time regular if slightly accelerated.  Worried a great deal over her pelvic troubles, said she knew she had to have another operation, etc.  When she found no attention was paid to this, she ceased.  By suggestion firmly administered patient improved so she was able to walk out to meals, then finally was gotten out to walk around the grounds.  If watched, would sway from side to side and shake all over, but if commanded to [illegible words] try to do as she was told.  Ultimately improved so she dusted her room, made her bed, etc.  Very particular about her personal appearance and neat about her surroundings.  When visited would resort to her old cries and whines, making the life of her family wretched by her doubts and worries.  Sleeps well and eats [ill.] given to using a great many endearing terms; has a habit of holding a person or a chair, etc., as though she needed support.  Facial expression generally one of typical [ill.].  Cannot be gotten to sew.  Claims eyes are [ill.] or that she shakes too much, etc.  Only attends entertainments and church on compulsion and then looks as though she were a martyr.  In April had a light attack of small pox, which frightened her nearly to death.  She did not feel she had sufficient attention from the nurses, the others had more than she, etc.  After release from small pox ward in June was somewhat more lazy than formerly, claiming she was weak, etc.  When this was found not to be the case and no attention was given to her plaints, she ceased and is now in about the same condition mentally and physically she was before the attack.  
Sep 23, 1903.  During June, patient ran a typical course of Enteric Fever.  At present, condition is good physically and quite clear mentally, but indifferent to surroundings.  Visited often by family.
Sep 26, 1903.  Paroled.
Jan 21, 1904.  Discharged improved.
Note attached, typical pathology report.  “Pathological and Bacteriological Laboratory of the Delaware State Board of Health, Fred’k D. Chester, Director, A. Robin, M.D., Bacteriologist and Pathologist.  Newark, Del., June 12, 1903.  Dr. Mr. H. Hancker, Dear Sir, The examination of the specimen of blood, Laboratory No. 3158, submitted to the Laboratory June 10, 1903, does show the presence of the Widal Reaction.  The case is therefore one of Typhoid Fever.”


History and clinical notes:
History: Was brought to Kent County Alms House last May by parties that he was living with; wandered away from his work.  Since he came to the Alms House was very restless, has slept but little, could not keep him there as they had no accommodation.
Jun 1, 1903.  Patient is a very poorly developed man physically.  Talks but little and then can scarcely be understood.  Is an imbecile.  Has tuberculosis of lungs.  Transferred to TB.  
December 4, 1926.  Died in hospital.


History and clinical notes:
History: Patient has been in Del Hospt for some time suffering from Rheumatism.
Apr 5, 1901.  Has been in bed since admission.  Very noisy and troublesome at night.  Has a large scar about 6” long inner aspect of left thigh.  Complains of a great deal of pain in this limb.  Cannot talk English.  At times, especially when dosing, has slight choreic movements.  Was visited by friends today who stated that he was injured by cars about 4 months ago and that he has not been well since then.  Has been at Alms House, at Farnhurst, but was discharged from there April 15th.  Has been very restless and has been so weak that he has to be kept in bed and in restraint; tosses restless about from side to side.  Both conjunctivas intensely congested, pulse full and rapid; complains constantly of pain in head.  Cold applications on head produce no relief.  Is much weaker.
Apr 28.  Is much weaker today, although still noisy.
Apr 29.  At 5:30 this a.m. attendants noticed that he was failing fast and died in a few moments.
Apr 29, 1901.  Died.


On certificate of:
Drs. John Palmer, Jr. and James L. France

History and clinical notes:
History: For past two years has been little feeble in intellect – given to wandering around, especially at night.  Talks to herself at night.  Has been living with daughter and talks continually of going home, but has no other.  Sleeps very poorly.  Appetite very good.  Takes very little interest in her surroundings.  Misaprises that her grandchildren are her own children.
Apr 5, 1901.  Did not sleep much last night.  Seems to have very little realization where she is.  Does not recognize the doctor or attendants a second time.  Walks around the wards a great deal, continually chattering, will talk to anyone who listens or else to herself.  Answers questions readily but information not accurate.  Has no knowledge of time or place.  This morning was untidy, not withstanding that she was on the closet a few minutes before.  Appears sometimes to desire to go home but readily sidetracked on another subject.
Apr 6, 1901.  Left on parole with a friend of family.
May 13, 1901.  Discharged unimproved.


History and clinical notes:
History: Patient has had epilepsy since birth, but never showed symptoms of insanity until about one week ago, when she became very violent, attempted to strike Mrs. [name redacted, same as patient’s].  Had to be restrained at that time.  Has been living with Mrs. [n.r.] at Harrington for about 14 years and has always been a faithful servant.  Has delusions of persecution that are well marked for past few days has not ate anything and has slept but little.
Aug 1, 1902.  Since admission has been practically stationary, working at times industriously both on wards and in laundry.  At other periods sitting around and doing nothing unless constantly urged.  Has frequent epileptic attacks but these are not severe and only inconvenience patient for the time being.  Is very angry if any of her belongings are disturbed.  Very desirous of decorating herself with ribbons, etc.  Neat in habits and personal appearance.  Eats ravenously, sleeps well, and seldom requires medicine except for constipation.
May 2, 1904.  Physical condition good.  Works daily in laundry.
Nov 14.  Works all the time.  Is good natured, good physical condition.
Jun 5, 1905.  Has epileptic convulsions frequently, otherwise in good health.
Feb 20, 1906.  Mental and physical conditions unchanged.
Nov 20, 1907.  Has frequent epileptic convulsions.  Works on ward every day.  
Jun 3, 1909.  Condition not improved, coughs a great deal.
Sep 20.  Tubercular area in both apices.  Coughs and expectorates a great deal.  Very cheerful and amiable.  Transferred to T.B., has epileptic convulsions, but not frequently.
Jan 31, 1910.  Had several convulsions today and feels very weak.
Feb 1.  Rested poorly, quite talkative in the morning, grew much weaker in the evening.
Feb 2, 1910.  Died this morning at 4 a.m. in status (epilepticus).

Final disposition:
Died of status epilepticus; buried at DSH #181


On certificate of:
Drs. James L. Crossmore and L.S. Conwell

History and clinical notes:
History: Patient has been sick off and on all winter, chiefly grippe.  Has been very violent, destructive, knocked on other doors, broke out windows, had to be restrained.  Tied with rope.  Mother high grade imbecile, has always managed to make her living, husband was fairly educated.  Several other children – these all seem bright except daughter who is somewhat feeble minded.  Last Friday patient attempted to pull his own tongue out.  Appetite enormous.  Wanders around the country, has only been capable of minding [ill. – could be ‘cows’], etc.  Answers questions slowly; does not always comprehend what is asked.  Cries and moans occasionally.  Physical condition of patient good, prognathous face, small head, vacant expression.  Skin abraded all around the waist, objected to taking bath, tried to bite and kick.  
Aug 26, 1901.  Has grown fat and happy since admission.  Is quiet, helps polish floors.  On parole with brother.
Sep 2.  Returned by brother.  Was well for 3 days then began to refuse to eat, took off his clothes, crawled on floor.  Is quiet now, but depressed and frightened and more stupid than when he left.
Sep 17.  Quiet.  No longer confused.  Gaining in weight.
Nov 18.  Fat and strong, eats and sleeps well.
Jan 12, 1902.  No change.
Apr 16.  No change.
Jun 10.  More stupid today.
Jun 13.  Brighter.
Jun 24.  Very stupid, would take no nourishment or medicine today.
Jun 25, 1902.  Refused food and medicine this a.m.  Was given Mag Sulphate, milk and eggs by nasal tube at 8:15 a.m.  Regurgitated about ½ of same at once.  Vomiting twice during morning and seemed very weak and stupid.  Died suddenly at 12:20 p.m.  At post mortem, no gross cause was found.  Cause of death reported as post dementia exhaustion.  Buried in hospital cemetery.  Grave 108. [Ledger says #107, but Cemetery Book says #108].

Final disposition:
Died of "post dementia exhaustion."  Buried at DSH

Additional notes:
Buried at DSH, Grave #108 (says 107 in ledger book, but this is a mistake, according to cemetery records).  One sister and one brother also described as MR.  Sister was still living with their parents as an adult.


On certificate of:
Drs. Frank Roop Smith and P. Isenscheid (?)

History and clinical notes:
History: Patient has always been a temperate man, has had kidney and bladder trouble for 3 years.  Suffers from incontinence at times.  3 ½ months ago had a stroke; all right side paralyzed at time, speech indistinct.  About six weeks before began to improve, gradually regained use of leg and arm, but has not perfect control of them yet.  For past few weeks has been trying to get out of bed at night – did so occasionally and fell several times.  Talking incessantly, kept family awake nights.  Appetite excellent and sleeps some through the day time; hardly two hours straight.  No increase of irritability.  Has not recognized his daughter since the stroke.  Patient very feeble, thinks he is in the poor house.  
May 1, 1901.  Out of bed.  Sits in chair all the time during day; is feeble in every respect.  Complains but little.  Appetite good.
May 14.  Tears clothes if not restrained.
Jun 7.  Is failing in strength.  Eats and sleeps well.
Jun 9.  Several bed sores over sacrum and crack.  Unable to get up.  Heart weak.
Jun 13.  Has an irregular temp, 99-102, pulse 100-130.  Heart sounds of poor quality.  No murmur detected.  Lungs clear.  Eats well.  Urinary and fecal incontinence.
Jun 20, 1901.  Is unconscious this a.m.  T.P.R. 100-128-36.  Some pulmonary oedema at bases posteriorly.  Died, 4:35 p.m.


Complications:
blind in right eye; kick of horse when a boy

History and clinical notes:
History: Has been failing for some time.  Wanders away from home, does not know where he is.  Talks to himself, chiefly at night.  Tries to get out at night, sleeps poorly.  Appetite good.  Has no memory.  Continues to work well at simple things – originally a good hard worker.  Hit on head by young colt when 8 years, very ill following injury.  History given by 2nd wife, who knows little of his previous history, only married 4 years.
Dec 30, 1902.  Condition the same.
Jan 20, 1903.  Condition the same.
Jun 1.  Patient quite contented and comfortable.  Works some about the garden and ward.  Physical condition unchanged.  
Jan 16, 1904.  Vision of left eye totally destroyed, vision of right failing rapidly.
Apr 24.  Vision entirely gone, failing rapidly physically.
Jun 12.  Confined to bed, emaciating rapidly.
Jun 19.  Very much worse today.
Jun 29, 1904.  Died, senile dementia.


History and clinical notes:
History: About 2 years ago both ovaries removed on account of organic trouble.  Shortly after this, symptoms were noticed that were peculiar.  She began to detest her husband and his family while formerly she thought a great deal of them.  This has continued until lately she imagines that they are all in league against her and that they are trying to rob her of property.  For past few weeks has wandered from home a great deal until her friends were alarmed against her.  At times sleeps well while again she is very restless.  Appetite is good.  Has lost considerable flesh since operation.
Jun 4, 1901.  On parole.
Feb 15, 1902.  Discharged unimproved.


History and clinical notes:
History: Has been intemperate for many years; great man to spend money, and like good company.  No disease of any kind.  Has name of being a good fellow.  Has been married almost 25 years, never had any children.  This attack commenced last week.  Left home (first time) drinking hard, commenced to talk in a peculiar manner, going traveling, to Omaha, everywhere, had imagined he gave a great deal of money away; thought he was [ill.] so much money that he need never work any more.  No hesitation in speech noted by friends.
Jun 25, 1901.  Says he is worth $100,000 to $200,000 dollars.  Believes his wife is a little crazy.  Memory good.  Speech shows no [ill.] though it is rather drawling.  Well nourished slender male of about 50 years.  Eyes gray.  Slight ataxia on extreme deviation, one pupil oval lat 180 degrees 4 mm – O.S. similar but slightly larger.  Doubtful reaction to light, feeble reaction to A&C. [ill.] media clear, never heals, gray in deeper layer.  [Note: I have no idea what this is all about].  Tongue moist, corrugated, slight general tremor.  T.P.R. 98.3, 64, 18.  Heart, lungs, and abdomen show no gross lesion (doubtful prolongation of expirations).  Gross strength of limbs normal.  Slight ataxia of arms.  Reflexes: no Jaw Jerk.  Biceps Jerks normal.  No KJ even with reinforcement of Jendrassick.  No AC J, QJ and GJ feeble.  No Pl reflexes.  Station sway increased, can not stand on one foot with eyes shut.  Sensation normal except for delay in the usual perception.  No asteriognosis.  History of incontinence of urine for six years, or intermittent lateral dip [ill.] of difficulty in walking of quick jumping pain in legs for 4-5 years past.
Aug 12, 1901.  Getting fat.  Mental condition unchanged.
Sep 28.  Good physical condition.  Very [two illegible words] in habits.
Nov 8.  Untidy.  Tears clothes.  Says he is worth $10,000,000 and he held all important offices in state.  Is failing quite rapidly.
Jan 12, 1902.  Believes that purgative salts were put in supper yesterday and claims he had a severe diarrhea past night, but which is not true.  Is very cross and has refused breakfast and dinner.  Continues very untidy and must be restrained to keep him from tearing clothes.
Feb 27.  Quiet, cleanly, feels well.
Apr 16.  No change.  Vaccinated.
Apr 22.  Good take.
Jun 13.  No change.
Jul 30.  Has occasional attacks of weakness and of increased tremor and ataxia.
Aug 30.  Ptosis of O.S. increasing.
Oct 7.  Complete ptosis O.S.  Mounts stairs with difficulty.  Transferred to Ward D.
Dec 30.  Condition the same.
Jul 12, 1903.  Patient has failed rapidly for the past 3 months.  Has been in bed about 4 weeks.  Rapidly losing in strength.  Eats little.  Bed sores.  
Aug 13.  Patient noisy and abusive at night.  Last night he abused a fellow patient and he retaliated by striking him several times in the face, causing several slight abrasions and blacking his eyes.
Dec 8, 1903.  Died at 7:20 a.m.

Additional notes:
Note: The Jendrassick maneuver involves telling the patient to lock his index fingers together and then try to pull them apart.  It distracts the patient and usually results in a stronger knee jerk reflex, though the mechanism for how/why is not well understood.  Astereognosis means the inability to identify objects by touch, which, if present, would indicate some brain lesion or abnormality of function.


History and clinical notes:
History: In this Hospital from Dec 26, 1898 to May 15th, 1899; when she was removed by husband against wish of Superintendent.  Officer who brings patient knows nothing about her.  Wants her own way, makes it uncomfortable for husband, scolds all the time; does not like strangers; likes her youngest daughter but dislikes eldest, who had to leave home on account of disagreement.  Has been better mentally than when here before.  Husband could not make her mind (he is of imbecile grade himself).  
Aug 1, 1901.  Since admission has worked on ward, kept a great deal to herself; always neat and clean and when spoken to plainly has done what was required of her.  Says she is here for a purpose, will not go home, does not want to see any of her people, especially is upset by visits of her husband.  Is sometimes pleasant and agreeable with physician, again does not [ill.] to have anything to say.  [Ill.] shake hands, once in a great while has a short period of depression during which she has her head buried in her hands and won’t say anything to anyone.  Seems to take a pleasure in working, but will only do the kind that suits her.  Physically in good condition.
Sep 30, 1901.  Discharged unimproved.


History and clinical notes:
History: Before husband died (3 years ago), patient signed away her rights to property.  June 2nd of this year, court decided that she was not entitled to any of the property.  This worried her a great deal, and she became very much depressed, did not sleep and wandered from her home, wrings her hands a great deal.  Resists everything that is done for her.  Patient would not get out of carriage and it required considerable effort to get her to enter Hospital.  Patient has a number of bad bruises about her person, arms and limbs.  Sister says patient injured herself by squeezing her arms.  Last Saturday was quite a little noisy, moaned, etc.  Has lost flesh – is very anaemic.
Aug 4, 1901.  When first admitted very hysterical; threw herself around, banged head against wall, tried to strangle herself with her hands, cried and moaned.  Had to be restrained a few times, for a week was constantly watched.  Kept in bed for three weeks, opium and Valinace (?) administered as needed.  Sometimes was clear and tried to collect her thoughts but as a rule moaned and cried.  She had no money.  They had taken her clothes.  She had no place to go.  Was visited by attorney but clutched and cried so that he could get little out of her.  Always wanted to see the doctors.  Was not satisfied to have anyone pass her door without calling them in.  Objected to the treatment she received.  Said everyone was [ill.] with her, kept repeating over and over again.  That she was a lady and should be treated as one.  For past two weeks has been in front ward, only brought there by greatest tact.  When once there she decided/demanded to return to Ward 3.  Told as long as she controlled herself she would be allowed to remain.  First night she pounded on the door, but when threatened with removal ceased and has acted quietly ever since.  Holds herself rather aloof from the other patients.  Still very nervous and readily excitable, but on the whole a vast improvement in her condition.  In October had mild attack of erysipelas beginning around ears and roots of hair, spreading down the outside of face.  Responded to treatment well; during this attack mental ability seemed much duller than usual.  Did not seem to grasp the trouble with her face.  As she improved physically returned mentally to same condition as above notes.  Only once or twice ate her excretions – was very uncleanly in her habits.  Thought the house was on fire, that she saw a crowd of Negroes outside her window.  That everyone wanted to poison her, that she was no good in this ward.  Gradually improved until she was able to be transferred to B, the week before Christmas.  Here she behaves very well on the whole, occasionally worries about herself and moans a little but the mention of returning her to [ill.] wards is sufficient to keep her quiet for a time.  
Apr 12, 1902.  Visited by sister yesterday; was quiet and had little to say for herself.  Of late has not worried quite so much.  Has gained in weight and except to utter a few plaints relative to “she has no clothes”, “Is she to be put in the Colored Ward?”, “I am very naughty, [ill.], very naughty,” has very little to say.  Physically she looks better.  Eats and sleeps well, etc.  
Sep 23, 1903.  Fairly good condition physically.  Thinks she is soon to be normal.  Always says “I won’t be here long.”
Nov 14, 1904.  Condition the same.
Jun 5, 1905.  Begs not to be turned away, “nowhere to go.”  Eats well, but grows emaciated.
Feb 9, 1910.  Fell from a chair on which she was sitting sleeping, and sustained a fracture of the neck of right femur.
Feb 21.  Rests comfortably on a water bed.  Eats and sleeps well.
Mar 4.  Quite pale.  Seems listless when spoken to.
Mar 11.  Semicomatose.  Had a fainting spell today.
Mar 13, 1910.  Died.  Chronic valve disease of the heart.  Exhaustion from intra-capsular fracture of femur.

Final disposition:
Died from chronic valvular disease of the heart and exhaustion from intra-capsular fracture of femur


History and clinical notes:
History: Patient was admitted yesterday without papers.  Brother states that patient has been a steady drinker for years, drinking 8-10 glasses of whiskey a day.  Has been enabled to attend to his work and has been an industrious worker.  Six weeks ago got into an altercation in a saloon and was shot.  Ball entered about 2 in below center of right clavicle.  Was taken to Delaware Hospital but the ball was never found.  Paralysis of first and second finger persisted for a time but this gradually disappeared.  Was discharged from Del. Hospt. 3 weeks ago.  Short time before leaving hospital, first symptoms of insanity was noticed.  Began tearing his clothes, talked incoherently, wanted to fight everyone that came near him.  After he was taken home, above conditions became exaggerated; wanted to get dressed and go out and fight someone.  Tore his bed clothing and resisted everything that was done for him.  Although he is getting stronger, patient is still quite weak and feeble.  Is anaemic; sleeps poorly at night and takes but little solid food.  Will drink milk freely.
Patient is an anaemic-appearing “soody” (??) complexioned white male of about 35 years.  Ideas incoherent and speech indistinct; gives practically no history.  Eyes: no gross lesion.  Tongue: moist, thick, gray central coat, margins clear, pale red.  Pulse reg, tension mod. 84.  Heart shows no gross lesion.  Lungs (R) marked impairment of percussion noted, posteriorly up to 6th rib, anteriorly ref to 4th rib.  Expansion and [ill – looks like ‘freniton’] possibly diminished over this area.  Breath sounds vesicular but diminished in strength; over affs (??) part of lung there are no signs of gross lesion.  R lung shows no gross lesion.  Abdomen: neg.  Limbs: On central anterior surface of R am (4”) below acromion there is a circular pale blue scar, 8 mm in diameter, movable, induration slightly.  (Just to left of left nipple is a 3 x 1 cm superficial scar.  Elsewhere there are a few bluish induration of [ill. – looks like ‘Chr Tufla’; could be “indications of Chromium Sulfate??].  There is no wasting of R arm).  Moderate movement of R elbow and shoulder cause resistance from patient on account of pain.  Patient winces equally on deep pressure of both arms.  No anaesthesia (patient is tractable).  R grip fair; 1st and 2nd fingers weaker than others.  L grip good.  Gross strength of arms fair, left being the stronger.  Gross strength of legs fair.  Station fair.  No apparent ataxia of arms.  Reflexes active and equal throughout.  Rx: given iron, styol, pixe tid. (??) Trional gr xxv 6 pm (??).  Mag sulph ℥ (ounce) i stat.  Milk, eggs, toast, tid.  
Jul 2, 1901.  Restless.  Sleeps poorly.  Taken little food.  Constipated.  Rx. [ill. words].  
Jul 4.  Sleeps little, soiled bed, eats little.  Is complaining, in [ill.] and intractable.  
Sep 30, 1901.  Discharged restored.


History and clinical notes:
History: Officers who brought patient know nothing of his history.  Aunt gives history that [patient] has been irritable for many years, eccentric and queer.  Wife gives history that [patient] was in Kent County Alms House, Maryland, for a week with an attack similar to this.  Overcome by heat each time.  Has been peculiar in behavior at times.  Threatens to kill his family or to burn down his house.  Gets spells of rage, does not know what he wants to do, wanders around, has no cause for anger.  As a worker does get on well with his companions but does not get on with his boss; curses frequently.  Generally has work, however, and people like him.  Gets up at night and makes fuss over little things, many times imaginary causes.  Brother was deranged at home for years.  Uncle was insane; jumped out of window and killed himself.  [Patient] hid himself in closet, stripped naked, when wife went up and looked in closet, found him but he would not answer.  [Ill.] only kept on blaming (??) with his cheeks puffed out.  Chased wife out of room, then went to bathroom and kept spitting and spitting, would not talk.  Finally got made and jumped at wife.  Told a man who came in he was going to burn down house, asked for Laudanum and wanted to end his life as he had no desire to live.  Stumped his toe against the machine, got mad and he broke the machine.  Called his wife all sorts of ugly names, accused her of improper intercourse with the doctor.  Call her to come and be killed.  Has frequently pushed her out of doors in her night dress and locked the door on her.  Also has hurted (??) daughter in a similar time.  Creeps around the rooms in his bare feet and watches wife at her work.  Tries to frighten her.
Jul 13, 1901.  Has been very quiet since admission.  Was removed on parole by wife against advice of Supt.
Sep 30, 1901.  Discharged improved.

Additional notes:
Found in 1900 and 1910 census.  In 1910 still living in community with wife and youngest child (then 15 years of age).


History and clinical notes:
History: Since discharge from this Hospital (Oct 27, 1897 to March 12, 1898 in hospital, home on parole until Jun 12, 1898 when she was discharged improved) has been fairly well.  Always worries a good deal, but not melancholy.  Wanders around the house the first month, does not seem to know what she wants to do – is decidedly melancholy and says she has lots of troubles.  Says she worries over her husband’s death.  Daughter’s statement is that she makes [ill.] fuss over his death now than she did actually two years ago when he died.  Has lost flesh for past 3-4 months, but most markedly during past month.  Has no appetite at all and eats very little indeed.  Sleeps well.  Patient appreciates very well that she is melancholy; says she is worse early in the morning, wants to come and stay here a few days.  For past few days was worried all the time and worked none.  Prior to that for months worked very little.  At other times always was a good worker, if anything, tendency to overwork.  Since admission has been somewhat melancholy, but always ready to work and interest herself in what was going on around her.  Has slept well.  Appetite extraordinarily good; occasionally has driven into Wilmington with her daughter.  Occasionally has a worried expression and says she is nervous [ill.] herself.  Finally said she felt well enough to go home, that they needed her and she wanted to work.  Left on parole Jul 28, 1901.
Sep 30, 1901.  Discharged improved.


History and clinical notes:
History: Brought from Delaware Hospital where he was being treated for sunstroke.  His insanity developed according to certificate after recovery from the sunstroke.  Men who brought patient knew nothing of him except that he had been ill in bed.  So violent that he had to be strapped in; also that he was unmanageable in the hospital.  Brother says he has only been in this country 6 weeks.  Last Tuesday working at tanning (??), drank too much ice water, overcome by heat.  Taken to hospital.  After attack seemed all right until 5th of July, then did not know his own brother.  Did not talk sensibly, incoherently, and more than was his usual habit.
Jul 11, 1901.  Patient has taken but little nourishment since admission; was fed with nasal tube today.  Pulse very rapid and has been since admission.  Temp 104.2, [ill.] in teeth.  Is slowly failing.  Cannot talk English.  Is failing very fast.
Jul 15, 1901.  Died at 8 p.m. Cause of death exhaustion from acute delirious mania.

Final disposition:
Died of exhaustion from acute delirious mania


On certificate of:
Drs. S.C. Frederick and Egmont T. Negendauk

History and clinical notes:
History: Eight years ago patient began to complain of pains and explosions in his head, of sore throat and ear troubles.  He was treated for a time by the family Dr. and for five years past by W.S.W. Clussmore (??) a “Hornegts.” (??)  The explosions of which patient complained seemed to light up the interior of skull making it visible to him.  Under treatment the boy improved.  Until two years ago, patient has been an efficient clerk in a large grocery store.  At that time he returned home unable to continue; after being put to bed he lost power of speech, but soon regained same.  One and one half years ago patient was left alone as result of a quarrel with a younger brother with whom he had been living on a farm.  On arrival of parents he told them how newcomers had their barns burned and cows poisoned and was so frightened that he had secured windows down and hidden all dangerous instruments.  This is the first the father had noticed of any mental derangement.  For several months dating from this time, patient was under treatment by a Dr. Othenbourg for the supposed results of masturbation and at this time patient was easily irritated and repeatedly left dining table to run up stairs, returning shortly to threaten his father.  Personal habits are cleanly.  Patient’s letter to his father show him to be a good [ill.], but utter contents are foolish and improbably.
Jul 31, 1901.  History given by patient agrees in material points with that give above by father.  Claims the man he has lived with is not his father; his own father is a doctor; says he has seen him in the park; cannot explain the affair.  Believes he taught his father and mother to read and write.  Speaks slowly.  Claims to eat and sleep well.  Last explosion in head occurred July 21, 1901.  
Oct 23, 1901.  Fair physical condition.  Dementia slightly [ill.].  No more explosions.
Nov 8.  Says he feels as well as ever.
Nov 18.  Vomited twice yesterday and once this a.m.  Is salivated, no cause discoverable except nausea.  6 p.m. slight fever.
Nov 19.  Temp normal, pulse 80, respirations 8.  Refuses to talk.  No gross lesions detected.  Salivation continues.  Rx. Calomel, milk Σ every 3 hours.
Jan 12, 1902.  At times is markedly salivated and occasionally vomits.  Has no ambition and is made to sit up with difficulty.
Feb 27.  Occasional attacks of indigestion when retains almost nothing.  Is quiet, depressed, almost quarrelsome if spoken to.  Sweats profusely and skin is often cyanotic.
Apr 15.  No change.  Vaccinated.  Apr 20.  Good take.
Jul 30.  Very irritable.  Good physical condition.
Oct 7.  Complaining and irritable.
Dec 30.  Condition the same, patient is markedly hypochondriacal.  Moody and at time a little excitable.
Aug 20, 1903.  Getting very obese.  Good health.  Complains of the most absurd ailments.
Sep 23.  Father and mother visited him a few days ago and patient abused them.
Feb 11, 1904.  Says he is sick, but refuses medicine, claiming we are trying to poison him.  He seems to be suffering from (General Malaise) and is too tired to expectorate in cuspidor and instead “spits” on bed linen and floor.
Oct 18, 1905.  Attempted to assault Dr. Davies and in self-defense was struck by Dr. D.
Apr 24, 1940.  Died in hospital.

Final disposition:
Still in hospital.  Later note added, died at DSH 4/24/40.

Additional notes:
Died at DSH on 4/24/1940 of cerebral hemorrhage.  Last name may have been Baisley.


History and clinical notes:
History: Admitted first on January 22, 1895, on parole March 30, 1895.  Discharged recovered May 1, 1895 (see case 665).  Patient’s head was injured prior to other attack.  Since he left hospital in 1895 has been working industriously and seemed all right.  About two weeks ago began to ramble in his talk, could not rest at nights.  Wandered around all the time.  Eat poorly, sometimes well, but as a rule not.  Sleep very poor.  Has lost flesh markedly the past few weeks.  Talk incoherent, trash, spoke to everyone he met.  Had cross spells when not listened to.  Never tried to hurt anyone, but has threatened people, especially a young lady who would not marry him.  Moderate drinker.  Never under influence of alcohol.  On parole October 12, 1901.
Nov 25, 1901.  Discharged improved.

Additional notes:
Admitted three more died, died in DSH in 1951.


History and clinical notes:
History: For more than or about two years patient has been more or less nervous, sleeping poorly at night.  Has not shown however any symptoms of mental derangement.  For past two weeks he has been much worse; has lost 19 pounds.  Appetite good.
Aug 4, 1901.  Went home on parole.
Sep 30, 1901.  Discharged restored.


On certificate of:
Drs. George W. Marshall and George M. Pliasautome (?)

History and clinical notes:
History: Has suffered from kidney disease four or five years.  Has had attacks of dropsy, abdomen swells much more markedly than legs, although R leg swells considerably at time when she is on her feet.  Had marked varices of legs, followed by ulceration, first on one side of R leg, then on other.  This condition of R leg exists now.  Always bright and cheerful up to past two years; hard working woman; very little sickness up to kidney trouble.  Has had 12 children.  Two died at birth, 8 died from 6 months to 3-4 years.  All children were good and healthy and died of natural causes, not in any way connected with mother’s health.  [Patient] has raised two sets of grandchildren, worried over them more than she ever did over her own children.  Last set used to get mad because she wanted them to stay at home and they used to beat her.  Mental symptoms began 2 years ago; she began to see various things around her.  Thought women dressed in white were in the berry patch, thought people were always coming into the house.  Would hold long conversations with imaginary individuals, would call constantly for the children, whether they were there or not.  These symptoms grew worse gradually.  Slept poorly at night, would get up and look out the window.  Appetite always good, of late seems to think only of eating.  Recently has been so crippled on account of leg that son cannot manage her at home.  Mumbles constantly to herself, frequently incoherent for long time.  Difficult to understand what she says.  Is not violent, but occasionally has slapped people without reason.  Never tried to hurt anyone as herself.  Recognizes her son as a rule, occasionally not, but has no knowledge of her surroundings or the people she has known for many years.  If she looks at them a long time, occasionally seems to remember faces, but never names.
Aug 1, 1901.  Died after an illness of 3 days.  Seemed to feel the heat very much, became very restless and feverish.  Kept in bed with difficulty until she passed into semi-unconscious condition.  Breathing at first rapid, became stertorus, and finally very irregular.  Heart action almost as good on day of death as earlier – sounds clear and regular.  Day previous to death lay in semi-comatose condition.  Swallowed with great difficulty and small quantities of liquid only.  Failed gradually until Aug 1, 1901, when she died at 8:31 p.m. without regaining consciousness.


History and clinical notes:
History:  Brought by friend who states that for past six months patient has been getting increasingly feeble in health and intellect.  Wanders around the house, especially at night, all the time attempting to straighten things but really tearing things up.  Wandered out in woods night before last, did not have anything but night clothes on.  Has been unclean but of late more particular as to calls of nature.  Has to be reminded all the time about taking care of herself.  Chatters constantly, generally incoherent nonsense.  Has been refractory but of late has been more obedient, especially to those whom she likes.  Since past six months has been dead set against her niece, who was always especially kind to her.  Mind has become enfeebled lately, has no knowledge of dates, places, etc.  As to people, sometimes she knows them, sometimes not.
Aug 4, 1901.  Since admission has been very quiet and peaceful, easily managed.  Every morning wants to go home; says she will go for day or two and then return here.  She must really go.  When put off positively says “she does not like Jim, she wants nothing to do with you.”  But by the next visit of physician is quite ready to start the subject cheerfully again.  Has absolutely no idea of the place she is in or the surrounding country.  Imagines this is Philadelphia and that she can easily walk home.  On admission had a nodule size of small egg in under surface left mamma involving and obliterating nipple of that breast.  Since admission this has commenced to ulcerate.  Patient also markedly pigeon-breasted and suffers from [ill.] kypho-lordosis.  Physically poorly nourished.  Has a peculiar musty odor about her that it is impossible to get rid of with bathing.  Memory for past recent events very poor.  Varies in her stories constantly but always in a cheerful happy presence of mind.  Sleeps well, appetite good.
Jan 8, 1902.  Continues as above.  The mammary tumor is making slow progress.  Is quiet and cheerful on ward.  Works quite industriously at times.  Occasionally asks to go home.  She must have the key to get her [ill.], then she will go.  She cannot really stay.  Talks cheerfully with attendants and other patients and is quite a pet on Ward B, where she is always ready to help.  
Apr 12, 1902.  Complained of feeling sick yesterday and put to bed.  No apparent physical cause for her feelings other than mammary ulceration which is increasing in area and depth.
Apr 22, 1902.  Died of smallpox and buried here.

Additional notes:
Buried at DSH, Grave #99.  Had no children, was a widow.


Insane Relatives:
father died insane; brother had epilepsy

On certificate of:
Drs. J.O. Pierce and J.S. Prettyman, Jr.

History and clinical notes:
History: Has been living with Mr. [name redacted] for past 3 years.  How the first symptoms manifested themselves is not known by those who bring her.  For past two weeks has become quite unruly.  Has taken her clothes off and wandered on the streets not sufficiently clad.  Talks about people having her money while in fact has always been a poor girl.  At night does not rest, walks the floor and her relatives could not do anything with her.  Would resist when they attempted to restrain her.  Is very religious, talks a great deal about religion.  Frequently speaks of how virtuous she is.  Appetite very irregular.  Sleeps poorly at night.  Health failing, steadily losing flesh.
Aug 4, 1901.  Patient extremely intractable at times, until indeed [ill.] wandered into dining room and stood staring at all that was going on.  Never seemed to mind the fact that she was in the way.  When taken out would exclaim that that was what she wanted – to make the attendants come out of the room and exert themselves for her.  Sat for hours in the window taking off and putting on her shoes and stockings.  Said her feet were mixed up with her respirations.  Does not give any consecutive information.  Occasionally will answer a question directly but usually gives an incoherent or foolish reply.  Is aware of all that goes on around her, interferes with other patients.  Wants to go walking with those whom she knows are not fit to go far.  Is lazy about getting up in the morning.  Rarely on time for her meals.  As soon as [ill. words] starts for water closet or for her room and [ill.] her key so as to keep attendants waiting.  Is all the time talking about her respirations, about what she sees, but it is impossible to nail her down to any one subject.  One day will not answer the Dr. at all, sits stolidly in her chair, with eyes half shut and fixed intention of paying no attention to what is done or said to her.  On another occasion will rush up to Dr. as though to her dearest friend and will have some nonsensical remark ready.  At other times follows physician around and listens to what is said with the others.  Occasionally interrupting.  Whole manner of bearing of patient theatrical, seems determined to make herself a nuisance and acts as though acting a part.  By fits and starts she is rather erotic but up to present date no bad [ill.] have been observed.
Jan 8, 1902.  Has had another period during which is was necessary to transfer her to Ward 3; she broke glass, hit patients, tore up beds, etc. on B.  Also refused food for few days.  Part of the time being fed by tube or else forced to drink a quart of milk with egg at one sitting.  Seems to like it on Ward 3.  Although Quieter and better does not wish to leave.  Physically is looking somewhat better.  Continues to call on [ill. – looks like ‘ceyets’] and the [ill. – looks like ‘hiarrus’] whenever she is addressed.  Occasionally answers rationally.  
Apr 12, 1902.  For past three days on Ward 3.  Without cause in [ill. words] the other morning and when the attendants and doctor tried to stop her she scratched them severely.  In restraint a couple of days.  Now seems some better but still very unapproachable.  If touched draws away, brushes off place where she was touched with her hands vigorously, shakes herself free, etc.  Eats and sleeps well.  Will not talk to anyone, sits and stares at the ceiling or at her hands for hours.  Occasionally kneels as though praying, runs her lips a little but utters no sound.
Sep 23, 1903.  Very violent at times.  Has turned on attendants several times and fights viciously.  Muffs have been ordered, very delusional and hallucinatory, very disobedient, surly.
Feb 19, 1904.  Uses profane and obscene language at all times, violent and surly.
Jun 15, 1905.  Remains the same.  Appetite fair, sleeps well.  
Feb 20, 1906.  No change.
May 1918.  Patient getting worse mentally and physically, after suffering through dyspepsia.
July.  Patient appreciably had jaundice.
Oct, 1918.  Patient had an attack of epidemic influenza.  
Nov, 1918.  Patient suffering from jaundice.
Dec, 1918.  Patient getting worse.
Jan, 1919.  Moderate enlargement of the liver.  Slight jaundice.  Digestive disturbance.
Mar, 1919.  Negative enlargement.  Paralysis of pain at irregular intervals.  Splenic enlargement.  The edges of the liver rounded and granular.  Hepatic and splenic dullness.
Apr 7, 1919.  Intense jaundice.  Temp 100.  Pulse 128.  Patient very weak.
Apr 10.  Patient in [ill. – looks like Thipor’].  
Apr 11, 1919.  Patient in coma since 5 a.m. and died at 12:35 p.m.  Hypertrophic hepatic cirrhosis (7 months).


History and clinical notes:
History: In this Hosp. August 9, 1892 for several weeks.  Since leaving has been contrary and rather weak-minded, but conducted her household affairs up to death of husband, Dec 1900.  Since then she has been growing gradually worse and worse, wanders around the house, imagines people are robbing her, getting the best of her estate, that she is losing all she has.  Full of delusions of persecution, says people are in her room, that their eyes are queer, that she has various things in her throat, etc.  Talks constantly, lamenting all the time, first feet, then mouth, then chest.  Pretends to cry all the time, but not a tear.  Did not worry over husband’s death at all.  Memory in some things sharp, especially relative to pecuniary matters, on account of her sight her memory is not so good for people.  Mislays her belongings and accuses people of taking what she has lost.  Was married 47 years, commencement of her trouble was greed for money, tried to jew everyone down and crowed over a bargain.  Noted for her desire to get ahead of everyone.  Made the latter years of her husband’s life very miserable.  
Aug 4, 1901.  Since admission has been very quiet and with little tact easily managed.  Asks after her clothes, her money, etc., but is some reassured about them.  Knows where she is and wants to remain here.  Rebelled against taking off her clothes the 1st night, but afterwards was easily influenced to do so.  Physically rather weak and poorly nourished.  Dozes often for several hours, lies around either on her bed or the sofa, takes very little interest in those around her.
Aug 22.  Has suffered from obstinate diarrhea for two weeks past, growing gradually weaker, being bed-rid due for several days past.  Has often refused treatment and has eaten very little.  [Ill.] hemorrhages have occurred in to skin on back of hands.  Patient removed today by [correspondent – name redacted] with warning of weak condition and possible demise in ambulance.
Aug 22, 1901.  Discharged unimproved.
Aug 25, 1901.  Failing, very weak, Dr. Palmer reports.

Additional notes:
Dr. Palmer reports she is failing and very week on Aug 25, 1901


History and clinical notes:
History: Patient was found leaning against a lamp post, shouting with all his might.  After being arrested patient was noisy and violent, making restraint necessary.  On admission, patient is perfectly quiet and tractable and is dressed in a gray blue suit with a dark strike, apparently an institutional suit.  Physical Examination: weight 134 lbs., negative except that pulse rate is 120.  Patient is apparent a Pole who understands little English.  Mental state stupid.
Aug 12, 1901.  Patient slept well.  Ate a good breakfast.
Aug 15.  Has not said a word since admission.  Is cleanly, tractable, and quiet.
Nov 8.  Quiet, clean, works when watched; good physical condition.  Usually has a foolish smile on face and moves lips as if talking to self.  Observes quickly coming and going of doctor and other events.  Never or rarely speaks.
Jan 13, 1902 (says ’01).  Clean, quiet.  Help about infirmary.  Often smiles and whispers foolishly to self.
Feb 27.  Very helpful on ward; is is kittenish (??) as ever in actions.
Apr 15.  Good health, quiet and clean.  No change in habits of whispering something or watching one who apparently no observed (sic).  Helpful in infirmary.  Vaccinated today.  Good take.
Jun 13.  No change.
Oct 7.  No change.  On day was found apparently trying to hang himself on a water pipe in back toilet room.  And later pulled pipe down, wristlets and help put on and worn since.  
Jun 1, 1903.  Patient failing.  Looks very anaemic, but blood count is up to standard.  Evidences of beginning tuberculosis in base of left lung.
Feb 6, 1904.  Rapidly losing flesh, appetite impaired, put to bed and placed on liquid foods, gradually or rather rapidly grew worse.
Feb 8, 1904.  Died at 2 p.m.


History and clinical notes:
History: Patient violent at times, lasting several hours, break [ill.] furniture, glass, etc.  Officer who brought patient knows nothing of history.  Patient gives her name and address correctly, seems somewhat hysterical, says she will tell all about it and then repeats sentence several times without being any more communicative on subject she desires to talk about.  Said she wanted to go home but made no opposition at all when nurse came to take her to the ward.  After a little, quieted down, did as she was told and some commenced to work on Ward.  For several days was very excitable, refused to eat repeatedly, but never expressed any delusions or hallucinations and as soon as she found that the rules were to be kept she was all right excepting that she kept saying over and over again she would tell all about it.  Improved rapidly and some was anxious to go home.  On Sept 11, was allowed to go home on parole.
Sep 22, 1901.  Returned by husband [name redacted] and brother.  Was well until 5 p.m. yesterday when she began to dance, ask if she was crazy, shout, hope God would kill her, she was going to die in the grave.  Slept from 2 ½ - 6 a.m.  Noisy all other times, not destructive.  Now is talking constantly, resists slightly being brought into hospital.  Hysterical.  Laughed when saw attendants on Ward 6.  Rx. Bact. b.i.d. – Chloral gr xv, restrain if necessary.
Jan 6, 1902.  Since last admission patient has quieted down again, after two days of considerable excitement.  Very industrious and agreeable on ward.  Takes great interest in everything around her.  For past week has been anxious to go home.  When this is promised it seems to excite her somewhat, then she quiets down again.  Allowed to go home on parole Jan 6, 1902.
Sep 2, 1902.  Discharged.


History and clinical notes:
History: Patient was admitted here April 4, 1901 and was removed by friends April 6, 1901.  Was discharged unimproved.  Patient lives so near the R.R. lines that they are afraid she will be injured, as she wanders from her home constantly and no one watches her.  For history, see Case Book 4, Page 161 (41611264).  Since admission has been very quiet and peaceable; wants to make friends with everyone, with the exception that she is constantly trying to get out of the door.  Does not disturb anyone.
Sep 1, 1901.  This morning one of the other patients pushed her and she fell on the floor, fracturing her left femur (intracapsular).  In bed, with sandbag and extension.  Saturday and Sunday very restless, restrained in bed with difficulty.  Slept very little.  Only complains of pain when she is touched.
Nov 2.  Since patient’s fall she has been kept in bed with extension apparatus.  No appreciable improvement.  Sand bags cause patient a great deal of annoyance to her [several illegible words] and patient never complaining, lying quietly, eating well and sleeping well until abscess developed on small of back over spinal column in line with lumbar vertebrae.  This developed until it was size of an orange.  Operated on Oct 31.  Removed considerable dead tissue and large amount of pus.  Patient bore operation well, and afterwards seemed a little brighter.  Abscess wound packed with bichloride gauze, cavity extended down either side of spinal column exposing ligaments and deep fascia.  [Patient] failed rapidly and was extremely low for the balance of her life, sustained by stimulants every hour, day and night.  Death came peacefully at 10:20 p.m. Nov 2, 1901.
Nov 2, 1901.  (My note: Died from complications of fall and broken hip.)

Final disposition:
Died of old age and complications of a broken hip (my note).


History and clinical notes:
History: For little over week has been imagining things were wrong, has turned over carpets, looked under chairs.  Sleeps only under narcotics, indifferent as to whether he has clothes on or not.  Today for first time uncleanly.  Irritable and peevish for many months.  Does not recognize his family.  Chatters constantly, making charges and talking about his troubles.  Up to past few weeks has always been healthy and good worker.  Enlarged prostate for 3-5 months has given him a good deal of trouble, preyed on his mind; finally could talk of little else.
Oct 1, 1901.  Patient very noisy at night.  Last night [another patient] kicked patient in face with bare foot causing marked swelling and discoloration of whole left face and lacerations of mucous membranes of mouth on left side.
Oct 10.  Patient sleeping in case (cage?).  Face much better.  Eats well.  Noisy at night.  Superficial several bed sore.
Nov 1.  Bed sore much larger/longer.  Patient eats and sleeps well.  Noisy at times.  Is growing thinner.  Tears clothes if not muffed and now has an ulcer on R wrist.  
Nov 10.  Wrist ulcer healed, bed sore [ill.] improved.  Failing in weight and strength.  Too weak to make a noisy.  Appetite failing.  
Nov 12.  Transferred to Infirmary.
Nov 13.  Failing rapidly.  Removed by relatives.  Discharged unimproved.
Died at home.

Final disposition:
Discharged unimproved; died at home the next day (11/14/1901).


History and clinical notes:
History: Brought by officers who know nothing of patient.  Patient is very uneasy and nervous.  Marked tremor of hands.  Hallucination of sight.  Says he has not slept well for past 3 nights on account of pain in arm (R).  Gives names and addresses readily, lives at [address redacted].  Hand dressed and patient sent to Ward VI.  Rx Chloral gr xv stat and repeat if necessary.  Restrain if necessary.  Tincture Nux Vomicae and Tincture Capsici xv, Milk ℥ (ounce) vj every 3 hours.  Mag Sulph purge in morning.
Sep 6, 1901.  Patient slept well last night, is quiet now.  Some tremor (general).  Typical alcoholic habitus.
Sep 10.  Eats and sleeps well.  Still slight nervous inclination.  Around wound of hand much less, no pain in arm.  Good general physical condition.
Oct 6.  Good worker, clean.  On parole today.
Nov 25, 1901.  Discharged.


History and clinical notes:
History: Officers who bring patient know nothing of his history.  Patient says he was brought there for the Delirium Tremens, that he was in the New Castle Hospital.  Says his head is covered with red ants.  Give an indefinite history of drinking.  Was quiet until 8 p.m. when fought against going to be (bed).  Claimed people about were trying to kill him.  In scuffle received a lacerated [ill.] wound over R eye in which one stitch was placed.  Restrained and chloral gr xxx given.
Sep 10, 1901.  Noisy first part of night.  Quieter this morning.  Cannot explain his actions.  Memory good for family affairs.  Says he is a hard drinker; was arrested for defecating in his own cellar.  Claims police said he would be killed here.  Physical exam: Slender, muscular, sullen appearing white male, height 5’10 ½”, weight 142 lbs.  Head measurements: Anterior post diam 18.7 cm.  Greatest trans diam 14.1 cm.  Facial length 12.1 cm.  Length/breadth index 74.01.  Bitemporal 11.6 cm.  Eyes gray, pupils equal, react to L.A.C. v = Tongue tobacco stained, no tremor.  Pulse 140.  [Ill.] regular. Heart apex [ill. – looks like ‘verable’] in 5th space 1 ½ to R of nipple.  Heart sound sharp, poor muscle note.  Lungs sonorous, rale over L apex few small moist rales over base posteriorly.  Abdomen neg.  Limbs: terminal phalanges of 1st and 2nd fingers R hand missing.  Gross strength normal.  Reflexes normal.
Sep 11, 1901.  Persecution ideas less marked.  Closing up.
Sep 14.  Few delusions.  Good health.  Good worker.
Sep 17.  Good condition.  On parole – by brother.  Brother gives history of bi-monthly sprees for past 1 ½ years.  Arrested several times for drunkenness.  That he is a hard drinker.  No [ill.] heredity.
Sep 30, 1901.  Recovered.


History and clinical notes:
History: Has been weak minded for 20 years.  For past 5 years has been much worse.  Lately has torn her clothing and been destructive.  Is getting worse.  Person who brings her knows nothing of her history.  Was only ordered to bring her here.  Since admission has been quiet and tractable.  Gets irritated at times but only [ill.].  Is very careless about her personal appearance, nearly always has her dress open down the front.  Will sit huddled up on floor is not watched constantly.  Eats and sleeps well.  Once in a great while will ask to go home.  Never talks unless addressed.  Very feeble minded and childish.  Sits for hours on a bench with head bent on breast and covered by her shawl.  Again stares around her for long time in wandering manner.  Once in a while is untidy.  Seems indifferent to discomfort of this.  Obeys all order at once and without question.  Takes absolutely no interest in her surroundings, has no idea where she is.  Cannot remember names or faces, never asks after any of her family.
Apr 12, 1902.  Remains unchanged.
Aug 1.  No change.
Feb 19, 1904.  Talks a great deal; uses profane language and asks after her son [name redacted] and begs to go home every day.  For last two days has had diarrhea and has been kept in bed; condition now improving.
May 2.  A fortnight ago, patient had an attack of facial erysipelas.  Has now recovered.  Is very untidy and profane.  Will not keep her clothes on.  In restraint today.
Jun 5, 1905.  No change.  Appetite good, sleeps well.  Very untidy.
Feb 8, 1906.  Died.

Additional notes:
Some confusion about date of death.  Had originally entered a date in 1906, but that seems to be incorrect.


History and clinical notes:
History: For two and one half years patient has been forgetful and childish.  Wander about occasionally.  Untidy at times.  Sleeps and eats well.  Is not destructive.  Has had an ulcer on back of left foot for some time.  Ten days ago developed an ascending redness and swelling of leg above ulcer.  Has been treated by Dr. Stout of Cheswold.  Broke left hip 3 years ago.  Ulcers on leg gradually have healed.  Patient kept in bed for just 10 days, wanted to get out all the time, asked for her stick, wanted to go home.  Smiled when visited by doctor and called down [ill.] blessings, etc.  Always cheerful and smiling even when talking about going home.  Later up about wards, able to walk with help from other patients, seems perfectly contented now.  Eats and sleeps well.  Only desire seems to be her stick; frequently takes naps during the day, attends Sunday service with great pleasure, seems very happy, never complains.  Mind very feeble relative to past, except when visited by relatives, then she asks after all her friends and relatives.  As soon as visitors have left seems to forget all about these.  Once or twice has been untidy, but since commode has been placed beside her bed no trouble in this respect.  
Apr 24, 1902.  For past day or two has not been so well.  Complains of pains in her back, is in bed and except when roused is very dull and sleepy.  Lies with eyes closed, pays no attention to calls of nature.  Breathing rather puffing but otherwise nothing of note.  Sensation and motion in all extremities poor and when fed swallows readily and without difficulty.
Aug 1.  About the same; sits up all day, eats her food only by being fed, frequent incontinence of urine.
Jan 1, 1903.  Has been up and about since last note.  Lately has grown more feeble and was placed in bed.
Feb 10.  Still in bed and is failing somewhat.
Mar 7.  Had a slight stroke of apoplexy today.
Mar 10.  Has failed very much since last note.  Is quite weak and feeble.
Mar 12.  Failed rapidly since last note and died this 4 p.m.
Mar 12, 1903.  Died 4 p.m.  Cerebral apoplexy.


History and clinical notes:
History: Has been of a very irritable disposition since childhood.  Would talk confusedly and angrily whenever crossed.  These outbreaks would last usually an hour.  Twenty five years ago had typhoid fever and became much more irritable thereafter.  During attacks would think people were all against her and that they should be looked after.  No particular delusion.  Ten years ago in an outbreak struck her mother during.  Some times speaks of her punishment and of some deep sin.  Eats well.  Usually sleeps well.  Of late has been noisy at night.  Since admission has been fairly quiet and orderly, once in a while scolds or is careless about her clothing.  Generally has a distant dignified manner with which she holds every one aloof.  Again is very friendly and approachable.  [Ill.] information relative to the condition of other patients – in a commanding manner – and coincides with any remark uttered in her hearing as though her word were necessary to have the orders effective.  Has quite a friendly gossip with two or three of the patients on her ward at times, then again sits by herself and smiles distantly and will not say anything.  When visited by friends talks about the ward as though it depended on her presence to be run properly.  Seems perfectly satisfied with her surroundings, does not express any desire to leave.  Eats and sleeps well.  Will not work under any persuasion; says there are others to work, she has never had to and will not now.  Once in a while when on a walk has wandered off from the other patients, but as a rule is very tractable.  Physically in good condition.
Apr 12.  Remains unchanged.
Feb 19, 1904.  Works daily in dining room.  Physically well.
May 2.  Very lazy, refuses to work.  Eats and sleeps well.  Mental condition the same.
Nov 14.  No change in any way.
Jun 5, 1905.  No change.  Eats well but is very lazy.  Lies around all day.
Sep 28, 1922.  Died.


On certificate of:
Drs. David S. Vallandingham and T.A. Evans

History and clinical notes:
History: One brother heavy drinker earlier in life, now considerably broken mentally.  Otherwise no history of heredity.  One sister and five brothers all well with one exception.  Patient a (as) child healthy; no bad habits.  Married at 20 years.  When 16 or 17 years of age had attacks of maniacal excitement, tore her clothes, swore.  Ran away from home.  Apparently got all right except headstrong, insisted on marrying.  For two years had no children; mentally seemed all right.  Following childbirth commenced to be peculiar.  Pain in top of head; nervous.  Works and works until utterly collapsed.  Talks constantly, sense and incoherently.  Complains that she is not treated right, especially by her own people.  During the five pregnancies she has had, patient in fair mental condition and seemed to take interest in household affairs and all the delusions, etc. retreated.  In the periods between pregnancies, however, all the mental symptoms reappeared and remained apparently about the same until again pregnant.  Last child born 10 years ago.  Since then periodical attacks, lasting from few weeks to months, but never completely normal in [ill. – looks like ‘alterius’].  This attack has lasted a year, mind wandering, talking about church and dress.  Wanders out at night.  Dresses up.  Decorates herself with flowers.  At times seemed (to) interest herself in household affairs.  Sleeps little, appetite fairly good.  Husband left her two weeks ago; she then hurt all his clothes, [ill.], etc. cried a little.  Patient has been in hospital near Baltimore at two different times.  Patient wanted to go there again as there was pleasant company and entertainments.  Likes to dance and dress, laughs a great deal, even in lunch.  Wants to be treated but does not want to go to Hospital except near Baltimore.  Earlier used to sleep with razor under head, has often pretended to hurt people but never has done so.
Oct 20, 1901.  Since admission has been quiet, orderly, and interested in all that goes on.  Works industriously on wards, never asks to go home nor does she talk about her people.  All her conversation directed to her clothes, dancing, entertainments, or imaginary pains of which she complains occasionally – in her head, around her heart.  These latter are cured by the promise of a dance or entertainment.
Jan 8, 1902.  Same as at last note – has been working in attendants’ dining room for past five weeks.  Takes a great interest in keeping things tidy.  Enjoyed the Christmas festivities a great deal, does not seem able to stop talking or writing about them, says Hospital life just suits her.  
Feb 8.  Removed from dining room because she accused one of the employees of improper intercourse with her and because she carried letter from a patient to an employee.  Matter was thoroughly investigated and evidence seemed entirely against her statement.  Friends give the history that she caused a great deal of trouble at her home by implicating various men.  She used to go around (??) the sheets and solicit their visits and take money from them and afterward would talk indiscreetly about them.  Patient herself says she sees no harm in such relations.  That she “finds it only natural.”  Acknowledges that she masturbates excessively, that she just has to.  Patient feels absolutely no shame and talks in a most open manner about the affair.
Apr 12, 1902.  About same as at last note, put back to work in attendants’ dining room from lack of anything better.
Feb 20, 1906.  Failing physically.  Transferred to TB for fresh air and more nourishing food.
Feb, 1908.  [Ill.] improved mentally and physically.  In good health.  Has been working for several months at Doctor Hancker’s house.
Feb 7, 1908.  Paroled.
Sep 7, 1908.  Discharged improved.

Additional notes:
In 1900 census was living with husband, noted that she had had five children, but none were living at that time.  In the 1910 census she was back at DSH.  In 1880 census was listed as a married daughter, living at home with parents; same name as parents still.  Death certificate says she died 2/3/1919 at DSH of chronic gastroenteritis and phthisis.  Was not able to find any info about why her 5 kids all died.This is the woman I asked Dr. Liarakos about, but got no reply


History and clinical notes:
History: Very little history given by Steward (of Alms House).  Patient of violent disposition, resists everything she can, great talker.  Since September 22, 1901 has been very violent and excited.  Biting and kicking everyone within reach, worse at night.
Oct 20, 1901.  Since admission except first day or two has been very approachable.  Sits around and chats and takes an interest in everything going on around her.  First day or two very violent in her talk, cursing and slandering at great rate; spitting and thrashing around until she saw no attention was paid to it.  Shortly was transferred to Ward B and since then has been very agreeable.  Truly Irish in her repartee, occasionally little irritable but otherwise nothing specially to be noted.  
Jan 8, 1902.  Patient shows no change.  Always one of the first to greet the doctor on visit; great for a bit of talk.  Works a little but sits around chiefly talking to the other patient or watching what is going on.  Has ground parole when she desires it.  On December 24, 1901 rather irritable while preparing to go to confession because attendants would not give her the clothes she wanted.  When told to be still became quite abusive.  A threat of transfer to Ward 3 however quieted her at once and she was more docile than ever.
Feb 15, 1902.  During past few weeks has been rather depressed and quiet.  Sits around looking rather dull but always answers all questions readily and is biddable and pleasant on ward.  Her husband gives the history that patient is subject to periodic attacks of excitement and that following these she is more or less depressed for some time.
Apr 12.  Quiet and peaceable; on Ward B where she spends her time sewing for the Institution.  Much easier to get on with immediately following her periods of excitement than later.  Seems to grow increasingly disturbed until finally has to be transferred to the back wards.  Here in a few days she is quiet and orderly again.
Aug 1.  Since death of husband has been very much depressed; sits by the hour saying nothing; hands folded in lap; told the doctor that she would not be long after her ‘old man.’  Facial expression typical of resignation and sorrow.  Eats poorly at times.  Sleeps well.  Occasionally helps a little on ward.
Feb 19, 1904.  Very simple in speech and action.  Has written some sensible letters lately, to which she has received one reply.  Physical condition good.
Mar 31.  Has been in bed a week with temperature 101-102 and pulse about 110.  So much depressed and feels very weak, although she does not complain of any pain.  Eats milk only.  
May 2.  Patient still in bed.  Sits up part of day, but under protest.  Pulse and temperature normal.
Nov 14.  At present time is very sullen and quiet.  Physical health good.
Jun 5, 1905.  Very dirty; somewhat violent; abusive in language.  Eats well.
Aug 1.  Patient rather feeble.
Aug 22, 1911.  Died at 1 a.m.  Cause is aortic insufficiency.


On certificate of:
Drs. J.M. White La Coni (?) and William C. Pierce

History and clinical notes:
History: In this Hospital February 23, 1900 to April 14th, see p. 42 (40421145).  Discharged Improved 20 November 1900.  Up to past two weeks has apparently been perfectly well.  Then commenced to sit around, would not talk or answer questions.  Up and going about the house, or outside if she had a chance.  Seemed indifferent as to whether she had clothes on or not.  Occasionally got excited, imagines her hair is on fire.  Thinks she sees imaginary objects.  Talks incoherently at times; again in childish manner.  For past week has not worked any; seemed indifferent to eating, had to be forced to eat at times.  Not withstanding all this has attended to wants of nature.  No history of self abuse or any bad habits.  Seems somewhat down hearted when menstruating.  Soon passes off, however.  Has been married 11 ½ years, 3 children, all well, no miscarriages.  Birth as a rule easy.  Did not nurse children.  First attack after being married about 2 years; lasted a couple of weeks, then second three or four years from this.  Attack in 1900 was third.
Oct 20, 1901.  Since admission has been quiet and very much depressed; has talked very little; occasionally has complained of headache.  Frequently [many illegible words]; occasionally would sew a little but as a rule has sat with her hands folded, staring ahead of her, and taken little interest in her surroundings.  Once in a while would brighten up and smile, but only occasionally.  Several times expressed desire to go on B ward where she was when here before, saying she would be better there, but transfer made no appreciable difference.  Sleeps well, eats well except as above mentioned.
Dec 23.  Since last note has gradually brightened; taken an interest in work and surroundings.  Asks to make visits on the different wards with the Doctor.  Says that her mother used to have periodical attacks of depression similar to hers until the menopause after which patient says she was perfectly normal.  Patient gives history of being in Norristown Hospital for six months (name when there redacted) prior to marriage.  Says that her attacks last about the same time and that she herself is aware when they commence but does not seem able to help herself.  Is looking forward hopefully to advent of menopause, thinking that maybe she too will be better then.  Patient very industrious, very easily influenced, desires to go home with husband again.
Dec 23, 1901.  On parole with husband today.
Feb 15, 1902.  Discharged improved.

Additional notes:
Was always depressed when menstruating.  According to Delaware Death Records, she died in 1913 at age 53 of stomach cancer.


History and clinical notes:
History: Patient on admission has remains of leg ulcer on R limb above ankle.  Screamed and cried and scolded when it was dressed.  Talked incessantly.  Scratched those around her when opposed and when they desired to do anything for her.  Objected to staying in bed for few days treatment – only kept there when all her clothes were taken from her.  Kept constantly demanding these, saying she could not stay, “please order the carriage,” she must go now, etc. etc.  Ate and slept well.  Occasionally, while in bed, would get out and rummage in bureau drawer belonging to another patient.  Claimed the things were hers; would listen until she thought attendants were out of hearing, then would return to rummaging.  Later, up in day room, very talkative and agreeable with everyone, chief topic her lovers – who she intended to marry, what she thought of wearing and doing, etc.  Every time a man would enter room she would immediately try to engage his attention, smiling and chuckling to think how attractive she was.  Made great opposition to bathing, screaming and scratching until she was in the water, then seemed to enjoy herself.  Eats and sleeps well.  Takes great interest in what does (sic) on around her, will not do any work, however.  Occasionally, if she can get hold of scissors will cut up anything at hand, like a tie or apron.  On the whole very cheerful and contented.
Jan 8, 1902.  Rarely asks now to go home, seems pleased with any attention she receives.  Since removed to another bedroom has ceased rummaging in bureau.  Physically in good condition, considering age, rheumatic deformities, etc.
Apr 12.  Same as at last note; occasionally complains of being cold having a headache occasionally, otherwise in excellent health and remarkably active and energetic for her age.
Apr 23, 1902.  Died of smallpox and buried here.

Additional notes:
Buried at DSH, Grave #100.  In the cemetery record, this grave has no name associated with it, and the person buried here supposedly died on 4/25/1902, rather than 4/23/1902.  But I suspect this is her.


History and clinical notes:
History: Officer who brought patient knows little of his history except that he is so violent and abusive at times that he drives all his people away from him.  In order to get him to the Hospital had to use considerable force, even after tying him.  Also had to bring him in a very disreputable condition as to cleanliness and clothes as it was impossible to get him fixed up.  Attacks have been variable for past nine years.  At times very destructive.  According to history, patient’s head has been injured.  R elbow straight and ankylosed.  No other gross physical lesion except for chronic and marked chorea form motions.  Eats and sleeps well.  Talkative, demented.  Is restrained to chair to keep from falling.  
Apr 13, 1902.  Confluent papular eruption appeared on forehead and then spread as a discreet [ill.] over face, back, and limbs.  Papules shot like.  No prodroms.  Temp 101 3/5.
Apr 14.  Some umbilication of vesicles that have followed papules.
Apr 15.  Transferred to VT for small pox.
Apr 20.  Had a marked case of confluent small pox, [ill.] conjunctivitis.  Eruption now to 8th day becoming pustular on face and chest.  Is failing rapidly in strength and complains much of tenderness of skin.
Apr 21.  Brighter today.  Pustulation almost general, beginning desiccation on face.  Less conjunctivitis.
Apr 22.  More delirious.  Tongue clear and moist.
Jun 13.  Completely recovered from severe attack of small pox.  Mentally and physically slightly stronger than before.
Oct 7.  Getting fatter.  Is a quiet, orderly patient.  Chorea form movement less marked.
Jan 25, 1903.  Patient is quiet and orderly.  Sleeps well, appetite good.  Choreic movements.
Aug 21, 1903.  Gradually failing in strength and weight.  Chronic chorea, working all the time.
Feb 17, 1906.  Died of pulmonary embolus.  Autopsy.

Final disposition:
Died of pulmonary embolism; buried at DSH #140


On certificate of:
Drs. Henry W. Biggs and Edgar Worthington

History and clinical notes:
History: Husband gave following history: Patient married twice, 2 children by 1st husband.  Married second time 14 years.  Patient in America 15-16 years.  Always been high-tempered.  Gets mad easily and often without cause.  Would not be beholden to anyone.  Always been a good worker up to last few weeks.  About three weeks ago complained of feeling funny, worried over mother’s death, fell in kitchen and became stiff, could not talk.  Always knows what is going on around her.  Attack lasts few minutes, then sleeps an hour or so, then all right except complains of feeling weak.  (Eleven years ago had had similar attacks, then got all right).  Attacks grew worse last few days; commenced to scream and carry on so that her people could do nothing with her.  Thinks her daughter has not cared for her, that her husband is not attentive.  That her people did not want her, etc.  
Nov 2, 1901.  Since admission has grown quieter, takes an interest in working and in her surroundings.  Talks rationally and is anxious to get well and go home.  Once when excited threatened to kill herself, but since she has been employed never seems to have any idea on the subject.  When husband visits her she tells all sorts of stories as to how the patients abuse her, how ill-treated she is, etc.  Lately has been so quiet and cheerful that she has been transferred from 3 to B.
Nov 3.  Husband visited her today, patient much disappointed that he did not take her out; had a crying spell after he left.  Later in the day seemed more cheerful.
Nov 7.  Since last note patient has been more cheerful, has worked willingly on the ward and has been looking forward to husband’s visit.  General type of patient that of high grade imbecile, seems to have very little realization of the people around her, of any work except simplest sewing, does not seem to have any knowledge of thrift or industry.  General education very meager.  Can read a little, novels chiefly.  Husband took her home Saturday afternoon.
Nov 7, 1901.  Discharged improved.


History and clinical notes:
History: Since 9th has been drinking hard (2 days), could not manage him at home.  Patient perfectly willing to be treated and comes voluntarily.  
Oct 17, 1901.  Went home on parole.
Nov 25, 1901.  Discharged recovered.


History and clinical notes:
History: In March, 1901, began to tell family that a ship was coming over, laden with money for her, and that she was very wealthy, having a large estate in England.  This has been her constant story.  Of late, she has added that her lawyer is locked up in Wilmington by the authorities to prevent her getting estate.  Two days ago wrestled and [ill.] his revolver from husband, and was conquered only after a struggle.  Sleeps well as a rule, often dozing during day, due, she believes, to drugs, chloroform, ether, etc. given her by doctor and many other people.  Good appetite.  Periods are regular, last 4 days, and with very little pain.  Complained moderately of bearing down pain for several years (11) past.  Says her sickness is the result of [ill. – looks like ‘mennurisue’].  Complains daily of pain in neck, in heart, twitching of face, of trembling all over.  Except for womb trouble is said to be in good physical health, since admission has been very orderly and clean and neat on ward; except to ask after her people and express desire to go home has been perfectly satisfied.  Has helped attendants with the work and taken quite a little interest in sewing, etc.  Her delusions relative to her property are fixed and she leaves (??) in all the information she can give.  [Ill.] two lords and a [ill.] are on their way to see her from England.  They are at present detained in New York or Wilmington by people who are jealous of her great fortune.  Received a letter from a lawyer in Wales whom she said was attending to the matter for her.  He wrote saying nothing could be done (at the instigation of her husband, hoping to satisfy her) but she could read relative to such a large estate, that her enemies made him write in this manner.
Oct 26, 1901.  Internal examination, fibroids of uterus, retroflexion, complete procidentia (??), ulceration of external os.  No woman trouble, tissue of vagina is all in healthy condition.
Oct 30.  Delusions kept up constantly, accelerated as time appointed for operation grew near.  Patient refused to eat, refused to take any medicine, said she was not to be operated on, etc.  Prepared for operation with difficulty.  Afternoon before her heart became slightly irregular, patient very much excited.  Talks freely with doctor relative to her delusions.  Fought so against operation that it was decided not to do it, although husband and sons were very anxious for one thinking it might cure patient.  
Oct 29, 1901.  As patient continues the same and family desires operation, she was removed on parole as the Superintendent did not deem any operation in this case advisable under the circumstances.  
Sep 15, 1902.  Discharged unimproved.  Dr. Stubbs gives history that youngest son has taken [patient] to Europe to look for fortune and with hope that then she will be cured when she finds there is none.


On certificate of:
Drs. A.B. Harris and Theodore Becker (?)

History and clinical notes:
History: Patient’s father died in this institution February 23, 1900 (see p. 110, Book IV) (41101213).  Officers who brought patient know nothing of history.  Patient very quiet, would not answer; praise Lord Dr. she had been sick, finish.  Knew that father was dead and that he died here.  On the ward was afraid, somewhat excited while talking, some calmed down.  Brother-in-law gives history that [patient] has sister in Newton Asylum (married and has 3 children), been there about 1 year.  His wife was perfectly sound mentally.  Mother-in-law very nervous, one brother has good education and seems all right mentally, but does not like to work.  For past 5-6 years [patient] has been living at service.  Up to time she came to brother-in-law, seemed all right.  Then could get no satisfaction from her.  Eat little supper.  Sat on chair for couple of hours, then all of a sudden asked for minister.  Then asked again.  Reason why said “Maybe I get married tonight.”  Kept standing on one foot for 15 minutes looking at [ill.] Or at work.  After that, left house for 10 minutes and came back and sat down same chair again.  Then asked for pillow and wanted to lie down.  Complained of being dizzy.  Later wandered off again.  Police picked her up about 2 o’clock, was supposed to be with young man who deserted her then.
Nov 14.  Since admission to Ward B has taken quite an interest in sewing, interviewing the other patients, etc.  Does as she is told and is very tractable.  During any conversation however, she will walk off suddenly, pretend she does not know what she is talking about, will stare at questioner as though not comprehending, then laugh or say “Am I crazy?  What makes you think [ill.] etc.
Dec 23.  Since last note has been about the same; anxious to go out.  Mother took her on parole today with the understanding that if [patient] did not behave she should return at once.  [Patient] seemed still irritated about the loss of her trunk and worried about over it than over her own mental condition or her habitation in the hospital.
Apr 12, 1902.  Discharged improved.  [Returned to hospital; see page 363].

Final disposition:
Discharged improved, but returned to hospital in 1903 for two years, then removed against advice.

Additional notes:
Newspaper article from online:  The Sunday Morning Star, July 22, 1906, page 1.  “Is Emma Reidel Sane?  Prof. Herrman employs counsel to secure her release from hospital.  She had once before been committed to Farnhurst, and is again in that institution undergoing treatment.  About three weeks ago, Emma Reidel, a young woman, was adjudged insane and taken to the Delaware State Hospital for the Insane at Farnhurst, where she now is.  Her mother, who conducts an intelligence office for the Fourth street below Walnut declared that her daughter is not insane and was removed to the hospital without her knowledge or consent.
	The girl was taken under treatment previous to being confined in the State Institution by Prof. Herrmann, the specialist, but after a short time he dropped the case because his instructions had not been carried out.  However, Prof. Herrmann has interested himself in the case and retained as his counsel former Judge J. Frank Hall, who will, on the part of the relatives of Miss Reidel, enter habeas corpus proceedings the coming week to secure her release.
	Prof. Herrmann, when asked, stated that in his opinion Emma Reidel is sane, but is suffering from nervous attacks, which are curable, and that if she is kept in confinement will surely become demented.
	As assistant to Dr. William H. Hancker, superintendent of the State Hospital at Farnhurst, said last night by telephone that Miss Reidel had been in the institution before, but was released.  For some time nothing had been heard from her until about three weeks ago, when she was again committed for treatment.  “She is certainly a fit subject for an institution of this kind, else we would not keep her here,” said the doctor.  “At times she is nearly rational, but often she gets very excitable and violent.”
	The girl was committed to the institution after examination by two physicians.  According to the statement made by Prof. Herrmann, proceedings for the girl’s release will be undertaken thweek.  From ancestry.com we see that she is still at DSH during the 1910, 1920, and 1940 US censuses.  No death info.


History and clinical notes:
History: Patient has worked steady until about 6 years ago when he became so feeble through old age that he had to relinquish work.  About 3 years ago had a severe attack of apoplexy.  Left side became paralyzed, has remained so ever since.  Has gradually become so feeble minded that his wife has been unable to care for him.  Speech is affected, but usually makes his wants known.  Is failing both mentally and physically.  Suffering from constipation.
Dec 17, 1901.  Patient enjoyed fair health until a week ago when began to look worn and feeble.  Today patient developed a liquid diarrhea.
Dec 20.  Continuance of diarrhea, 8-12 stools (food and liquid) in 24 hours.  Treatment of no avail.  Rx Pit of opi Cu Camphor and Nux.  With Bismuth ℥ (ounce) ss every 3 hours.  Milk diet.  Predigested beef juice.  Strychnine and whiskey.  Patient failing rapidly.  In bed.
Dec 25.  9 a.m. T.P.R. 103 1/5, 120, 28.  Very weak, diarrhea continues.  1 p.m. T.P.R. 103, 120, 40.  Some crepitated rales especially over bases posteriorly.  Heart action weak and at times intermittent.
Dec 26.  Failing continually.  Diarrhea continues.  T.P.R. 100, 130, 45.
Dec 27.  Died at 9 a.m. today.


History and clinical notes:
History: Threatened to knock wife down.  Otherwise would not threaten anyone.  Has been melancholy about year.  Has begging (??) look, absentminded for past months.  Would read poetry – different from usual way (??).  For past few months has worried over his affairs (partner robbed him of some money) then grew worse; more communicative, especially about his affairs.  Today started off in maniacal manner, more than during last three months, sniping and crying; would light light and wander around house looking for people who were after him.  Sleeps very poorly, appetite fair.  Some days won’t eat anything.  Today talked incoherently, [ill.] in sheet, thought he was coming to a hotel, wanted to register.  For past two weeks has been losing flesh.  Doctors have been treating him for kidney trouble for past 7 years.  Has history of having passed a stone.  Late has complained of having a tumor, but no history of same from physicians.  Left arm paralyzed (?).  Physical exam: On admission, moderate height slightly corpulent patient, white male of about 50 years.  Hair slightly gray and thinned.  Pupils equal, react well to L.A.C.  Eyeball prominent, slight divergent strabismus o.s. fixing.  Tongue moist, slight gray coat, slight tremor.  Pulse 7, moderate, reg. 90.  Surface temp norm.  Heart: poor muscle sounds.  No murmur.  Lungs show a few dry rales.  Abdomen shows no gross lesion.  R arm and both legs show good development with normal gross strength.  Left arm and should(er) moderately atrophied and flaccid, gross strength much reduced.  Movements of same jerky, but coordinated.  Reflexes: no jaw jerk.  K.J. active, left possibly the more so.  Station. good.
Oct 21, 1901.  Very noisy from 5 a.m. on today and restraint in chair necessary.  Is obscure and incoherent.  Says he has mice troubles and that people are against him.
Oct 22.  Very noisy all night in spite of gr xxv of Chloral.
Oct 23.  Restless with restraint necessary.  Eats well.  Urine shows very faint trace alb and a few [ill.] hyaline casts.  Was given Morph ¼ gr and Hys 1/100 7:30 p.m.
Oct 25.  No restraint.  Is slightly lachrymose.  Believes his son-in-law [name redacted] has worked against him and hints at other family troubles.
Oct 31.  Quite cheerful but confused.  Wishes to go home.
Nov 3.  Went home on parole today.
Nov 25, 1901.  Discharged recovered.


History and clinical notes:
History: Man gives history of self-abuse for long period – so excessive that penis very sore.  Says all he needs is sexual intercourse to make him well.  History furnished by physicians substantiates this statement as to masturbation; says also that the man is a sexual pervert.  That the attack began almost a year ago; has been gradually increasing and that his head was injured but does not say when or where.  Man has been in New Castle Jail for 30 days for vagrancy; is a tramp from Baltimore.  Physical exam on admission: white male about 5’4” tall, weight about 134 lbs., hair and moustache brown, eyes: pupils equal, [ill.] react well to L.A.C.  Tongue moist, light brown coat.  Pulse 94, regular, tension fair.  Chest well developed; good expansion; lungs show no gross lesion.  Heart apex visible, palpable in space beyond nipple line.  No murmurs but valvular element is accentuated.  Abdomen shows no gross lesion.  Limbs normal form and strength.  Reflexes and station normal.  Old scar over frenum.  History of three attacks of gonorrhea [ill.] 2 years ago.  
Oct 22, 1901.  Was very noisy early in night and had to be put in cage.  Claimed this a.m. that people were stamping on him, accusing [name redacted] who was at time in recreation room; or says it was because of unsatisfied sexual desires on which subject is continually harping.  Rx house diet, Mag Sulph (WEIRD SYMBOL).
Oct 23.  Restraint necessary during day, is quieter at night but restraints continued.  Urine shows trace of albumin a few [ill. words] coarsely granular casts.
Oct 30.  Has been quiet for a week past though muffs were necessary during day.  Wrote a letter to a woman asking her to marry him.  Had an attack of the digestion.
Oct 26.  [Note date out of order].  This morning his complete upper plate of false teeth was broken by [name redacted] to whom he had given them to clean.
Nov 16.  Good worker on ward.
Jan 13, 1902.  Always making foolish requests.  Eats well.  Wears restraint at night prevent masturbation.
Feb 27.  Behaved well until a few days ago when restraints became necessary.  Would run about ward.
Mar 10.  R hematoma acorn moderate (??).  Stupid.
Apr 15.  Hematoma subsiding.  Vaccinated.  Good take.
Jun 13.  More stupid.  Fair physical condition.
Oct 7.  Slightly brighter.
Dec 30.  Condition same.
Jan 25, 1903.  Condition same.
Aug 20.  Good health.  Very stupid.  Never speaks except to answer question in monosyllables.  Conduct good.  
May 5, 1935.  Died in hospital.


On certificate of:
Drs. J.S. Vallandingham and B.B. Ferguson

History and clinical notes:
History: Husband left patient about four years ago.  Husband took child away from her and this seemed to worry patient.  Patient has been living with her father since; has been working there.  Two brothers have had consumption (one dead).  Often threatens to burn up place, to kill her people, but never has made any attacks.  The past few years (5) has been peculiar, gradually increasing in severity.  According to history, cause is unhappy marital relations.  Constable who brings patient knows nothing else except that when he went to get the patient she refused to go – with little coaxing came all right, gave no trouble on train except laughing a good deal.  
Nov 14, 1901.  Sits around the ward watching what is going on but taking little interest in work herself.  Reads a great deal and seems occupied with her own thoughts.  Every once in a while breaks out in senseless laughter; somewhat careless about her personal appearance.  Sleeps well at night.  Eats well.  Visited by sister; this did not seem to cause her any pleasure.  Never expresses any desire to return home or see any of her people.
Dec 30.  Since last note about the same; except that she had to be transferred to Ward 1 for fighting with another patient.  Half the time has her dress carelessly fastened.  Unless kept at constantly very careless about her physical condition and appearance.
Apr 12, 1902.  Remains unchanged.
Apr 16.  In bed all day yesterday, complaining of stomach.  Tongue coated and history of constipation.  This morning covered with papular shot-like (??) rash, chiefly on face and chest.  Transferred to Suspect Ward at 2 p.m.  Temp 103.2, Pulse 68 [ill. – looks like ‘dicheotic’], Resp 23.  At 8 p.m. Temp. Temp. 104; Pulse 68; Resp 20.
Apr 17.  8 a.m. Temp 100.8, Pulse 90, Resp 23.  At 9:30 transferred to small pox ward.
Apr 21.  Passed by bowel an iron nut ¼” in diam – in all directions and a circular piece of [ill.] with a hole in the center; latter depressed – edges of circumference sharp.  Entire piece is 1” in diameter and 1/16” thick.
May 1, 1903.  Has been in bed for some time past, suffering from pulmonary tuberculosis.  Is losing flesh and strength.
Jun 18, 1903.  Patient has steadily failed since last note and the disease has run usual course.  Died at 8:50 a.m. of pulmonary tuberculosis.


On certificate of:
Drs. Charles S. Ritchie and Irvine S. Vallandingham

History and clinical notes:
History: History of having been on an almost continual spree for six months past.  Has taken whiskey only.  Five weeks ago seemed to see things and people around him at night.  At present sleeps poorly, no hallucinations.  Appetite poor.  Fainted in the morning of the day of admission.  Present condition: Slender white male of about 35 years.  Eyes: no gross lesion.  Tongue: moist, gray-coated, no tremor.  Speech distinct.  Pulse 90, tension moderate.  Heart, lungs, and abdomen show no gross lesion.  Few apigmented (sic) spots on left chest wall and on leg.  Reflexes normal.  Some general tremor and tremor of extended hands (cold?).  [Ill. words]. Rx Tincture Nux Vomica Tincture Capsici ℥ (ounce) xv every three hours, ℥ (ounce)  [ill.] of milk.  [Ill. words] tid.  Mal Sulph stat.  Sol Chloral ℥ (ounce)  ss and repeat if necessary.  
Nov 14, 1901.  Passed a fair night.  Treatment con’t.  
Nov 15.  To Ward C.  Boarders table.  No drugs.
Nov 16.  Seems (??) cold.  Rx [ill.] mixture ℥ (ounce) every 3 hours.
Nov 18.  Cough continues.  Some diarrhea and nausea.  Rx Bismuth and socal (??).
Nov 19.  Much better; out of doors.  
Nov 23.  On parole.  In good physical condition except for chronic gastritis.  
Feb 15, 1902.  Discharged recovered.


History and clinical notes:
History: Married about 20 years.  Husband says that there have been no children but possible miscarriages early in married life.  Menstruated regularly up to last 2 years.  Since then has been irregular – periods from few days to week, intermissions from two weeks to four.  Always [ill.] very markedly.  Recently has complained of pains in wrist, in leg, in back.  Has been melancholy about 2 months.  Last two weeks has deepened.  Commenced to think people were shunning her, not as friendly as they might.  Stayed by herself a great deal.  Stopped work although always a good worker.  [Ill.] dog that used to be the apple of her eye she turned on and would not have anything to do with her.  Thought she was losing her mind, that neighbors did not want to see her, that everyone slighted her with exception of husband.  She has [ill. words] affectionate with him lately, never turned against her, but even he could not get her to take medicine.  Last two weeks has wandered around the house, has talked to herself a good deal, does not want to eat, prefers to lie in bed in the day time.  Delusions are chiefly religious.  Thinks she is not as good as she should be.  Feels she is being convicted for some sin, but what she does not know.  One uncle, softening of brain, about 25 years, in Kirkbride’s for few weeks.  Afterwards at home for couple of years.  Other uncle drunkard and insane for time, never in institution.  Father living well and healthy (72 years), mother found dead in bed, very stout.  Several brothers and sisters, all sound and well.
Jan 8, 1902.  Since admission with exception of 3 days has been kept in bed continuously.  From Nov 30 to Dec 26 has been fed by tube once or twice daily.  At first struggled against feeding and afterwards accustomed herself to it so that she kept up a continual conversation with attendants etc. during process.  The first month of her confinement she was almost continuously in a straight jacket to prevent her doing injury to herself, as she pounded against the beds, wall, etc.  Except under constant surveillance nothing could be done with her, as she twisted herself in the straight jacket, frequently getting it off.  The night of Dec 18, at 1 a.m., she was found hanging out the window with a towel tied tight around her neck.  The attendant having failed to lock screen, patient was able to get out of bed, crawl through the space between sill and bars and hang there.  This being possible [ill.] to her great emaciation.  After this, patient closely watched but made no other attempt on life.  When visited by friends or husband gave long account of abuses practiced on her here.  Called doctor who fed her every name in dictionary that was disagreeable.  Later relapsed into silence which she would not break for anyone.  Said her food and water was poisoned, that everyone wanted to kill her.  That the Dr. had gotten all her money, that she knew where she was and why.  Then again, she would have a quieter spell during which se would occasionally say she knew where she was, knew she was not well and would talk about her friends and husband.  These spells were few and far between however.  See p. 227.  With exception of few hypodermics of morphine and an occasional use of chloral has received no hypnotics.  By tube she has had Iron, Qim (??), and Strych b.d.  Beef juice, whiskey, [ill.] food etc., as well as milk and eggs.  Patient suffers from marked constipation, relieved only after large doses of cathartics given by tube, as well as rectal enemas of oil and salts as well as water.  Patient has suffered with this trouble for years and generally has been in the habit of having but one movement a week.  On Dec 26, following feeding, Dr. offered her a piece of toast which she ate ravenously.  Later in the day desired something else to eat and during the following week it seemed as though she could not satisfy her appetite.  Later this diminished and now she is eating moderately again.  Yesterday for first time desired to get up.  Takes very little interest in her surroundings directly but under half-closed eyelids watches everything that goes on around her.  Husband has not been to see patient for a week, but she has not troubled to ask after him.  Nor on questioning has she displayed any interest in him.
Jan 26, 1902.  4:30 a.m.  Died peacefully after a protracted period of excitement, great physical prostration and malnutrition.  Toward the end had repeated attacks of diarrhea, could retain nothing in her stomach.  Grew so weak it was dangerous to feed her by tube.  At the end took no interest in her relatives, except to ask constantly for candy and fruit, which was given her once or twice at their solicitation and which she ate ravenously.  Finally had to be restrained for eating her own excretions.  Would smear herself over with bowel movement unless constant watched.  The last two weeks of her life masturbated to such excess that she was marked inflammation and excoriation of the external genitalia.  The end came peacefully and suddenly on the 26th.  Was visited by Dr. at 9 a.m. at which time she seemed a little brighter and quieter.  Asked for some milk and said she felt better.  A few minutes later attendant went in and said she was breathing slowly and seemed unconscious.  By time doctor returned at 9:30, patient had passed away.

Additional notes:
First mention of straightjacket (as a specific term).


History and clinical notes:
History: For past two months patient began to act peculiar and several times wandered from home so that her relatives could not keep her at home.  In industrious and is a moral, good woman.  Eats and sleeps well.  Talks great deal to anyone and tells everything she knows, all her troubles for years back whether family secrets or not.
Jan 8, 1902.  Since admission has been quiet and orderly on ward, takes great interest in cleaning and dusting, gives full particulars as to her own condition physically following slightest inquiry.  Often complains of pains but these are transitory and easily dispelled.  Eats and sleeps well, keeps herself neat and is altogether a model patient.  Does not seem in the least bit discontented although she appreciates fully the class of people she is living among.  Slightly thinner than should be the case, otherwise physically nothing noteworthy.
Apr 1.  For past two months has been working in attendants’ dining room and has done very well.  Her chief trouble is excessive talking, chatters right along without intermission, the more one tries to quiet her the more she gets.  Takes great interest in the dances and other entertainments, fixing herself up a good deal, bows of ribbon, etc.  Thinks she is particularly attractive.  Never gives utterance to any delusions or hallucinations.  Masturbates at times but judging by her appearance, not excessively.  For past few days has been anxious to return home.  Visited by friends today with whom she had long, whispered talks.  They said she gave them long accounts of the other patients and their peculiarities.
Apr 5.  Went home on parole today as parents were old and alone and needed her to work around the house.
Apr 17.  Same as at last note.
Oct 8, 1902.  Discharged.  [Readmitted #2369, Book VI, page 291].

Final disposition:
Discharged, but readmitted several years later.


History and clinical notes:
History: Since last January has not seemed right.  Would walk around a great deal, did not seem to think about anything but eating or medicine.  Wanted doctor all the time.  Thought all time she was dying.  Could not sleep; never worked any.  Never talked to neighbors.  Would not read.  As soon as she had eaten, would go to sleep.  Has been a widow three years.  Did not seem to grieve her husband’s death.  Married life was not a particularly happy one.  Was married about ten years.  Had two children.  First one dead born.  Living child healthy, husband died of consumption.  Patient has always been of nervous disposition, easily excitable and worrying.  Before marriage had a nervous spell that needed treatment.  Always thought she was dying on the slightest provocation, etc.  Since January the above symptoms have been steadily increasing and patient has grown very indifferent to surroundings.  Came to Hospital perfectly willingly; did not remember either name of place or hospital after she had been told a number of times.  Laughs quite a little.  Says she does not know what is the matter with her; in her next breath asks after the doctor as she wishes to be healthy, wants to go home tomorrow.  
Jan 8, 1902 (says ’01).  Since admission has lived quietly on ward, smiling and sleeping and eating.  Occasionally when ordered does a little dusting.  Does not seem to appreciate surroundings or take much interest in anything but herself.  Physically in excellent condition.
Jan 24.  Patient about same as at last note.
Feb 15.  Patient has menstruated twice this month, flow excessive, but apparently caused patient no discomfort.
Apr 12.  Past week patient has been very indifferent to her surroundings, using the floor or bed without any compunctions to urinate or defecate.  Does not seem to think she need lift a finger to do any work.  Complains of being sick all the time.  Bowels have not moved for weeks (in reality she has diarrhea); she has the most awful pains and no one does anything for her.  Eats ravenously and objects seriously if her amount of food is limited.  Wants to go to bed all the time; if put there has the same cry about getting up.  Cannot please her in any way.
Apr 17.  Physically and mentally same as at last note.
Jun 2.  Has a bad convulsion this a.m.  Afterwards very dull and stupid; soiled her clothing; wandered around ward; did not seem to be very clear as to what she wanted.  Transferred to Ward.  Seemed all right balance of day.
Jun 3, 1902.  At 8 a.m. another convulsion, twitched all over, frothed at mouth, [ill.] eyes.  Appeared semi-unconscious.  This condition lasted nearly ½ hour then lay quiet for quite a time.  During night bowels had moved fully, patient seemed weak when attendant took her up to be washed.  Through the day several convulsions, never regained complete consciousness.  At 8 p.m. a very hard one and again at 9:30.  Respirations were very much labored; some rattling of mucous in throat.  At 9:45 visited by Doctor found patient gasping for breath, pulse feeble.  Some twitching of limbs.  Returned in 15 minutes with med., during this time patient had a very hard convulsion, afterwards moved out of room into hall.  By the time this was done, respirations had ceased, with one or two feeble gasps.  Hypodermics etc. of no avail.  Pulse in carotids for fully five minutes, very feeble but discernable.  Patient died 10:05.  Doctor remained until 10:20 when all efforts were given up.


Complications:
exopthalmic goiter; valvular disease of the heart

On certificate of:
Drs. Frank F. Pierson and George R. Carmichael

History and clinical notes:
History: Thirteen years ago patient became rather peculiar and of an abusive temperament and became more so 8 years ago with the appearance of goiter.  Five years ago her husband died, and since then patient has become still worse.  She believes that the insurance company did not pay up to full and talks a great deal on this matter.  She has also accused Jackson and Sharp (for whom her husband worked) of cheating her.  Recently, within a few weeks, she has believed herself pursued by Negroes and Chinaman and has spells of cursing them.  Has slept poorly and as a rule has eaten little for five weeks past; occasionally is ravenous.  Has refused all treatment.
Jan 8, 1902 (says ’01).  Patient markedly emaciated.  Eyes prominent; heart rapid.  Skin pale, sallow, dry.  Since admission has slept little except several nights with chloral.  Walks around the ward continually, mumbling to herself a good deal.  Answers questions but slowly and does not seem to appreciate surroundings keenly.  Eats poorly and only when urged.  Patient is an aunt of [name redacted] a former patient in this hospital, who at present is in a Hospital for the Insane in Lancaster Co., Penna.  Sister gives history – that she beat her children, was restrained only with greatest difficulty, uses very obscene language at times, of late will not talk any unless forced to it.  Patient had [ill. – looks like ‘tmiss’] 18 years ago.  Blind for some weeks following labor.  Had one child born with caul, another had hare lip and cleft palate, this one lived until 5 months of age.  Following all her labors never the least sign of depression or excitement – had 8 children in all, the 5 living are all healthy and sound mentally.
Jan 24.  For past week patient has been masturbating constantly until restrained with gloves.  Does not moan and cry as much as when first admitted.  Still wanders around the ward a good deal.  The goiter is at times considerable.  Patient anaemic, skin sallow, dry, harsh.  Bowels normal.
Apr 12.  In bed most of the time.  Restrained to prevent constant masturbation.  Eats and sleeps well, has little to say.  When Drs. visit her shouts “Say, look here;” “Wait, I want to tell you something” but can get no further.  Knows names of doctors and apparently is conscious of her surroundings although she says nothing.
Apr 17.  Severe diarrhea for past three day.
Apr 22, 1902.  Has failed constantly and increasingly; diarrhea profuse, nourishment taken badly; end came peacefully apparently at 2 p.m. today.  Body wrapped in bichloride sheet and delivered to undertaker by order of Board of Health (owing to quarantine of hospital).
Note: Hospital under quarantine for small pox epidemic.

Additional notes:
One child born with 'caul' one born with cleft lip and palate (lived 5 months)


History and clinical notes:
History: Ten days ago, patient fell or slipped down in wagon and wished to remain at his brother’s home over night.  He was taken into the house, acted queerly and slept poorly.  The next day he continued to act and speak peculiarly and developed attacks of jerking his limbs and twisting his face and complaining of pain in some part of body and talking of dying.  These attacks lasted about 20 minutes and occurred 4-6 times daily, until 3 days ago.  For 2 or 3 days past, has had intermittent spells of loud talking, claiming he was God or cursing vigorously.  The patient has slept and eaten fairly well since beginning of attack.  Believes someone has put a spell on him.  Present condition: Tall, slender white male of about 28 years.  Hair thick and brown.  Skull shows no deformity.  Eyes gray, pupils equal, 4.5 mm, react rather poorly to L.A.C.  Pulse 96, quick; tension fair.  Heart: afterbeat distinct in 5th space ½” [ill.] nipple line.  Sounds sharp and valvular.  Lungs show no gross lesion.  Abdomen: no gross lesion.  Limbs: gross strength normal.  Reflexes: normal.  Patient says he is not married.  While being bathed patient was very violent.  Was put in restraint and in cage and given Mag Sulph ℥ (ounce)  and Chloral Tinct [ill.] 10 p.m. hyoscine 1/100.  Slept early part of night.  
Jan 5, 1902 (says ’01).  Rational (?) and quiet this a.m.  Rx milk, eggs, and toast diet.  3 p.m. violent and incoherent.  Hyoscine gr 1/100.  10 p.m. noisy and violent.  Cage and restraint necessary.  1/100 hyoscine.  
Jan 6.  No change.  Hyoscine at 3 and 11 p.m.  Eats well.
Jan 7.  Fairly quiet last night.  Restless and incoherent this a.m.
Jan 12.  Requires hyoscine almost every night.  Is at times quite rational, at others very incoherent.  Eats fairly well.  Large boil on left forearm and superficial abrasion of wrists from restraint.
Jan 15.  Quieter, though incoherent.  Restraint removed.
Jan 18.  Sleeps and eats fairly well, occasionally has an acute outbreak of shouting, moaning when is controlled by Hyoscine 1/100 gr and Morphine ¼ gr. by po (mouth).  
Jan 24.  No restraint for several days past.  Eats and sleeps well.  Boils on arm improving.  Mental condition much clearer.
Feb 4.  Mentally bright, fair education; is rational on all points.  Fair physical condition.
Feb 27.  Quiet, cleanly, helpful.  Anxious to go home.
Mar 1.  Home on parole.
Apr 12, 1902.  Discharged recovered.

Additional notes:
Clear case of traumatic brain injury leading to seizures and bizarre/violent behavior


Complications:
chronic bronchitis, emphysema, acute nephritis

On certificate of:
Drs. William R. Bullock and J.W. Bastian

History and clinical notes:
History: Brought by friends who can give no details.  Patient has been ill in Delaware Hospital, Wilmington.  Has been very restless and noisy of late and is transferred for that reason.  Entrance exam: slender, emaciated, tall white male [ill. – looks like ‘one remooed’].  Will not protrude tongue.  Pulse 96, slightly irregular and intermittent.  Tension fair, vessels sclerosed.  Chest: supra- and infra-clavicular fossae marked.  Heart afterbeat in 5th space at nipple line, quick and irregular.  Sounds veiled by noisy breathing, especially at base.  At apex, appears to be a systolic murmur.  Lungs: hyper resonant, expiration prolonged through out with a few dry rales posteriorly over apices.  Abdomen rather scaphoid, walls soft.  Limbs emaciated.  Superficial ulcers over internal condyles of elbows.  Reflexes: K.J.’s active.  6 p.m. Patient has been very restless all day, making restraint necessary to keep him in bed.  He is delirious and incoherent and unable to answer any questions rationally.  Whiskey and predigested beef are taken but milk is refused.  Rx Strychnine sulph 1/30 t.i.d.  Whiskey ℥ (ounce) ss every 3 hours, ditto predigested beef milk q.s.  History by daughter (2-8-02).  Patient has had a bad cough for years and has been troubled by frequent micturation for a year past.  He worked up until Sat p.m. 12-28-01, when he lost his way when going home and was picked up and brought home.  That night he was restless and irrational.  The M.D. called, said he had pneumonia and he was taken the next day to Delaware Hospital.  Since then he has spoken rationally only once or twice and has been restless and delirious.  Today patient has taken very little nourishment, has been very delirious and recognizes no one.  8 p.m.  Patient has just died.  
Urine exam: yellow 1017 acid, floc sediment, albumen distinct trace, no sugar.  Numerous epithelial hyaline and coarse granular casts, round epithelial cells and uric acid crystals.  [Patient] was addicted to use of tobacco to excess, never drank any, no sign of any mental impairment in his life; rugged, hearty blacksmith, worked for Penn RR 40 years.  Yesterday while coming over talked rationally and [person] who brought him over, only thing he said out of the ordinary was whoa-whoa-whoa.  [Person who brought him] thinks that he meant the horses were going too fast.  Exhausted when he arrived here.  Left Delaware Hospital fairly strong.  
Jan 7, 1902.  Died the same day he was brought to hospital.

Final disposition:
Died, complications of old age and pneumonia.  Died same day he entered DSH.


On certificate of:
Drs. A.E. Frantz and George R. Carmichael

History and clinical notes:
History: One year ago patient claimed her doctor had performed an abortion on her.  She never repeated that or said or did anything else peculiar until one week ago when she awakened from sleep at night and began to shout, call on God to help her, run about the room.  Her husband easily quieted her and she returned to sleep.  The next day complained of back and abdomen and of being worn out.  Three days ago began to shout and shriek and talked continually about the doctor and the abortion and said her life and that of her husband was ruined.  Has slept poorly for 3 or 4 days and has not eaten much due, she says, to lack of appetite.  This morning burned her underclothes.
Jan 8, 1902.  Until bed time was quiet on ward, talked with another patient, an old acquaintance and seemed quite reconciled to being in Hospital.  After retiring roused the whole ward with shriek after shriek.  Threw herself around the bed, turned a quite (sic) patient [name redacted] out of hers and would not be pacified.  [Several illegible words] became quiet and continued so until later.  At 11 transferred to Ward 3 as she began screaming again.  [Ill.] at once became quieter until towards morning.  On the visit this a.m. told Dr. she really could not stay in such a place much longer, otherwise was quiet and orderly.  
Jan 24, 1902.  Transferred to Ward 3 yesterday as she was undressing herself, tearing up the beds, and doing what she called ‘gymnastics’.  Very hysterical.  Throws herself around, tears her hair, cries and moans, fawns on those around her.  Says she is very ill, wants sympathy, that the awful people here are killing her, etc.  During one of her attacks of excitement broke flower vases, etc.  Generally can be talked into quiet behaviors, but it does not last long.  General behavior very theatrical.  Physically she is improving somewhat.
Feb 15.  Has just recovered from a severe attack of tonsillitis that kept her in bed a week.  Tonsils abnormally large, fill in vault of pharynx [ill.].  Mother gives history that patient has always had trouble at times with similar attacks.  Temperature ranged from 101 to 102.4.  
Mar 1, 1902.  Left on parole with [mother].
Apr 12.  Letter from [father] says patient is doing remarkably well, his only regret is that he had her in the hospital – seems entirely recovered.
Apr 12, 1902.  Discharged recovered.

Final disposition:
Discharged recovered, but back in DSH in 1910, 1920, died there in 1946.

Additional notes:
History of wild attacks; but then gets better.  Was back in DSH at 1910 and 1920 census.  Died at DSH 6/13/1946.  Bburied at DSH, Grave #576.


History and clinical notes:
History: Patient has been forgetful and childish for a year or more.  Four weeks ago became still more forgetful and unable to find way in and out of house.  Has been cleanly in his habits; eats and sleeps well.  Five days ago could not find way home, got lost in woods and spent the night there and was quite severely frozen.  Examination shows a moderately well nourished medium sized white male of about 65 years.  Eyes show no gross lesion.  Tongue moist and clean.  Pulse 90, regular, vessels sclerosed.  Heart apex beat in 4th space, ½” [ill.] in nipple line.  Heart sounds clear, no murmur.  Aorta 2nd +.  Lungs resonant, breathing vesicular, abdomen.  Limbs: gross strength normal.  Tendon reflexes and especially K.J.s.  Develops occasionally a coarse tremor of one or more limbs, especially when same are under tension.  Big toe of R foot swollen and darkly discolored.  Rx Moist HgCl dressing to foot.  Patient quiet, cleanly, and senile.
Jan 18, 1902 (says ’01).  Doing fairly well.
Jan 25.  At 12:15 p.m. today patient, while eating his dinner, began to choke in presence of patients and attendants Ward C & D.  Dr. Hancker was immediately notified and Dr. Watson and Dr. Van Epps, all of whom were working over patient within a moment or two.  Dr. Hancker had the patient held up by feet and inserted finger in throat.  Over the epiglottis a piece of sweet potato the size of a marble was removed, but did not relieve patient.  Artificial respiration was resorted to but without avail and arterial pulsation ceased at 12:30.  Coroner was immediately notified.
Jan 26.  Coroner’s physician Draper made a postmortem examination 4:15 p.m. in present of Hospital Staff and others.  In opening up larynx a piece of meat about 2 1/2 “ long and 1 ¼” in length was found imbedded in the larynx, holding the epiglottis in an upright position.  A portion of the foreign substance was bent over and lay in the aesophagus, but the larger portion filled up entirely the opening of larynx.  Death was pronounced as due to asphyxiation.
Jan 25, 1902.  Died.


History and clinical notes:
History: On January 21st, 1902, commenced with religious excitement, wanted friend to pray with him, thought he was going to die.  After praying a while, great (?) happy and seemed satisfied, in a few hours seemed all right.  Next day went to see Doctor, then commenced with the religious excitement again.  This attack lasted 5 hours.  Sunday a third attack commenced on visit of friend.  Began to shout and talk about religion.  Kept shaking hands, cried a little, seemed to know everyone around him, ate heartily yesterday.  In house all day.  Brother slept with him Sunday night.  Did not close his eyes, seemed frightened, did not talk much.  Between one and two a.m., jumped out of bed, ran downstairs and out for ½ mile to a neighbors in his night shirt.  Went in and turned dogs out, pulled chain off the board.  Friends took patient in house.  Told them that their child was Jesus, that the Lord had blessed them, etc.  Brother who gives history says that all the family are sound, sane, no drunkenness or insanity.  Patient has always been healthy, good worker.  Temperate; on one or two occasions has had a little too much intoxicant, but this exceptional.  Has been attending revival meetings past two or three weeks, but up to Friday night did not seem to take much interest in them.  Physical examination shows no gross lesion.  Patient is quiet on ward and confesses to no especial delusion.
Feb 8, 1902.  Excited, calls various persons Jesus Christ, irrational, restraint necessary.
Feb 15 (says ’01).  Quieter, restraint removed.
Feb 17 (says ’01).  Quiet, cheerful.
Feb 27.  Emotional at times, today is quiet and depressed.  Eats and sleeps well.
Mar 3.  At work on ward.
Apr 15.  Good worker, rational.  Vaccinated.  Good take.
May 28, 1902.  On parole.
Sept 8, 1903.  Discharged recovered.


On certificate of:
Drs. John P. Wales and Evan S. Shortlidge

History and clinical notes:
History: For fully a year has been absent minded.  Wanders around house, goes about without apparently knowing where she is; unable to attend to wants of nature.  This condition followed on severe illness she had some years ago.  
Feb 6, 1902.  Since admission, has been fairly contented on the ward during the day; at night very restless [ill.] got up and unpacked bureau in room, finally dressed herself completely and said she was going home.  Does not attend to wants of nature at all; has a constant dribbling of urine for days at a time, of which she is apparently utterly unconscious.  Once or twice has asked to go home, but perfectly satisfied when told that her sister wishes her to remain here.  Sits around the ward and watches the patients, occasionally says she is Miss [her last name], that her father and mother were Quakers, etc., but does not seem to have the slightest realization of where she is, no recognition of time, etc.  Apparently knows her friends, but [ill.] forgets that she has seen anyone.  Physically – other than arm trouble in good condition.
Mar 10.  Had a severe choking spell at breakfast due to the lodgment of a large piece of meat, which she stole from another patient’s plate, over the epiglottis.  When examined by Doctor, respirations were very shallow and feeble, face markedly cyanosed and flaccid.  The piece of meat removed with difficulty after which patient soon rallied.  This accident was followed by a period of great irritability on the part of patient – would try to bite anyone who came near her, snarled if spoken to, and was very obstinate about doing anything, as walking, eating, etc.  This soon passed off and she was as usual.
Mar 12.  For past three weeks has been in bed on Ward B, dull and stupid; does not want to talk.  When roused says “Go away,” “Let me alone,” etc.  On liquid diet altogether as has difficulty swallowing.  Will not even rouse herself to speak to her sister.  Sleeps a great deal of the time, occasionally gets up and wanders around the room, knocking on the door or window.  Has had quite an attack of indigestion which was followed by a marked, general rash, of a papular and pustular character.  Worst marked on trunk and arms.  This she irritated a good deal by excessive scratching.  The pustules averaged about a split pea in size, were slightly umbilicated.  Under treatment, the eruptions gradually dried up and is fading away.  Only can get patient to take medicine with difficulty.  Spits everything out she can and rather seems to take delight in doing so.  Pays no attention to calls of nature.  During this entire attack has had no temperature, pulse slow and somewhat feeble at times.
Mar 12.  For past month had been lying quietly in bed, objecting to all movement or disturbance.  Has slept or dozed a great deal.  Appetite has failed gradually and she has grown weaker.  For past days heart has been acting feebly.
Apr 30.  Marked cyanosis of face and extremities.  Respiration rapid and feeble.  Numerous rales.  Failed rapidly and died 5:30 a.m., May 1.
May 1, 1902.  Died.  Cause of death: senile asthenia.


History and clinical notes:
History: Has been drinking for about two weeks.  Finally became so violent and uncontrollable that his family had him arrested.  Officers who brought patient know nothing of history beyond the fact that he has been in jail 3 days, during which time he was restrained all the time.  Eat little and did not sleep at all.  Constantly talking and screaming, complained of seeing snakes etc. after him.  Very nervous and at times incoherent.  Typical drunk.  O.s. [ill.] normal.  Tongue coated and tremulous.  Pulse 90, regular, fair tension.  No gross lesion of heart, lungs, or abdomen.  Rx Tr Nux Vomicae to Capsici aa m xv.  Milk ℥ (ounce) vi every 3 hours.  Mix Chloral ℥ (ounce) ss at night.  Mag Sulph℥ (ounce) stat.
Feb 10.  Recovery uneventful.
Feb 24.  Left on parole by himself this morning.
Apr 12, 1902.  Discharged sober.


History and clinical notes:
History: For almost month has been poorly.  Memory good for recent events, [ill.] discuss the past.  Poor sleeper and eater, stayed at home most of the time; occasionally would feed horse, etc., but generally did nothing.  Last Sunday while in church, he started up suddenly after sermon; went up front and wanted to play, did so for almost 15 minutes, praying for everybody; went home shouted and prayed.  Went to bed but continued to pray, stops and listens for awhile, occasionally thinks people are after him.  Since Sunday has had a few short periods in which he has apparently been rational but on the whole has been praying and listening every since.  On admission, asked for the Doctor.  Said he was not insane, wanted to be examined.  Started to take off his coat and vest and then stopped to listen, raising his head as though he heard voices in the air.  Has been constantly taking patent medicine, does not believe in doctors.  This has been increased of late.  Slender, poorly nourished white male.  Pupils equal and react to L.A.C.  Tongue moist and clean.  Lungs negative; heart action labored, sounds have poor muscle tone.  Action regular, 76 per minute.  Patient is very deaf.  Refuses to eat much; often pauses and looks upward as if hearing voices.
Feb 17, 1902.  Sleeps poorly if not given sedative.  Eats but little.  In bed.  Rx Strych Sulph gr 1/30 t.i.d.  
Feb 25.  Out of bed.  Has almost constant hallucinations of sight and hearing.  At bed time would not lie on bed for it and floor was covered by snakes.  He was given a hypodermic of Hyoscine gr 1/100 and Morphine gr ¼.
Feb 26.  Patient quiet, says he don’t feel so well.  Pulse rather weak this p.m.  
Feb 27.  In bed but feels better.
Mar 1.  Very weak this a.m., rallied later in day.
Mar 3.  No change.
Apr 15.  About ward.  Quiet.  Full of persecution delusions.  Vaccinated today.
Jun 13.  Is stronger physically, but mental condition unchanged.
Jul 30.  In good physical condition, no change in mental condition.
Sep 27.  Seemed depressed, would not eat, complained of left arm hurting him.  Temp 103, P 110, R 24 (SP in house).  6 p.m. Has eaten nothing.  Temp 104.  Considerable impairment over base of left lung due to old lesion.  Some impairment of right base posteriorly.
Sep 28.  T.P.R. 103-100-26.  Feels badly all over.
Sep 29.  T.P.R. 101-104-24.  Eats little.  No change.
Oct 6.  Temp normal this a.m.  Looks bright and well.  Slight cough.
Dec 6, 1902.  On parole.  No appreciable change in condition.
Apr 13, 1903.  Discharged unimproved.  [Out in margin is penciled in, Disch Apr 13, 1903, Imp.]


History and clinical notes:
History: Attack has been coming in gradually for at least three years.  No history of intoxication or excesses [see note below].  Struck his wife today because she wanted her purse, first time.  Has worked but little during past three years, fanatic on religious topics, has idea that God has put a curse on him, that he is trying to live right, but that it does not help.  Always has been exceedingly kind husband both before and after attack.  No history of any excesses in expenditure [see note below].  History of insomnia.  Does not go to bed until 3 a.m., etc.  Appetite good.  Always wants to go out and preach, in street car or to his friends, chiefly.  Cannot be diverted from his object.  On admission, patient objects strenuously to remaining in his room.  Restraint was put on and patient put to bed.  Two hours later while stumbling about, patient fell and received a slight cut over Left eyebrow.  Patient believes he sees archangels around the room but denies any delusions of grandeur.  Physical exam: Fairly well-nourished sandy complexioned white male of medium height.  Eyes: pupils unequal.  O.s. 4 ½ mm oval, lat 120.  o.d. 3 ½ mm, lat 120.  No ptosis or diplopis (??).  Movement ataxic.  V =     Tongue moist; the seat of irregular movements.  Speech very [ill. – looks like ‘scanning’].  Pulse 90, tension fair.  Chest expansion fair.  Lungs so no gross lesion.  Heart: marked accentuation of aortic 2nd, which has a ringing sound.  Abdomen shows no gross lesion.  Limbs: gross strength fair, left arm seems stronger.  Reflexes of upper limbs normal.  Jaw Jerk (?), K.J.s weak on left, absent on R.  Marked ataxia of arms and of station.  Plantar reflexes show weak flexion.  
Feb 26, 1902.  Restraint necessary at night.  Hypodermic Hyoscine gr 1/100 and morphia gr ¼ given first two nights.  Eats fairly well.
Feb 27.  Wife says patient has promised her golden palaces.  
Mar 14.  On Ward C.  Quiet and cleanly.  Writes letters to [illegible name, looks like Lulu] expressing his love and to others concerning contracts involving millions.  This a.m. had 3 revelations from God saying that he was to be President of the U.S.
Apr 15.  Since last note has been failing but always had his grand ideas.  This a.m. at about 5:45 when attendants opened room, patient was found lying face downwards with weight of neck and head resting partly on a looped handkerchief tied to foot transverse bar of bed and partly upon floor.  The left arm was partly flexed under body.  Post mortem discoloration of dependent portions moderate.  P.m. rigidity marked.  (Dr. Hancker and Dr. V.E. found patient as described.  
Apr 15, 1902.  Committed suicide by hanging.  

Note in margin: From friends the information is obtained that patient indulged in excesses to great degree – had for several years, unknown to his family.  Had bought large quantities of jewelry etc. for prostitutes; gave letters to everyone for money or jewelry.  Ran through his money rapidly.  Did not seem to have any idea of expenditures, etc.]

Final disposition:
Died, suicide by hanging while patient in DSH, during smallpox epidemic.


History and clinical notes:
History: Officers who bring patient know nothing of his history.  He has been intemperate.  His daughters keep a millinery establishment on King St. and patient owns the property.
Feb 27, 1902.  Visited by wife and daughters who give following history.  Patient always a drinker, was left independent by his father 14 years ago, in a short time ran through thousands of dollars in drinking, carousing, etc.  The last two years has been constant menace to his family, threatening to kill his wife repeatedly.  For past three months has had hallucinations and delusions [ill.] his attacks of intemperance.  Always has carried a revolver, slept with it under his pillow.  Has flourished it in the face of his wife saying she was talking about him and he would not have it.  Some pacified however.  Last week called his wife upstairs and placed revolver to temple, saying he was going to kill her and his children.  She paid no attention to him but went downstairs and he some cooled down.  Has the idea that his wife has run through his fortune when as in reality he has done so himself.
Feb 27.  Hallucinations of sight and hearing.  
Feb 28.  Very violent and noisy during night, restraint necessary.  [Ill. words – looks like ‘was fixed to bod vi’].  Still noisy this a.m., morphia and hyoscine given hypo and patient restrained in bed.
Mar 1.  Very noisy last night until controlled by morphia and hyoscine hypo.  This a.m. is tremulous and excited.  Rx milk diet.  W/cap and Tinc aa 2xv every 3 hours.  Visited by wife and daughter who report that he has repeatedly threatened them with a loaded revolver, but failed to discharge same owing to nervousness.
Mar 2.  Quiet and rational all day.
Mar 3.  Out of bed, regular diet, quiet.
Mar 12.  Quiet and rational since last note.  Jokes of delusions.  Removed today by wife and daughters on parole.
Sep 8, 1902.  Discharged sober.


History and clinical notes:
History: Six weeks ago while going to work fell near Depot and hurt his head so that he has been confined in Delaware Hospital since this time.  While in Hospital a part of the time irrational and excitable, growing worse with time.  Wanted his own way, tried to jump out of window last evening.  Part of the time knew his relatives, again did not.  For past few nights very noisy and tried to dress himself to go home, etc.  Never cursed, never hurt anything or anyone.  Since his accident has been melancholy most of the time, does not seem to realize calls of nature.  Brother gives history that for past year [William, not the patient] has had a number of attacks similar to patient, lasting from week to two weeks, then free period.  Highest number of fits a day 7, these last for minutes, froths at mouth, convulsive movements of all limbs, etc.  For 15 years has worked at Penn RR Station, where he has always given satisfaction.  This past year work has been periodical but he has still been retained.  Always been temperate, no history of syphilis, scrofula, etc.  Brother says that since fall, [patient] has had no fits to his knowledge, injury was simply scalp wound [several illegible words].  
Mar 1, 1902.  Patient very noisy early in night, was controlled by Hyoscine and Morphia hypo.  Exam this a.m. shows emaciated black male about 5’7” tall.  Can give almost no information about self.  Top of head has been shaven.  Eyes: pupils 3 mm equal and apparently react to L.A.C.  No strabismus.  Tongue large, semi-moist, thick gray coat.  Pulse regular 72.  Tension fair.  Heart apex beat 5th space nipple line.  No murmur.  Quality of sounds fair.  Lungs show no apparent gross lesion.  Abdomen.  Limbs: gross strength much reduced.  Reflexes of arm normal, of legs quickened but equally so.  Jaw jerk present.  No ataxia of arms and station.  Sensation for touch and pain acute.  Rx extra diet, whiskey.
Mar 14.  Out of bed part of day.  Ravenous appetite.  Noisy at night (usually).
May 13 (sic).  Patient has been quiet and orderly for some time past.  Cheerful and happy disposition.  This morning feet were much swollen and was placed in bed.
May 14.  This a.m. was general [ill. – looks like ‘anacsaed’] of entire body; was placed on phenactine*, etc.  This p.m. the swelling much more marked and patient found at 4:30 p.m. in a semi-comatose condition.  Digitalis was administered hypodermically and patient was wrapped in hot sheets every ten minutes until there was profuse perspiration with some slight benefit.  At 7 p.m. had a convulsion.  Breathing stertorus, rales over both lungs.
May 18.  Is somewhat better although still feeble, breathing is difficult.  Temp varies from 96 to 101, oedema gradually disappearing.  Rales over lungs not so marked.  General symptoms better.  
Jul 27.  Has an epileptiform seizure yesterday and another today.  Is very confused and is getting much weaker.  On the back of each hand are prominent dense rounded flattened lesions apparently springing from the bones.  (These have been present since admission).
Jul 29.  In bed for past 3 days.  No improvement.
Oct 5.  Had had several epileptiform attacks of late.  Today had two others, which left the patient unconscious and quite rigid for several hours.
Oct 7.  Is improving, recognized those about him.  
Dec 30, 1902.  Condition has been one of gradual decline.  In bed constantly, much emaciation.  Bowels move involuntarily.  Bed sores, lues suspected.
Feb 1, 1903.  Failed rapidly and died today.
Feb 1, 1903.  Died.  Ex: Chronic mania.


History and clinical notes:
History: Since age of thirteen subject to epileptic attacks at various periods.  Had fall from wharf into river, probably hitting head, also had measles at age of 13.  Never had more than one or two (seizures) a day, lasting for minutes only.  Never longer than five minutes.  General twitching, preceded by scream.  Unconscious followed by laughing and pleasant return to consciousness.  In fifteen minutes all right again and at his work except for times when he received cuts and bumps.  Nocturnal attacks also, but never more than one at a time.  Sister remembers him having incontinence of urine but three times in all his fits.  She has had the constant care of patient.  Was able to work at laboring, liked by all his employers.  Recently has become somewhat irritable and disagreeable.  Enormous appetite – never gets enough, always wants more.  Always enjoyed good health with exception of epilepsy.  Once had a period of 5 years respite from his fits – at home patient is violent, has threatened to kill sister, even picking up various articles to do so.  But then has thrown them away.  Sister says that there is no insanity or epilepsy in any of their family, excepting that a baby boy, born later than [patient] died of infantile spasms.  No history of alcoholism, syphilis, etc. either in family or personal history of patient.  For past 2 years patient has not seemed as bright mentally as formerly – does not seem to appreciate surroundings [ill.] as previously.
Apr 1, 1902 (says 4.1.12).  Transferred from C to Ward 6, without caused commenced to fight an attendant during meal time; tore his coat off his back and was very much excited.
Apr 8.  If any patient approaches him or touches him unintentionally, patient gets extremely angry and hits the offender.  Restrained several hours today for this cause.
Apr 17.  One stitch for cut over left eyelid, caused by falling against bench during fit.
Jun 13.  [Many illegible words . . . restraint is . . . and troublesome at times.]
Oct 7.  Restrained with wristlets and belt as has assaulted an attendant twice.  In good health.
Jun 3, 1903.  Subject to violent fits of temper in which he will assault anyone who opposes him.  Has lately assaulted an attendant and severely kicked him.  Is now wearing wristlets and anklets.
Jul 20.  Today patient had a fight with another patient in a bathroom and was thrown to the floor, in some way breaking the left tibia just above the ankle.  Simple fracture.  Dressed with two straight splints.
Aug 7.  Plaster cast put on foot today.  Fairly good position.  Has to be watched constantly to prevent patient from walking on injured leg.
Sep 22.  Plaster cast has been removed; very little deformity and patient has good use of foot.  Condition otherwise unchanged.
May 24, 1905.  Condition remains unchanged.
Mar 5, 1907.  Died.  Status epilepticus.


History and clinical notes:
History: Has always been the black sheep of the family, and a periodical drinker and drunkard since becoming of age but of late has been much worse, probably taking two quarts daily of whiskey.  Of late has been very amorous and has so abused his wife by attempted coition and hugging that she has aborted.  Patient claims to have been drinking three weeks now and that he has been under Dr. Spruance’s care for 3 days.  Drank a pint of whiskey in the past 24 hours.  Dr. Spruance says the patient has had Morph Sulph and Chloral in big doses today.  At present, patient is somnolent and shows no tremor.  Heart action accelerated but shows no murmur.  Rx Milk ℥ (ounce) vi with Tr Nux Vomica and Tr Capsici aa mxv every 3 hours.
Mar 11.  Quiet and rational.  No tremor.
Mar 12.  Very restless and full of delusions.  Cage restraint necessary.
Mar 14.  Very marked delusions of persecution and hallucinations of sight.  Controlled last night by ℥ (ounce) ii ss [ill. – looks like Sommol] and of Morph Sulph.  Gr ½ and Hyoscine gr 1/50 by hypodermically.
Mar 20.  Quiet.  Sleeps and eats well.
Mar 24.  On parole.
Apr 12, 1902.  Discharged sober.


History and clinical notes:
History: Has always been weak minded.  Never went to school and worked always under supervision.  Has always enjoyed good health.  Often (?) is troubled with dysentery in summer.  Has always been careful, loving, and neat.  Eats and sleeps well.  Patient’s sister died last December and since then the patient has had no one to care for him.  Has always been careless as to where he attended to calls of nature.  Is a tall slender male.  No gross lesion except for an inflamed bunion on the left food and irregular heart action [ill. words] sounds.  Is unable to articulate any word directly and only a few imperfectly.  Eats and sleeps well.  Is quiet and cleanly.  
Apr 18, 1902.  Apparently had a chill at noon, ate very little dinner.  T.P.R. 102-120-24.  No apparent cause for illness.
Apr 19.  In bed, no appetite.  Temp varies 101-103.
Apr 20.  Temp 103 at 2 p.m.  1 ½ ° lower in evening.
Apr 21.  Temp 102-100 during day.  Much brighter.  No rash.
Apr 22.  Much brighter today.  Temp 99.3 this a.m.  Normal at 9 a.m., 11:15 a.m.  Maculo-papular no areola rash has appeared on face, forehead, chest, and abdomen, papules picturated (??).  Small Pox.  Transferred to Ward VI.
Apr 27.  Lesion moderate largely infiltrated [ill.] contents.  Fair general condition.
May 3, 1902.  Died this a.m. 8:15 of Small Pox.  Buried here.

Additional notes:
Buried at DSH, Grave #371.  Sister died previous December and he had no one to care for him.  Buried at DSH, Grave #101.


History and clinical notes:
History: March 1st, his uncle was taken with what was pronounced small pox and was removed to Pest House.  Relatives claim that he did not have small pox, but caught it after he arrived at Pest House.  As patient was suffering with [ill.] everyone was afraid of him and told him that he had small pox.  About March 3 he began to think he did have the disease and has worried ever since then – imagined that everyone was after him.  Does not sleep much.  Eats good.  Marked acne of face and neck.  Superficial gland on R side of neck much enlarged.  Patient very depressed.  Says little, but acts rationally.  Physical exam shows no gross lesion of eyes, tongue, heart, lungs, or abdomen.  Slight acne of body and limbs.  
Mar 21.  Today says he is going to be burned and asked us to telephone for Father [name illegible].  
Apr 20.  No change.  Vaccinated on April 16.
Jun 13.  Still depressed, acne of face better.  Good take.
Jun 17.  Face much improved.  Still very depressed.
Oct 7.  Much brighter mentally.  Quiet, cleanly, and a good worker.
Nov 24, 1902.  Paroled.
Apr 13, 1903.  Discharged recovered.


History and clinical notes:
History: Has been drinking hard for 2-3 weeks past.  Has had hospital treatment, but relapsed on going home.  Entered here June 3, 1898; was paroled, returned, and was discharged from books 11-22-98.  Is now restless.  Is afraid his heart is not contracting correctly.  Say he has invented a patent fuel for which a company has subscribed $4 or $5,000,000 and in which he holds $1,500,000.
Mar 24.  Complains of insomnia.  Eats well, still slightly nervous.  
Apr 1.  Doing well. Sleeps 7 to 8 hours at night.
Apr 4.  On parole.
Apr 12, 1902.  Discharged sober.


History and clinical notes:
History: Has been in Alms House since August 1900.  Nothing was known of previous condition.  Has always been very useful about the place.  Of late he has been playing police man with a large belt and has been found choking a comrade.  On admission talk volubly of his family, his various positions held.  Is rather incoherent.  Is willing to stay and quiet if not questioned.  No gross physical lesion.
Mar 31.  Very noisy at night, quiet in day time.
Apr 16.  Quiet for two weeks past.  Good worker.  Vaccinated today.  Good take.  
Jun 13.  Has been quiet and a very good worker.  Is bright and very helpful on ward.  
Jul 24.  Has just recovered from a mild attack of facial erysipelas, during which he complained especially of severe headache.  
Aug 18.  Good health and conduct.  Works in clothes room and dining room of Ward D.  Good worker.  Competent.
May 24, 1905.  Condition remains unchanged, continues to work about dining room.
Mar 19, 1907.  Became suddenly violent and had to be transferred from Ward 2 to Ward 6, refuses to eat sufficient food.
Mar 30.  Is suffering from pulmonary oedema and is failing rapidly.
May 10, 1918.  Patient working in the clothes room of B Ward.  No change in his mental condition.  Physically apparently well.  
Jan 3, 1919.  Patient complains about the pain in perineal and rectal regions.  Upon rectal palpitation found the posterior lobe of the prostate enlarged.  It is a tumor confined in a capsule.
Aug 15.  Rectal palpitation shows the coresistance (sic) of the carcinomatous gland extremely hard and the tumor growing very fast.  Patient complaining of severe pain in the rectal and perineal regions, going down to the leg, which is due to the presence of the growth upon the sacral nerves and ganglia.  Sometime hematuria.  Progressive depreciation in general health.
Mar 30, 1920.  Patient very weak, hematuria [ill.].
Apr 3.  Patient died this evening 6 p.m. 
Apr 3, 1920.  Died at 6 p.m.  Carcinoma of the prostate (2 years).

Final disposition:
Died of prostate cancer; buried at DSH #313


On certificate of:
Drs. Edgmont T. Negendauk and J. Paul Lukens

History and clinical notes:
History: First symptoms manifested about 6 months ago – began to become melancholy; went to her room a great deal and cried, which was contrary to her usual condition as she was vivacious and happy.  Began to say that house did not appear the same to her.  Menopause ceased about last November, although she had been extremely irregular for months before.  Mother died Feb 2, was worse after this.  Some had so hallucinations of sight; said she saw thing in the wall.  Melancholia condition has continued without interruption from the beginning.  During the past two weeks has been worse.  Sits by herself, rubs her hands, saying “Oh my,” “Oh my.”  Last night very restless, did not sleep well.  Although the usually sleeps fairly well.  Appetite varies.  Sometimes good, sometimes refuses to eat.  Has steadily lost flesh.
Mar 25, 1902.  Patient in Ward A.  Very quiet.  Does as she is told, without opposition.  Slept well without medicine of any kind.  Appetite poor; but eats when coaxed a little.  Out walking all the afternoon, without a murmur.
Apr 12.  For several days was on Ward 3 owing to excitable period, during which she moans, wring her hands and was in constant activity.  Restrained a couple of days after which she was quiet.  Circulation very poor; skin dry, leathery, yellow.  Bowels constipated, digestion bad, on extra diet for a few days, picked up considerably, transferred to Ward B, where she is quiet.  Sits around a great deal holding her hands; looks depressed and occasionally groans when addressed but as a rule answers all questions in a depressed, absent manner.  Takes absolutely no interest in her surroundings; will not work.  Eats and sleeps however fairly well and is particular to calls of nature and her personal neatness.
Apr 7 (sic).  Complained of feeling badly; apparently heart was troubling her; improved on Strych Sulph grs XXX.
Apr 16.  Rash noted beneath left breast, small papules, more or less sharply defined, shot-like under skin.  Temp 100.4.  Pulse 116.  Resp 30.  Transferred to small pox ward at 2:30 p.m. 
Aug 1.  After return from small pox ward patient considerably brighter.  Much troubled by persistent [ill. – looks like ‘oululiti’] of left forearm.  This gradually subsided under treatment and patient was able to go home with brother on parole last week.
Dec 27, 1902.  Discharged recovered.

Additional notes:
"Began to say that house did not appear the same to her."  Classic description of a person suffering from major depression.


History and clinical notes:
History: Patient always steady worker, industrious and sober, was night watch at Clayton House, seemed to disagree with him, always a great reader and home body.  For past few months has been complaining of sleeplessness; head felt queer; would not want anyone to touch him.  Would strike anyone who disturbed him; stopped work and wanted medicine.  Appetite excellent; sat around house, moping most of the time; worried about his condition.  Yesterday showed first violent symptoms; kept going in and out the door; finally started to run up the street as hard as he could without his hat and coat.  Would not let anyone touch him.  When his father arrived, walked home backwards.  When he reached the door, jumped over the sill as he had done in the morning.  Put to bed with difficulty; seemed very much disturbed; spitting constantly in faces of those around him.  Tossed around the bed, frothed at the mouth, screamed for his mother or for water, knew all the family perfectly.  Would not eat anything until this evening; violent all the night.  Convulsive movement of extremities; at times seemed to have difficulty in speaking to those around him.  Whether unconscious or not father does not know.  For short periods was quiet and drowsy.  Then would wake up suddenly and be as violent as ever.  No history of convulsions or infectious disease in childhood.  Rheumatism inflamed; at 16 years of age due to over exposure to wet and damp.  [Several illegible words] where he stopped work seemed to have some eye trouble; kept in dark room for several weeks and then was better; lately eyes have bothered him again.  Patient one of seven children, all of whom are well and living.  [Patient] is the 2nd oldest.  No gross physical lesion.  K.J.s slightly +.  If not held, throws self about roughly.  Says nothing.  Saliva drools constantly, often refuses to eat.  Quiet at night.  Is pockmarked on body.
Apr 15.  Vaccinated.
Jun 13.  No change.  No take of vaccination.
May 1, 1903.  Today was sent to bed with a temp 103 ½.  Examination showed scattered areas of pneumonia – probably tubercular in origin.
May 15.  Patient failing rapidly.  Temp 102.  R 40. P 125-150.
May 22.  Patient died this morning at 11:20 a.m.
May 22, 1903.  Died.  Tubercular pneumonia.


History and clinical notes:
History:  See book III, page 248.  Discharged improved September 30, 1901.  Since patient went on parole has been working off and on at his trade.  Of late has taken to drinking.  Today desires to be treated and say he intends doing better in the future.  Is inclined to be disagreeable when opposed.  Seems drowsy and rather mixed as to what he has been doing of late.  No gross physical lesion.  Quiet, tractable.  Good worker.
Apr 15.  Vaccinated.
May 25.  Eloped (see p. 282).
Jun 10, 1902.  Discharged unimproved.


History and clinical notes:
History: Patient has been in Laurel for about 1 year, but has been suffering from La Grippe, for which she was treated.  Mr. Phillips who brings patient to hospital knows but little of history of patient.  Says about a week ago wanted to commit suicide and on the way here wanted to jump from train.  General health is poor.
Apr 12, 1902.  Complains constantly of headache, wants sleeping medicine, must go home.  Nothing satisfies her(e).  Moment she sees doctors commences her various plaints.  As soon as she is alone is perfectly quiet again.  Has no realization of time or place.  Rather disorderly in her appearance but attends to calls of nature.  Sleeps and eats well.
Apr 17.  Remains the same, vaccinated.
Jun 13.  Still complains of head or stomach aching her – wants medicine constantly.  Whines all the time.  Says she is neglected.  “Honey, how soon can I to go home” is her constant plaint.  Once in a great while brightens up and is quite pleasant.  Has very little appreciation of her real condition.
Aug 1.  No appreciable change.
Sep 22.  Still complains of headache.  No change in general condition.
Oct 3, 1903.  Paroled.
Jan 21, 1904.  Discharged improved.


History and clinical notes:
History: Patient says he was in jail for four months some years ago for slapping a woman.  Patient comes from jail, where he has been about six weeks for attempted assault on the wife of the man he worked (for) – chiefly threats, etc.  Patient at age of 10 years was taken from home for destitute children in Philadelphia and bound out to Mr. Tyndall.  Of late has been threatening to kill people, difficult to get on with, etc.  Patient has very little appreciation of his condition.  Knows little of his previous history, and gives all information in a hesitating, dragging manner; at times instead of answering gazes vacantly in face of questioner.  Has practiced masturbation excessively for years.  Sturdy physique, no gross lesion.
Apr 16, 1902.  Quiet, good worker.  
Apr 20.  Vaccinated today.  Good take.
Jun 13.  Quiet, good worker.  Somewhat sullen.  
Jun 3 (sic).  General health good.  Works about the ward and farm.  Very irritable and quarrelsome.  
Aug 20, 1903.  Health good.  Works daily about the farm.  
May 24, 1905.  Condition remains unchanged; physical health good, is surly at times but not troublesome.
Dec 23, 1935.  Died in hospital.

Additional notes:
Buried at DSH, Grave #453.  Bound out as child to farmer in Sussex County.


History and clinical notes:
History: For over two years has been acting in a peculiar manner; did not know one cent from another; was accustomed to starting fires around the place at any time.  Up and busy all night; talking to himself all the time.  Yesterday had a bed quilt propped up and said it was his wife.  Has no realization of time.  Talks about events that happened years ago.  Has not been working much this past two years.  Has an enormous appetite, eating as many as a dozen eggs a day.  Habits very bad – no control of bladder or rectum.  Spits all around house.  Has no knowledge of his surroundings.  Undresses himself on all occasions.  Patient has been living in Sussex Co for about 20 years.  Left his family in New York state; has not wondered about them, or they about him, since.  His farm in Sussex is mortgaged and he has no other property.  Heart action poor, sounds poor.  Chronic bronchitis with considerable expectoration.  Slight fever.  In bed.
Apr 20, 1902.  No fever for a week past.  Cough much less.  Out of bed [ill.] daily.  Vaccinated 3 days ago.
May 7.  Has been in bed for some time, cough is much worse, steadily losing flesh.  Has phthisis Pulmonalis.  Large cavity upper lobe of right lung.  Friends were notified of his condition today.
May 20.  Has failed rapidly and cannot last long.  No reply to letter sent May 7.  His nephew was again notified told that he could not last very long.
May 22, 1902.  Died at 9 a.m., quietly and unconsciously.

Additional notes:
Buried at DSH, Grave #106.  "Yesterday had a bed quilt propped up and said it was his wife."


On certificate of:
Drs. Thomas C. Frame and Wilbur D. Burton

History and clinical notes:
History: Officer who brings patient has known him for several years.  Says he has been very quiet, inoffensive, and remarkably good habits for a colored boy.  [Patient] was baptized four weeks ago in Baptist Church, after that was very much excited, growing worse with time until past two days has been extremely violent.  Put in jail this morning because he was up on State Street with his clothes off, running around ringing door bells.  Seemed to be hunted.  Could not give any information as to himself or what he wanted; seemed frightened all the time.  During period in jail has been pretty restless.  Wanted to get away.  Did not eat anything yesterday or today.  Has not slept for past two nights.  Family decent and respectable and no heredity or cause for this outbreak other than the religious excitement mentioned.  Very well-muscled, short, colored male.  No gross physical lesion.  Will not talk.  Must be fed and refuses food at times.  Under restraint.
Apr 15.  Vaccinated.  
Apr 20.  [Ill.] take. (Doesn’t say “good” – but can’t tell what it does say).
Jul 14.  [Ill.], cheerful, cleanly.
Jun 3, 1903.  Mental condition much improved.  Good worker.  Good physical condition.  Plays ball nearly every day.
Jul 12.  Has been in good mental condition until yesterday when he again began acting strangely.  Hallucinations and delusions taking a religious form.  Noisy at times.  Restraint ordered today.
Aug 20.  Excitement still continues.  Restraint necessary.  Eats well, sedation at night.  
Sep 22.  Somewhat quieter at present.  Has lost considerable weight.
Nov 27, 1905.  Has been quite well for some time and has been working in dining room.  This evening while carrying meals up from kitchen eluded the vigilance of his attendant and escaped.  Eloped.
May 7, 1906.  Discharged recovered.

Additional notes:
"Officer who brings patient has known him for several years.  Says he has been very quiet, inoffensive, and remarkably good habits for a colored boy."  ".  Has been quite well for some time and has been working in dining room.  This evening while carrying meals up from kitchen eluded the vigilance of his attendant and escaped.  Eloped."


History and clinical notes:
History: One year ago had stroke, after which he never cleared mentally.  Patient in bed many weeks; afterwards feeble, memory poor, wandered around aimlessly.  Appetite good.  Sleeping poor.  Especially bad at night.  Personal habits very bad of late.  Utterly indifferent to cleanliness.  Incontinence of urine at times excessive.  Since first attack has had a couple of slight strokes; lost sensation and motion for time being but recovered in a short time.  Could not talk or eat well, incontinence bladder and rectum marked.  For past three weeks has been growing worse mentally; very contrary – wants to wander off, get out of window, obstinate and disagreeable when opposed.  Up to about 5 years ago patient always hard worker, in good health, moderate drinker only.  Then had a severe attack of albuminurea, which has persisted ever since with more or less severity.  All his children well and [ill. – looks like ‘stiny’].  Wife died of tuberculosis 7 years ago.  Mental insufficiency (?) and aortic stenosis.  Sounds poor.  No swelling of feet.  Metatarsal and phalangeal bones gradually became unduly elongated as we pass from from (sic) the 5th to the first in which the elongation is very marked, especially on the R foot.  Ankles quite stiff.
Apr 15, 1902.  Vaccinated.
Apr 18.  Very noisy last night.  [Ill. words] in cage.
Jun 13.  In fair health.  Noisy and untidy at times at night.
Jun 26.  This p.m. is very restless and weak and delirious.  Put in cage to prevent self-injury by falling.
Jun 27.  At 7 a.m. had an epileptiform convulsion.  Has been stupid all day, refusing food.  Took Mag Sulph and beef juice.  At 5:15 p.m. had a second epileptiform seizure.  Has constant incontinence.
Jun 30, 1902.  Died at 4:45 p.m.  Visited by Father Campbell at 3 p.m. at which time patient was almost unconscious.  Anointed.


History and clinical notes:
History: Officer who brings patient knows very little of history.  She has come from Philadelphia recently to visit people in Wilmington – history of drinking and various other excesses.  Comes to Hospital with face black and blue, eye suffused, general disheveled condition.  Says she fell from ladder, had not been drinking, etc.  Vaccinated on admission.  Has been quiet and orderly on the ward after first night when she sang and pounded on windows for more than an hour.  Screaming at the top of her voice because night watches would leave no light in her room.  Transferred at 3 a.m. to Ward 3 and restrained.  Quieted down immediately and no trouble since.  Soon could give a fairly rational answer to questions.  Said she had been drinking some time, living on the streets for about 3 weeks, had left her husband and he her several times.  Has delusions and hallucinations, former marked relative to her brother-in-law in Wilmington.  Has a blank, far-away look at times and is so absorbed in her thoughts she does not answer immediately she is addressed.  Keeps herself neatly however.  Sleeps and eats well and assists with ward work willingly.
Jun 13, 1902.  Has frequent attacks of thinking that her enemies are working against her – that her brother-in-law is making arrangements for men to have intercourse with her; that he wants to bring her down to the lowest depths if he can; that he has mixed poison for her, etc.  These attacks pass off in short time and she is pleasant and amenable to discipline.  Inclined to be very nervous about any little illness.  Does not seem to have a good grasp on events or places.  Very indifferent on the subject of her confinement to the Hospital.  Likes the girls on the wards and says she will remain with them for awhile, etc.
Aug 6.  On parole July 3 to the Smiths, here she is working steadily at any and everything – anxious to remain and give satisfaction; occasionally saying she would like to see her children.  Will not go out of the house or participate in any amusement.  Seemed very desirous to [ill.] with Miss Smith, to whom she became very much attached.  
Sep 8, 1902.  Discharged.


History and clinical notes:
History: Patient here before (see p. ____).  Came into Hospital very unwillingly.  Claimed she has been ill treated, that every one was deceiving her, etc. and resisted strenuously but as soon as she was in the ward became very quiet and orderly, doing whatever she was told, answering smilingly all questions, etc.  Memory good for past events, orientation excellent.  Has lost a great deal of flesh since last admission; has beginning cataracts in both eyes; spends a good deal of time watching the others or looking out the window.  Sleeps well and is quiet all night.  Appetite most excellent.  Occasionally says she wants to go home, that the people who brought her deceived her.  But is easily directed from this subject.  Vaccinated on admission.
Jun 12, 1902.  Move to Ward B today.  Fairly pleasant and manageable.  Will not work, says she does not have to.  Flies into a rage when her people are mentioned.  Objects to having her clothes marked.  Appetite and sleep good.  Occasionally complains that people are talking against her, that they wish her ill etc. but always states these facts with a smiling, undisturbed countenance.
Aug 6.  Condition remains unchanged since last note.
Feb 19, 1904.  Has had sore fingers; one has now healed the other still sore.  General condition fair.
May 2.  Condition the same.  Fingers still sore, continually begging for Epsom Salts.
Nov 14.  Condition the same.
Jun 5, 1905.  No change; has delusions.  Calls for Salts and Sulphur to clear her head.  Eats and sleeps well.  Is quiet and tidy about her person.
Feb 20, 1906.  Condition remains the same.
Nov 20, 1907.  In fair physical condition.  Eats and sleeps well.  No change mentally.
Sep 25, 1909.  In good condition physically; sight failing.
Feb 1, 1910.  General condition failing, and has a cachexic appearance.  Complains of gas in her stomach.
Mar 15.  Sleeps well but appetite poor.
May 13.  Has had some pain over stomach lately and today began vomiting, which did not yield to treatment.
May 15.  Fecal vomiting; bowels well cleaned out; some tenderness and distension of abdomen.  
May 16.  Growing weaker, and still vomiting.
May 17.  Remains conscious but constantly becoming weaker.
May 18, 1910.  Died at 5:45 a.m.  Carcinoma of Pylorus.


On certificate of:
Drs. Harrison W. Howell and Lewis D. Flinn

History and clinical notes:
History: Thursday a week ago fell down stairs while intoxicated, hurt his left arm and forehead, latter necessitated a stitch.  Following injury did not seem well, would not eat, could not sleep, worried a great deal over the death of a friend’s child.  Finally became very nervous and since not improving was admitted to the Homeopathic Hospital suffering from a marked cellulites on Wednesday of past week.  By Thursday night delirious, jumping out of bed, screaming and thrashing around, talking incoherently to himself.  On admission, the cellulitis extended from a little above the wrist to the lower border of deltoid, the arm was swollen to twice its normal size, increased pulse and temp., marked intestinal symptoms; patient in almost collapsed state.  This gradually increased until Monday he was nearly unconscious all the morning.  Under local app. of 5% and Tr. Nucis Vom. (weird symbol) V ev. 3 hrs.; quinine gr ii (*) ev. 3 hrs, whiskey, predigested beef and milk p.r.n. gradually improved.
May 6.  Incision at elbow allowed escape of ½ pint of pus and blood.  The scalp wound at margin of forehead and hair seemed somewhat indurated.  This also incised and about one ounce of pus escaped.  Locally bichlor dressings 1:2000; Icthyol 5% sol. to arm continued, as well as other treat.
May 7.  Patient a great deal better; mentally perfectly clear and realizes his condition.  Weakness not so marked as yesterday.  
May 21.  Patient has been up and about for past two weeks.  Swelling of arm has almost subsided; pus has followed the course of the biceps muscle for about 4 inches above opening made in elbow above alluded to.  The opening has been cleaned and packed daily with gauze soaked in bichloride solution up to abut 3” of axilla.  For past three days this cavity has been washed out with Peroxide of Hydrogen.  Patient has a good appetite and steadily gaining.  Dressings of Icthyol were discontinued today.
Jun 4.  Drainage tube and gauze dressing.  Induration almost gone.  Slight discharge.
Jun 9.  Simple cotton gauze bandage dressing applied.  On parole.
Sep 8, 1903.  Discharged recovered.


History and clinical notes:
History: Last Oct a year part of a wheel on which he was working broke and he was struck on the head.  A short time after this accident, which appeared trivial at first – he became somewhat depressed. (although his wife stated that he had been peculiar for a month or so before).  About a week after the accident he was taken to the Homeopathic Hospital where he was trepanned, but nothing found to require further interference.  The physicians stated that he was (has) softening of the brain.  He was taken home but never improved.  He became more and more depressed and for the past three months has been in bed most of the time; would not get up and when brother tried to get him up he resisted and became cross.  Lately he has refused to talk to anyone except when interfered with.  Has lost flesh rapidly during the past six months.  Sometimes refused to eat and has slept but little except by aid of narcotics.
May 21, 1902.  Has not improved mentally.  Is slowly becoming more feeble-minded.  Tears his clothes or removes then whenever opportunity offers.  Has to be restrained at times.  Sits with his head bowed down and when attempting to answer questions raises his head, mutters unintelligibly and resumes him former position.  Bowels are constipated at times while again he has several evacuations a day.  Occasionally urine has to be drawn by catheter.
Jun 4.  Is about the ward but is very feeble.  Can take only liquid nourishment and chokes at times on that.
Jun 10.  In bed, is growing weaker.  About 2” above left eye there is a depression in the frontal bone about 1” in diameter.  In mid-forehead there is an irregular vertical linear scar.  While high on the forehead is a semi-lunar scar (the flap for trephining).  Eyes show no gross change.  Reflexes fairly active and equal throughout.  Gross strength reduced.  Moderate bilateral ptosis.
Jun 13.  Was hardly able to swallow last night and this a.m. is unable to take nourishment.  Temperature is 103, respiration 80-88, pulse 120.
Jun 13, 1902.  Died at 2:45 p.m.

Additional notes:
Died from complications of head trauma and trephination.


History and clinical notes:
History: Mother died about six years ago; following this patient showed signs of melancholy, nervous and hysterical, neglected usual household duties.  This has continued with short periods of cessation of symptoms up to one year ago when she was operated on.  Following operation became very much worse in every respect.  Talked incessantly of committing suicide.  Early part Nov. 1901 jumped into Schuylkill River.  After rescue was placed in Penn. Hospital for treatment.  Removed against advice of physician by brother.  He supposing her perfectly well as she was much improved; within few weeks relapse and as bad as ever; crying and moaning; suicidally inclined.  Sundays especially bad as her brother kept a saloon which necessitated her working hard during the week days.  On Sunday abused her family, neglected household duties, scolded and required constant watching.  At 6 a.m. this day she attached piece of rubber tubing to gas jet, placed other end in mouth and turned on gas, which she inhaled until she fell to the floor unconscious.  This fall roused sister who slept immediately below her and she rescued her.  Patient complains of sleeplessness; says she is worried; answers all questions and is in fair physical condition on admission excepting bruise over nose occasioned by morning fall.
May 20, 1902.  Slept very little during the night on 30 grs. Chloral.  Was vaccinated today.  Has occupied herself in the ward with sewing; talks pleasantly with the other patients; does not seem worried about herself or annoyed that she is in Hospital.  Gives information willingly and is altogether an exemplary patient so far.  Appetite fair.  Habits good.
Jun 10.  Suddenly ran up the hall with hands thrown up, screaming at top of her voice.  Fell in clothes room in comfortable place, moved her arms and legs around until they were held, then movement ceased.  After screaming ceased, moaned noisily.  Hypodermic of hyoscine 1/100 some quieted her.  She was moved to her bed; this caused an increase of the moaning and groaning but when she found no one paid attention to her she soon ceased.  Except for this attack has been fairly pleasant on the ward; has worked steadily, occasionally objecting that she was too nervous.  Has very little control over her feelings.  Breaking into tears readily and appetite and sleep good.
Jul 12.  Swallowed a hair pin tonight; was found clutching throat.  The pin had lodged too far down to be extracted, so it was pushed down with oesoph banja (??).  Afterwards caused no disturbance and never was heard of.  On July 14th received large dose of oil, but no pin passed.  
Jul 23.  Found by night watches at 4 a.m. with throat cut – instrument knife kept by Miss [name redacted] (another patient), which [this patient] has probably stolen and secreted.  Night watches had heard a few groans in [this patient’s] room short time after their last visit at which time she was all right.  They opened the door and found her all covered with blood.  There were two incisions in the neck; one just above the clavicle in the Left side, the SCM (sterno-cleido-mastoid) muscle and smaller tissue and vessels being severed.  Another about 2-2 1/4 inches long behind the Left ear, involving considerable of the deep tissue.  These were salined and dressed.  Patient was in markedly collapsed condition, reacted [ill.] Strych, Cobbee, whiskey, etc. and local app. Of heat.  
Aug 6.  Wounds have healed nicely.  Patient somewhat quieter but still depressed enough to require confinement on Ward 3, with restraint at bedtime and an occasional dose of Valerian or Asafoetida to quiet her.  Harps for some time on the fact that she is lost; that she is no good; that she is as innocent as a baby.  Apparently has little realization of the gravity of the act she committed and is in just the frame of mind of make repeated attempts unless closely watched.
Aug 18.  A few days ago complained of diffuse abdominal pain, but no rigidity was present.  At present feels well but has an entire lack of [ill. – looks like ‘alwfitpor’].  Removed today by two brothers and a sister.  Will be taken at once to Med Hospt. Md.
Sep 8, 1902.  Discharged unimproved.

Final disposition:
Discharged unimproved; taken to hospital for treatment of swallowed hairpin.


Insane Relatives:
mother died insane; and other maternal relatives weak minded

On certificate of:
Drs. George W. Marshall and J.P. Lofland

History and clinical notes:
History: Has always had ‘fainting turns’ – probably petit mal.  Last Feb first symptoms of melancholia was manifested.  Began to neglect his work on farm.  At times he would brighten up for a week or 10 days and again would sink into depressed state.  Patient father and mother are both dead and 2nd cousin the correspondent took care of him.  About 3 weeks ago began to talk of suicide and his cousin found him going to barn with rope.  Patient stated that he was going to hang himself.  Sleeps fairly well, but don’t eat much.  
Jun 6.  Is often violent, refused food a times, never will take medicine.  Is very constipated.  Talks but little and then of persecution, never get well, etc.
Jun 9.  Eating better.  Take Mag Sulph voluntarily.  Is quiet.
Jul 16.  Will pick at face if not restrained.  Bowels moving normally.  Seems brighter.
Sep 23.  Small pox in house.  Vaccinated today.  Revaccinated 9-27-02.
Oct 6.  Both vaccinations taking well.  Moderate general and local reaction.  Has been wearing muffs to prevent him from scratching himself.  These are no longer necessary and he talk and act much more rationally.
Dec 20, 1902.  On parole.  Patient took articles from his uncle’s house, contracted extravagant bills in his name and was returned to Hospital December 24, 1902.
Jun 3, 1903.  Good health.  Works about the farm but has to be watched as he is tricky.
Aug 20.  No change in condition.  Good health.
Feb 14, 1904.  Developed a “sore throat” on 1-20-04 which was later pronounced diphtheria.  Antitoxin (3,000 units) was used at different intervals and case terminated favorably, on the 15th day of the disease.  Returned from T.B. Building on February 12, 1904.
Jan 6, 1915.  Has been working with Florist for past 6 months.
Jan 2, 1916.  Still working with florist and about grounds.
Mar 19, 1916.  Was acting in peculiar manner and was placed on the Ward; during the night he placed his head against the door and also broke window sash.
Apr 28, 1920.  Died in hospital.


History and clinical notes:
History: Patient left this institution Feb 1900 improved.  Has done very well since he left here.  Has attended to gardening around the house and was generally industrious.  About 4 weeks ago began to drink quite heavily and then in a few days began to show symptoms of insanity.  Carried a cane and every one he would see “he would poke his cane in their ribs” until everyone was afraid of him.  At night he would wander around the streets and his relatives never knew where to find him.  He has steadily lost flesh since the attack began.  He sleeps but little at night.  His conversation is becoming more irrational.  Has been much worse during past 4 days.
Jun 13.  Is noisy, talking almost continually day and night; seems in fair physical condition and eats well.
Jun 24.  Still noisy and profane, but less violent.  Is gaining in weight and looks very well.  
Jul 10.  No change.
Jul 29.  Still profane, noisy and untidy.
Sep 28.  Is as noisy and profane as ever.  Had a short chill this morning at 11:30.  Ate dinner and has not complained.  5 p.m. T.P.R. 103 3/5, 120, 26.  Examination shows no cause for fear beyond an abrasion of leg.
Sep 29.  T.P.R. 8 a.m. 104.
Sep 30.  T.P.R. normal.  Leg slightly infiltrated (??) and foot swollen.
Oct 7.  T.P.R. normal.  1° of fever as ever irregular.  Eats and feels well.
Dec 30.  Condition the same.
Jan 25, 1903.  For past ten days he has shown maniacal symptoms, troublesome and annoys other patients.  Restraint applied at this date, is somewhat quieter.
Jun 3.  Has had a severe attack of rheumatism but at present is in very good health.  Still very profane.  Eats well but is occasionally noisy at night.  Talks rationally.
Jul 12.  For the last two weeks has been very maniacal.  Very profane.  Hallucinatory, very untidy both night and day.  Eats well.  Noisy at night, sedation necessary almost nightly.
Aug 20.  Still noisy and profane.  Has to be isolated.  General physical condition fair.  Has symptoms of myocarditis.
Sep 22.  No change.  Violent and noisy.  Very profane.
Oct 11, 1905.  Died of lobular pneumonia.


On certificate of:
Drs. Stanton of Milford also accompanied him

History and clinical notes:
History: Dr. Stanford, who accompanies patient, states that [patient] was kicked by horse over lumbar vertebrae about 6 weeks ago and that there is still some pain over this spot.  Within a few days pain began in head and has been almost incessant since that time.  Was taken to Dr. S. Weir Mitchell, who stated that there was meningitis and that the probabilities were it was the commencement of paralytical dementia.  Patient has always been an upright man in every particular.  Never drank.  And [ill.] was always an industrious hard working man.  For past four days patient has been much worse.  Has threatened to kill himself and has threatened to kill others at one time brandishing a knife in front of his relatives, threatening to kill them.  Usually sleeps well at night and has a fair appetite.
Jun 13, 1902.  Quiet, cleanly.  Says back gives o trouble.
Jun 19.  On parole with wife.  Feels very well.
Jun 24.  Returned today.  Says he feels nervous [ill.] to work and they would not let him.  No pain in head or back.
Jul 22, 1902.  On parole with wife.
Dec 27, 1902.  Discharged unimproved.  
Note attached: Standard DSH memo form dated July 23, 1902.  “This is to certify that I [name redacted] wife of [patient] and [name redacted], sister-in-law of [patient] remove him from the Delaware State Hospital at Farnhurst against the advice of the Asst. Superintendent and will assume all responsibility in regard to his actions after he leaves said Hospital.  [Signed by wife and sister-in-law]


History and clinical notes:
History: Epilepsy since 16 year; family say caused by fright.  Married at 34 – 2 years after she came to America.  Epileptic attacks generally worse at periods, sometimes two in a month in these but generally one, up to past six months, when they have increased.  Screams and falls.  Has no [ill. – looks like ‘kumlidfe’] when attacks come on.  These last for few minutes, then in half hour she is all right.  Of late has slept a good deal after attacks.  No apparent predilection to night attacks.  Appetite poor, has suffered for years from weak stomach.  Until menopause (38) in fair physical condition; good hard worker.  Has been under treatment for epilepsy for many years.  No beneficial results observable.  Six months [ill.] her condition grew gradually worse; commenced to think her neighbors were talking about her.  That they were saying she was crazy.  She “heard them say so.”  Even when in her own house with the windows closed.  During past few weeks thinks her husband has turned against her.  That he talks about her; also that the children talk about her.  Of late has taken to sitting around doing nothing but working her hands.
Jun 13, 1902.  Since admission has given very little trouble.  Occasionally requires Chloral at night for sleeping – sings on the ward, at times watches other patients and says they are all making remarks about her; that they say she is crazy, that she is to be hung.  That she is to be burned up, etc.  Eats fairly well.  Talks constantly to herself but never noisily.  After visits of friends always worse.  So far no convulsions noted.
Jun 15.  Became very noisy tonight, tore her bed clothing in shreds.  Was restrained with camisole and tore that up.  Was given 1/100 hyoscine with but little effect.
Jun 17.  Still very much excited, tears her clothing, imagines that some one is in her room and bothering her.
Aug 6.  Quiet and amenable to discipline.  Talks pleasantly with the Dr.  Expressing a desire to go home.  Very rarely requires any medicine.  
Sep 13, 1902.  At home on parole.
Dec 27, 1902.  Discharged improved.


History and clinical notes:
History: First symptoms were manifested last Nov.  Dr. Messick, who brings patient, knows nothing of her history previous to [ill. – looks like ‘ananuciation’].  Husband states to Dr. that in the beginning she left home and it was two days before they found her.  Cause supposed to be due to patient’s daughter having a child by him, which is now 3 months old.  Very violent at times, tears her clothing, moans a great deal of a time.  Has threatened to drown herself and yesterday tried to kill her child by hitting it with a chair.  Does not eat.  Sleeps very poorly at night.  Disease is gradually increasing.
Jun 13.  Complains of troubles a good deal.  Says she has more than anyone else.  Answers all questions in a whining voice.  Occasionally brightens up and seems interested in what is going on around her.  Has very little education, therefore difficult to grasp depth of her dementia.  Breasts still sore, treated with Ung Bellad. (unguent of belladonna??).  Strapped today.  Somewhat greater relief following this treatment.  Patient asks to go home as soon as she is well.  Says she cannot stay here.  The others are too noisy for her.
Sep 4.  For a few weeks past has complained of pain along her spine and especially in coccygeal region.  She claims the pain to be the result of a fall on the stair steps.  Examination shows nothing beyond spinal tenderness most marked in coccygeal region.
Jan 12, 1903.    As patient has suffered from procidented uteri for some time an abdominal hysterectomy was performed today by Dr. Stubbs by and with the consent of husband.
Jan 15.  Patient doing very well, temperature never over 100°.  Mental symptoms improved, conversation much more rational.
Jan 24.  Continues to improve.  Temperature normal after last note, sutures removed today.  Wound perfectly clean.  No infection of any kind.  Mental state much improved.
Jun 3.  Patient made an uneventful recovery from the operation.  Mentally still much confused.  A muff is worn most of the time to prevent her pulling out her hair.
Sep 22.  Violent much of the time.  Typical chronic mania.
Feb 19, 1904.  Noisy occasionally at night – for some time has refused food and been living on Mellin’s Food, until yesterday when she ate meat and potatoes.  Has grown quite weak.  Has whiskey T.I.D. glass, vomits food very often.  Tears clothing and is very noisy at night.  
Nov 14.  Patient seems more bright and cheerful.  Eats well, and is not noisy at night.
Feb 20, 1906.  Fairly good physical condition.  Quieter at night.
Jun 10.  Patient shows great emaciation, hectic flush and other signs of phthisis Pulmonalis.  
Aug 20.  Patient coughs a great deal, growing weaker.  Appetite good.
Oct 3.  Patient in bed, very weak.
Oct 19, 1906.  Patient died at 2:40 p.m.  Phthisis Pulmonalis.

Additional notes:
Husband had a child by one of their daughters?  Was not able to track family any further online.


History and clinical notes:
History: Father states that he has drank off and on since his discharge May 13, 1901.  Lately he has been drinking very heavy.  Patient commits himself voluntarily.
Jun 12, 1902.  Went home on parole with father.
Sep 8, 1902.  Discharged recovered.


History and clinical notes:
History: Last summer he suffered from a sunstroke and had to quit work for a time.  Recovered.  Has had some trouble with his neighbor and the suit came off in court against patient.  This has worried him a great deal.  First symptoms noticed about a month ago; said that he thought his family were trying to poison (him).  Since then delusions of persecution have been constant.  Has threatened to kill his children several times as he thought they were trying to kill him.  Will not eat at home because of this and stays away from home and goes to his neighbors – general health is good.
Jun 13, 1902.  Says he could not have things the way he wanted them at home.  Has been quiet until this a.m. when became restless and complained of being kept here and of not having what he wants.  Mid-dorsum of tongue coated by a thick moist coat of brown and white, part of which was removed by [ill. – looks like ‘seesions’].  This coat consists in part of short dark hair like bodies resembling the spines of a strawberry.  Patient was transferred to Ward IV.
Jun 16.  Often must be coaxed to eat.  Believes he is wrongly held here, that he has been deceived.
Jul 10.  Take a little more notice of surrounding affairs.  Bowels normal.
Jul 29.  Says he feels perfectly well and wishes to go home.  Seems to realize that he had held peculiar ideas about people bothering him but know now that he was in error.
Aug 9.  On parole.
Oct 20.  Returned to hospital today.  Has been threatening the lives of others and running away from home.  He seems excitable and says we may as well put him out of the way and be done with it.
Aug 8, 1903.  Simple and very stubborn.  Garrulous in speech.  Tore up a letter from his daughter unread, said did not want to hear from her.  Does not eat very well.  No loss of weight.  Disobedient.
Sep 22.  No change.  Silly at times.
Dec 18.  Told Dr. H. that he was never married and also that he had no children.  
Jan 19, 1905.  Has been suffering from erysipelas (idiopathic) for past week but is rapidly recovering.  Mental condition remains unchanged.  
Aug 18, 1921.  Died in hospital.


History and clinical notes:
History: Was arrested for disorderly conduct last night, apparently has not been drinking.  See p. 264.  Has a few cuts about face and complains of pain in R chest for which there is no apparent reason.
Jun 12.  Played ball this p.m.  Feels and acts as if in good health.
Nov 3, 1902.  Paroled.
Apr 13, 1903.  Discharged recovered.


Complications:
blind (24 years); from being struck in right eye [ill. Words]

On certificate of:
Drs. Samuel McColley and T. Clarkson Taylor

History and clinical notes:
History: For almost 30 years has been subject to excitable periods, imagining the devil is after him.  People calling him nigger.  Has wandered off from home – especially at night.  During these attacks does not sleep or eat.  Generally last 2-3 weeks, after which he is apparently all right.  Has on an average 3 attacks in a year.  During attacks very taciturn, does not want anything to do with anyone, sits in a corner by himself or else wanders away.  These periodic attacks have been increasing in severity.  For past three weeks has not been working at all.  Heretofore generally stopped work for a few days to week at a time.  This last attack very severe.  Patient very excitable.  Has hallucinations and delusions of marked character.  Knows his nephew all the time as well as those around him.  After being talked to for a time becomes quieter and more biddable.  Patient realizes where he is – had no objections to coming at first, later resisted somewhat.  In Kirkbride Hospital 30 years ago for about 7 weeks.  Had a sunstroke a little over 30 years ago after which attacks began; before that perfectly sound.
Jun 13, 1902.  Hear action irregular and rapid pulse with rate of 140 per minute.  No murmur.  No swelling of feet.  Eats poorly, is constipated, seems depressed.
Jul 10.  Looks well.  Always constipated.
Jul 29.  Enjoying good health.  Is quiet and a willing worker with block.
Sep 4.  Heart action irregular 120 per minute.  Complains at times of not feeling well.
Oct 7.  Wishes to go home very much.  Claims he is very constipated, the attendants know to the contrary.  In fair physical condition.
Jan 25, 1903.  Quiet and orderly.  Chronic constipation.
Jun 3.  Patient is slowly failing in weight and strength.  Has to be encouraged to eat at nearly every meal.  Complains continually of constipation and thinks that he is partially decayed.
Jun 25.  Condition unchanged.  Several days ago while watching a ball game, patient escaped and went to his nephew in Wilmington, where he was found 3 hours later and brought back to the institution.
Aug 20.  Patient is losing strength and flesh on a constant state of worriment about his having to eat his meals.  If not watched, he would eat nothing.  Heart action arrhythmic.  General [ill. – looks like ‘atheronea’].  No change at this date (9-22-03).  Slowly failing.  Worries continually about having to eat.  Says he is all “stuffed up” and that his intestines are decayed.  
Dec 1.  For past few weeks he has refused to eat and it became necessary to use nasal tube to feed him.
Dec 14, 1903.  [Patient] died today at 8:30 a.m. due to mitral stenosis and arterio sclerosis.

Final disposition:
Died of mitral stenosis and arterio sclerosis


History and clinical notes:
History: Last admission was on May 9th, 1894.  Vol. III, p. 9.  At that time was noisy and violent.  Quieted down in a few days and worked in Supt’s family for almost a year.  Was discharged May 16, 1895.  Since that time has been living with mother with whom she has failed to agree of late.  Is quiet and tractable.
Aug 6, 1902.  For past three days has been growing quieter and more amenable to the discipline of the ward.  Works around a little and keeps her clothes in good condition.  On first admission much excited or else dull and stupid.  Lying around on the floor like a log, as though she were dead.  Eyes closed and mouth firmly shut, or else was sitting in a chair spitting all around her.  Took absolutely no interest in her sister who is on same ward.  Except when in these states of torpor, eats and sleeps well and is beginning to brighten up be interested in her surroundings.
Mar 12, 1903.  Discharged.

Additional notes:
Had sister on same ward, but paid her no attention.  Great description:  "On first admission much excited or else dull and stupid.  Lying around on the floor like a log, as though she were dead.  Eyes closed and mouth firmly shut, or else was sitting in a chair spitting all around her.  Took absolutely no interest in her sister who is on same ward. "


History and clinical notes:
History: About a week ago was driven off of picnic grounds and 15 days ago was arrested as insane and has since been in prison.  Officers can give no other history.  On admission patient is talkative, says he is a Catholic and that he is divorced from his wife.  
Jul 10, 1902.  Wore a belt and wristlets first few days.  Since then has been fairly quiet, works well and is a fair worker.  Wants to go home, to have visitors.
Jul 21.  Has been quiet, rational, and helpful on wards since last note.  Is a fair worker.  Removed today by brother-in-law [name redacted].
Sep 8, 1902.  Discharged recovered.


On certificate of:
Drs. Samuel C. Elbert and H. Clay Stevens

History and clinical notes:
History: Was brought by cab man who knows nothing of history.  Is quiet and tractable and talks sensibly.  History as given by patient: 13 years ago had small pox; 6 years ago can waited syphilis (sic) a year after which had sores on both shins and drooping of left eye lid and stiffness in legs developed.  At not time has there been pain in the legs.  There has been occasional headache.  Present condition: Well nourished male mulatto.  Moderate pock pitting of face.  Complete paralysis of left trimotor as shown by ptosis; mydriasis paralysis of iris, and external rotation of eye by ext rectus and sup oblique.  O.s. media lens clear.  Vitreous opacities.  Tendons (??).  Tongue shows no tremor or paralysis and is chronically coated with white.  Hears, lungs, and abdomen show no gross change.  Limbs are strong and muscular even on left.  The reflexes are active in the arms and spastic in the legs, especially on the left.  Ankle clonus is present on both sides and patella slow on the left.  The Babinski reflex is typical on each side.  McCarthy’s reflex is present on each side.  The gait is spastic.  No ataxia, tho (although) stands poorly on one leg from spasticity, sensation.
Jul 27, 1902.  Complains considerable of left eye but nothing more than muscle defect noted.  Is becoming untidy and has menaced trouble in walking.  Ordered to bed.
Aug 24.  Has just developed facial erysipelas.  Is in poor physical condition.
Aug 29.  Moderate involvement of face and now of scalp.  Heart action poor.  Is stupid and will not protrude tongue.  For some days has swallowed with difficulty and takes only little food.
Aug 30.  Erysipelas doing well.  Very weak.  Died at 9:20 p.m.
Aug 30, 1902.  Dead.


Insane Relatives:
paternal aunt insane, committed suicide; insanity runs on both sides

History and clinical notes:
History: Has been very peculiar for a number of years, but has been much worse for past five or six years.  About 3 months ago her husband would not live with her as he had no peace and she spent his money recklessly.  So she moved to her home in Sussex Co.  Since she has been at home, has been very restless and nervous.  Would not assist in any kind of work and when her husband was spoken of became very much excited and abused him fearfully.  General health has been very good.  Eats well, but at times sleeps little.  Sister-in-law knows but little more than above, except that a number of her relatives on both sides have been insane.
Aug 6, 1902.  Sits around the ward, would spend majority of day stretched on sofa is she were allowed; will not work; will not interest herself in any work.  Gets quite angry when asked to do anything.  When visited by her children or husband grows excited, face flushes, eyes [ill.] and she is angry and rehearses all her woes.  If opposed in any way is very disagreeable but as soon as she finds no notice is taken of it she grows cheerful again.  Memory relative to time, place, etc. good.  Sleeps and eats well.  Visited by husband yesterday, who wanted her to go home with him, but she would not.
Jan 23, 1903.  Very little change, says she will not go home to her family.  At times goes to bed and stays there for two or three days without showing symptoms of illness.  This morning expressed her delusions for first time.  Said that she had been frequently hypnotized since she had been here and that last night the brother of [name redacted] (an attendant here), came to her room and had her under his influence and that he was a beast and that she would kill him, etc.  
Sep 23.  Noisy at night.  Thinks that men come into her room at night and annoy her.  Cries a great deal.
Feb 19, 1904.  Very noisy and profane at night and quiet daytimes.  Fairly good condition.
Jun 5, 1906.  No change in any way.  Physical condition good.
Nov 20, 1907.  No change in any way.
May 26, 1946.  Died.


Insane Relatives:
two brothers dead and one sister epileptics; father drunkard

History and clinical notes:
History: Patient brought from Alms House.  Has always been idiotic; worse since head was injured 3 years ago.  Has development of boy of 13 or 14 years of age; doesn’t answer questions or take any interest in his surroundings.  Is unable to stand alone.  Poorly nourished.  Several burn scars on arms.
Jun 30, 1902.  Swallows with difficulty and takes only liquid nourishment.
Jul 1.  Slight fever; constipated; eats little.  Slight cough.  Respiratory sounds weak over whole left lung.  Expansion poor.  Is untidy.
Jul 6.  Is slightly better.  Has a slight evening rise of temp.  Swallows better.
Jul 8, 1902.  Acted as usual until 3 p.m. when was noticed he became blue and breathing was noisy; tempt was 105.  At 4:45 pm temp was 106 and respirations 69.  Died at 5:20 p.m.
Mother gives following history: [The mother] had 8 children.  4 epileptics (5th stillborn, 6th  died at 7 weeks old (9 months child, mother had malaria, child weakly).  8th, Leo V. died at 6 years.  Pneumonia and catarrh of head.  3rd living son Marshall at 27 years only perfectly healthy one of eight.  Of the 4 epileptics, 1st child Sallie was also paralyzed, died at 21 years; 2nd boy born blind and epileptic, lived until he was 13 years, perfectly helpless; 4th child Laura in Alms House at present, at 25 years; has been epileptic twice 7th year; 4th (sic) child was Elmer W. [patient].  As a child perfectly bright until 6th year when he commenced to have fits.  Had a good many fits, almost daily, and many times several in a day.  Between fits slept a great deal – did not seem to know much of what was going on, although he recognized his mother and brother.  Father’s side many members nervous – maternal aunt epileptic.  Many members suffered from heart disease.  Father drunkard; has very marked hernia which interferes with his work.
Note:  Trying to make sense of mother’s children.
1 – Sallie, epileptic, paralyzed, died at age 21
2 – Boy, blind and epileptic, died at age 13
3 – Marshall, healthy at age 27
4 – Laura, epileptic, lives at Alms House, age 25
5 – still born
6 – Died at 7 weeks, mother had malaria, child weakly
7 – Elmer W. [patient], congenital imbecile, head injury, died at age 20 in DSH
8 – Leo, died at 6 years of pneumonia and catarrh

Additional notes:
Buried at DSH, Grave #109.  Definitely one to write up.  Most children in family had multiple disabilities.  Only one child, Marshall, survived healthy to adulthood.  He married, but had no children, although he did take in a niece at age 9.  Brother died in 1944.


History and clinical notes:
History: Little over two months has been excitable; wanted to destroy everything within reach, clothing, furniture, etc.  Talks incoherently to herself, singing part of time, reciting poetry occasionally.  Appetite very variable; wants to be fed; sometimes would eat a good deal, then nothing.  Sleeping very poor – sometimes not at all for day or two.  Did not want to walk except with assistance.  Trouble seemed to commence even before husband’s death 2 months ago but not as marked as later.  Lost all interest in her children, house, friends, etc., but still recognizes them.  Remembers names, etc. of all her friends, when she wants to, next minute as incoherent as ever.  Mother has kept her locked in a room for past two months so that she could not injure herself.  Patient has always been of excitable, hysterical disposition.  Mother at present time is also very excitable and nervous.  Family is not at all intelligent.
Jul 20, 1902.  Visited by brother.  As [ill.] very sensitive; easily upset by little things.  Had a good deal of troubled during married (sic), lost a number of her children.  Had poor health nearly all time.  But no signs of insanity until after death of husband.  For past four days patient has been fed by tube, resists somewhat, but afterwards is quiet.
Aug 4.  For past week patient has been eating steadily, enormous appetite; craves ice cream and fruit especially.  Restraint still necessary at patient very violent at times, flinging everything put in reach at the visitor.  Very obscene in her language, especially when irritated.  Talks incoherently but not as markedly as at first; tendency to rhyme formation of sentences a lot using various synonymous (??) expressions in rotation or else words having same sound.  Sleeps fairly well.  Skin etc. much better color.  Still trouble by with diarrhea, which can but scarcely be controlled.  When spoken to, swears and curses.  Has been constantly disturbed and noisy, cursing every one.  Has lost flesh and is growing weaker.
Dec 13, 1902.  Has failed rapidly, since last not discharges have continued and nothing seemed to have any effect.  Sank rapidly all night and died of Tubercular Enteritis at 5 a.m.


History and clinical notes:
History: Patient has always been weak minded – never worked – always wandered around – difficult to manage.  Had one child about 36 years ago.  Feeble-minded to marked degree (died).  Since death of brother who looked after patient, she has grown more irritable and violent, more unmanageable in every way.  Very uncleanly.  Eats poorly of late.  Sleeps variably.  Past few weeks has been wandering off from her family more than ever.  Objected to returning.  Last day or two has been hitting the children – would not let nephew or his wife say a word to her.
Aug 7, 1902.  Since admission has been very variable, one day good humored, ready to talk and crack a joke, the next irritable and at times incoherent or obscene, ready to throw contents of chamber (pot) at intruder, tearing up bed and scattering it to four winds, throwing food around and making herself generally uncomfortable.  Then again would sit or lie by the hour or day, curled up in some comical position on her bed or in a corner of the room, arrayed in her bed clothes or at times naked.  Pretends she is dead, stretching herself out stiffly and making her body perfectly limp when touched.  Has a habit of rolling eyes so that nothing can be seen but whites.  At time very talkative, worrying all the patients with her chatter; again morose and silent, uttering not a syllable even when coaxed by snuff (??).  Very particular at times about her personal appearance, especially keeping her waist small.  Memory for past and present events poor, when she will take the trouble to answer.  In some things she is more than usually quick with an appropriate answer when she is being teased.
Mar 31, 1903.  Patient is very noisy and violent.  Talk most obscene.  Restraint and seclusion necessary most of the time.  Is untidy.
Feb 19, 1904.  Obscene and profane most of the time.  Several days ago fell and received cut over left eye.  3 stitches introduced and wound healed.  Yesterday was taken with profuse diarrhea and became rapidly very weak.  Muscles rigid, eyes exuding pus, and pulse very feeble.  Put on strychnine and whiskey, pulse improved.  Respirations still labored.
Feb 25.  Patient growing weaker.  Fed with milk and whiskey every three hours.  Pulse rapid and light.
Mar 6.  Patient is growing daily weaker.  Makes moaning noise occasionally as if in pain.  Takes whiskey but will not drink much of the milk.  Has become extremely emaciated and does not notice those about her.  Has two bed sores, one on each hip.
Mar 9, 1904.  Died at 4:15 a.m.

Additional notes:
Buried at DSH, Grave #125.  Another case of adult MR person who came to DSH after death of her caretaker.  Parents both long dead.


History and clinical notes:
History: Always enjoyed good health until a year ago when had an epileptiform attack from which she quickly and apparently completely recovered.  In September 1901 she had a second similar attack which left her changed, less bright and tidy than formerly.  The [ill.] in attendance attributed the illness to kidney trouble, although there is no history of other nephritis symptoms.
Jun 28, 1902.  Had a third attack, was unconscious several hours and revived quietly, but appeared to know nothing.  Since then has eaten little, has slept poorly and has often been stubborn and excitable.  She has not been destructive; wishes to get away and believes she has lost her money of which she has $500.00 in bank.  Does not wish to enter hospital and has to be brought in by force.  
Aug 7.  Mind is very feeble, has no realization where she is, who she is, or why she is confined here.  Memory for past as well as present events very poor.  Wanders up and down the hall.  Wants to get out.  Bangs on the door and yet is unable to express any other thought than “I want to get out.”  Seems quite shaky on her legs, falling easily from chair, bed, and sofa.  Is satisfied at times to sit quietly by the hour with her head down doing nothing.  Eats and sleeps well.
Mar 20, 1903.  Patient had a convulsion at 3 p.m. yesterday and was then quiet until 5:30 when she began having continuous convulsions and in the course of about 2 hours had from 40 to 50.  Had temp of 104 ½, slight oedema of legs and the urine examination showed albumin and hyaline (many) and few granular casts.  Active treatment was instituted and not until the patient was bled 20 oz. did the convulsions cease.  Patient gradually sank and died at 12:05 a.m. 
Mar 20, 1903.  Died of uraemia and chronic nephritis.


History and clinical notes:
History: Since June 28th has been very violent, attacks lasting 3-4 days.  Attempted to kill his wife.  Growing increasing worse.  Brought by Steward of Alms House who knows little of history.
Nov 9, 1902.  Quite demented.  Limbs, head, and body always the seat of choreiform movements when awake.  Is untidy.
May 6, 1903.  Patient ate breakfast as usual this morning.  Soon after (7:10 a.m.) patient was found sitting in his chair dead.  The coroner was notified and he ordered the body turned over to a New Castle undertaker.  The patient had been as well as usual and death was probably due to some heart condition.
May 6, 1903.  Died.  Coroner’s case.


History and clinical notes:
History: For past two years has been wandering around far from home; at times up around the house at night.  Occasionally indifferent to calls of nature.  Remembers her own people and the past very well.  Memory for present events poor.  Cuss at times – berating daughter when opposed.  Early life was healthy, never sick but typhoid fever at 45 years of age.  Births all living children, easy and natural births.  Only three living children, balance died of summer complaint, measles, etc.  
Aug 7, 1902.  Since admission has been on Ward B, quiet and contented after first few hours when she cried a little and wanted to go home.  Sits around and does nothing all day.  Does not interest herself in her surroundings to any great extent.  Eats and sleeps well and always looks cheerful.  First day some incontinence but this has cleared up.
Sep 12.  Has enjoyed usual health of late, is suffering only from senility.  Removed today by [daughter].
Dec 27, 1902.  Discharged unimproved.


History and clinical notes:
History: Thirty years ago wife believes he had an attack of melancholia.  Three years ago had a slight stroke and was weak on left side for about a week and his mind never recovered.  At times is quiet and easily cared for and at others must be watched to prevent him from getting lost in his roamings.  About a year ago had trouble with his [ill. – perhaps ‘renter’ or ‘ureter’] and has since been worse.  His disposition is good except when crossed when he becomes very irritable.  Eats quite well but indigestion is frequent.  Sleeps poorly, wandering about room.  Physical exams shows a well-nourished muscular white male of about 68 years.  Hair and beard long and gray.  Eyes pupil 3 mm react well to L.A.C.  No extraocular defect.  Tongue moist, clean, no tremor.  Pulse regular 80 – vessels healthy and tortuous.  Chest expansion good, breath sounds fair.  Heart apex beat diffuse and distance in 5th space ½” with nipple line.  Heart sounds clear, muscle tone poor.  Abdomen: hepatic border upper at 6th space.  Moderate and complete inguinal hernia on R.  Limb strength fair.  Reflexes normal throughout.  Hearing poor.
Jul 29, 1902.  Has been very noisy from 4 to 5 o’clock in morning of past two days.  Has twice refused to eat.  Is cleanly but eccentric, roaming about continually.
Oct 7.  Has lately been violent at times and now wears wristlets and belt.  Is noisy at times during nights.  During days is fairly good tempered, except at times.
Oct 1.  Vaccinated 3 times.
Oct 15.  Three good takes.
Dec 30.  On parole Dec 29, 1902.
Apr 13, 1903.  Discharged unimproved.
Note attached, standard Hospital memo form.  Dated December 29, 1902.  I [name redacted] hereby remove my husband [name redacted] from the Delaware State Hospital at Farnhurst against the advice of the Supt. who has informed me that he (the patient) is insane and not a proper person to be at large and that I will be responsible for his safe care and keeping and will exonerate the said Hospital from any damage or acts that might be done by my husband while under my care.” [Wife’s signature]


On certificate of:
Drs. Harris L. Paige and Thomas O. Clement

History and clinical notes:
History: July 20th became very much excited religiously, praising the Lord, singing and praying all the time.  Last Sunday caused considerable disturbance in church to annoyance of minister.  Has had attacks of religious excitement before but never as severe as present one.  Attends to her household affairs in a manner, but continually talking and praying.  Of late has slept little.  Officer who brings patient knows little about her except that she earns her living at times by washing when she can get it.  At other times supported by the town.  
Aug 6, 1902.  Since admission has been fairly quiet, although she has wanted to preach to the other patients.  Is perfectly rational, knows where she is and why and accommodates herself readily to her surroundings, taking an interest in the work and watching where she can be of use.  Wrote home to her people, seems anxious to get out, but makes no fuss about the Hospital rules.  Sleeps and eats well, physically in good condition.  Mentally inclined to be religiously excited at times.  Dropping readily into a Biblical expression to her thoughts.  Easily directed from these attacks however.
Aug 18.  Has been perfectly quiet since last note.  Removed today by husband against advice of Supt.  
Dec 27, 1902.  Discharged improved.


History and clinical notes:
History: Has always been intemperate, occasionally has broken down and been extremely nervous, crying, etc.  For past 17 years has worked but little.  Past 4 years stayed around the house, wandered around the house, ransacked everything.  Extremely irritable.  Objected to son-in-law with whom he lived and has made life intolerable for daughter of late.  Gets up at night and wanders around.  Complains a great deal of head.  Four years ago hurt by trolleys, never unconscious, but considerably bruised.  During past few months has been growing gradually worse, mind feeble, very forgetful, does not know half the time where he is.  Knows his daughter with whom he has lived but does not know [ill. – perhaps ‘the others’].  Habits cleanly as far as daughter knows.  Will spend all he can lay his hands on for drink, etc.  An irritable old man who would fight on slight provocation.  Memory poor.  Pupils slightly irregular and react slowly, about 2 ½ mm in diameter.  Tongue moist and gray coated.  Pulse 78, slightly irregular, vessels leathery.  Breath sounds apparently clear.  Heart, no murmur, muscle rate short and poor.  Abdomen: on the left there is a large complete inguinal hernia and on the right an incomplete inguinal hernia.  Limbs: reflexes equal and diminished throughout.  Gross strength very good.
Sep 24, 1902.  Vaccinated.
Oct 1.  No take.  Revaccinated.
Aug 20, 1903.  Still in good general health considering.  Eats and sleeps well.  Very quiet and inoffensive.
Jun 14, 1904.  Has been suffering from a severe enteritis for past 10 days and is emaciating rapidly.  Visited by daughter and Father Campbell.
Jun 25, 1904.  Died.  Senile dementia and enteritis chronica.

Final disposition:
Died of senile dementia and chronic enteritis


History and clinical notes:
History: Was a steady, careful man until 7 years ago when he began to go on sprees.  Since then he has an attack every 2 or 3 months during which he would be unable to work for about 2 weeks.  Has never had an attack of D.T.s.  This time he has been drinking only 6 days, takes whiskey only.  Has slept poorly last few nights.  His health has been failing for 5 or 6 months past.  Is quite tremulous, tongue coated.  Rx milk ℥ (ounce) vi Tr Capsici Tr Nux Vomicae aa mxv every 3 hours, to bed, Mag Sulph ℥ (ounce) i.
Aug 2, 1902.  Not so nervous.  Chloral necessary to sleep.  No hallucination.
Aug 3.  About ward, restless and rather irritable.  Complains of indigestion.
Aug 5.  Has recovered nicely from the attack.  Is worried, uneasy, and wishes to get home.  Removed today by wife.
Sep 8, 1902.  Discharged recovered.


History and clinical notes:
History: Recovered from typhoid fever six weeks ago.  Four days ago began to drink whiskey in large amounts.  (symbol looks like an egg with a line across it 1/3 of the way down) iv a day.  Is not very nervous, due to being well stimulated by whiskey lately taken.  Physician’s examination shows no gross lesion.  No tremor.  Tongue moist and gray coated.  Rx Tr Nux Vomica and Capsici aa mxv every 3 hours.  Milk ℥ (ounce) vi every 3 hours.  Chloral Mixt. ℥ (ounce) i stat.
Aug 8, 1902.  Was noisy last night and not completely controlled even by Morph gr ½ Hyoscine gr 1/50 in addition to Chloral.  [Illegible phrase – looks like ‘Slonwet non utertive’].  
Aug 9.  Slept poorly last night, hypodermic necessary, stomach quiet.  Rx above plus beef tea.
Aug 10.  Milk, egg, and toast added.
Aug 11.  On house diet.  All drugs stopped.
Aug 14, 1902.  On parole.


History and clinical notes:
History: Has had fits ever since a child.  Has attacks at irregular intervals, varying from days to weeks.  These attacks are described as typical of epilepsy.  Has been a periodical drinker whenever he could get the money.  Was adopted when a child from a Philadelphia house, by [name redacted] at Raoul.  This man was a hard drinker and is reputed to have often gotten the boy drunk.
Aug 14, 1902.  Had a very severe epileptic seizure today.  Is rather surly in disposition.
Oct 7.  Has been irritable and quarrelsome, restraint found necessary.  In good general health.  Vaccinated but no take.
Dec 30.  Patient continues to have spells; otherwise is quite and reserved.  Eats and sleeps well.
Aug 20, 1903.  General health good.  Has occasional severe epileptic seizures.
Jan 20, 1919.  No change in patient’s condition.  At times has very severe epileptic seizures.
Oct 28, 1919.  Patient during one of his epileptic convulsions fell with an outward twisting of the right leg and broke his leg, involving both bones: tibia and fibula.  Symptoms were instant and complete disability, deformity, and swelling.  Mobility and crepitus and local pain from direct pressure and also transmitted through pounding on the heel.  Reduction was affected by pressure and traction and maintained by circular Plaster-of-Paris cast.
Dec 16.  Removed the cast, union is firm.  Patient still in bed.  Some massage and passive movement.
Dec 17, 1919.  Last night patient had a severe epileptic seizure and fell from bed, breaking his leg again.  Fracture of tibia and fibula in old place.  Reduction and a Plaster-of-Paris cast.  Kept in bed.
Oct 13, 1925.  Died in hospital.

Additional notes:
Good argument for use of restraints/cages for sleeping.


History and clinical notes:
History: A year and a half ago her mother died and since then has been very depressed and has gone not at all in society but has continued successfully in business.  One month ago was shocked by family trouble and laughed violently at trivial things.  Was taken to Atlantic City two weeks later but became excitable in a short time and wished to go home.  She was then taken to the Country and again was dissatisfied and irritable with brother and seemed to believe that he and a dear lady friend had used her for immoral purposes and at other times claimed various people had committed improper actions toward her.  At one time imagined her father dead, committed suicide and was buried at Middletown and unknown to others took a trip to that place where she was found by brother.  Has also other delusions of persecution and some hallucinations of sight.  Sleeps only an hour or two at night, is very restless.  Has eaten poorly for past two weeks.  Has complained of some pain in head.   Patient apparently considers her self superior; answers are evasive and at time contradictory.  States that her brother and a friend in the country had taken medicine which made their eyes large and their faces peculiar, that her mind has heard and talked with the mind of a young male friend and that she can hear him even when surrounded by other.  By putting her hands together and pulling, she can send an electric current through her arm and body.  This same sensation was noticed when Dr. [ill.] of Phila felt her pulse.
Aug 15, 1902.  Continues evasion and manner paranoid.  Occasionally assumes an attitude of prayer with hands uplifted.  This p.m. was found seated in window with legs hanging out.  Refused to leave the position and was removed by force by Dr. Van Epps and two attendants and taken to Ward 3.  During scuffle, R cheek was bruised.
Aug 16.  R check black and blue.  Patient attempts to leave Ward whenever anyone enters or leaves.
Aug 18, 1902.  Removed this even by brother against wishes of Supt.
Note attached: Standard memo attached.  Dated August 18, 1902.  “I hereby removed my sister Miss [name redacted] from the Del State Hospt at Farnhurst against the advice of the Supt.  He informs me that her case is probably not a hopeful one and that she is liable to do herself or others bodily harm.  Knowing these facts I remove her and will exonerate the authorities of said institution should she commit any depredations or injure any of her friends or others.”  [Brother’s signature]
Aug 30, 1902.  Returned today by brother and uncle.  In spite of constant watching has on two occasions escaped from the 2nd story window.  Has never been at all suicidal or homicidal.
Nov 2, 1903.  Has improved since last note and although not yet well, was allowed to go home on parole.  Removed by brother.
Apr 13.  Patient has remained at home well.
Apr 13, 1903.  Discharged recovered.

Additional notes:
Tried to escape, both from hospital and while at brother's house.  In 1910 census, she was single, living with brother and father, brother's wife and children in Pennsylvania.


History and clinical notes:
History: Patient is brought by officers who know nothing of her history.  Is apparently disturbed, but is quite docile.  
Aug 23, 1902.  Notes from husband: Until 6 weeks ago, patient was completely well when, with no assignable cause, she began to run about the house at night hell raising that people when (were) trying to hypnotize or chloroform her.  She also believed that the family were being imposed on by the Jews and Italians with whom she asked them not to deal.  She believes that her husband’s gold watch was changed for a brass one when it was cleaned.  Of late she has collected pieces of paper such as the back of a bag of tobacco and calls them policies.  Recently she has warned her husband against certain articles of food, believing they were poisoned.  She has had no religious delusions.
Sep 20, 1902.  Is very melancholy – at times refuses food and will not talk.
Dec 4.  No improvements, has to be fed occasionally by nasal tube as she will not eat voluntarily.
Jan 1, 1903.  Has had several boils and carbuncles since last note.  Is fed twice daily with nasal tube.  Has been steadily growing more feeble and rapidly losing flesh.
Jan 3, 1903.  Patient was removed by husband today.  Has taken her food voluntarily for past 2 days.  On parole.
Apr 13, 1903.  Discharged unimproved.
[Pencil mark at bottom of page says “See Vol. V, page 123, page 135].


History and clinical notes:
History: Brought by officers who know nothing of the case.  Patient is very nervous and has all the appearances of being on the verge of the D.T.s.  He claims he has not been well for months and denies having taken too much alcohol.  This morning he says he was tarred and feathered and today was made to act as pall bearer to 3 different funerals.  Physical examination reveals numerous 2 or 3 day old black and blue marks on left shoulder and arm, on lower left abdominal region and on left leg.  There is marked tremor of tongue and of extended hands.  Rx Tr Nux Vomicae and Capsici aa mxv every 3 hours.  Milk ℥ (ounce) vi every 3 hours. 
Aug 25, 1902.  Delirious and at times very noisy.  Tremor very marked; takes medicine and nourishment well.  Chloral gr 20 and hypodermics of Morph Sulph gr ½ Hyoscine gr 1/50 necessary to produce sleep.
Aug 26.  Patient restless but tremor less marked.  Tongue typhoid (sic).  Mind incoherent.  Heart action 120 regular but weak.
Aug 27.  Was given no sedative during night; took treatment as usual until 1 a.m. when was noticed to be more stupid and much weaker.  Was given hypodermic of Heart Tablets [ill. – looks like ‘cosufe’].  Aromatic spirits of ammonia by mouth and external heat was applied but to slight purpose and heat (?) was applied but patient succumbed at 3:06 o’clock this morning.
Aug 27, 1902.  Died.


History and clinical notes:
History: Patient has always enjoyed good physical health and was an industrious woman.  Six years ago became forgetful and unreliable and since then has done nothing.  She has been cleanly for the most part, but has been destructive of her clothes and is often restless at night.  Has had no delusions and her mind is almost completely blank.  She merely repeats she wishes “to go home.”
Jul 1, 1903.  Has been in bed for a month or so.  Mind very feeble and is too weak to be up and about.  Has been gradually failing.
Jul 28.  Friends have been notified by letter of her poor health, but they have failed to respond.  Failing very rapidly.
Aug 2.  Failed rapidly since last note and died at 5 a.m. today.
Aug 2, 1903.  Died, senile asthenia.
There is a small (4” x 6”) lined note paper with a penciled note dated August 3, 1903.  Some of it is missing and what is left is very faint and mostly illegible, as well as very poorly written.  As best as I can tell, this is what is readable: “ . . . dear sir, a recieved your telegraph that Haret [patient’s name was Harriet] is ded; if John Mabury won’t I will . . . her body . . . her fare . . . . A.E. [last name redacted, same as patient’s].”

Final disposition:
Died of senile asthenia; buried at DSH #117


On certificate of:
Drs. Willard Springer and P.W. Tomlinson

History and clinical notes:
History: Patient has been depressed for some weeks and friends have noticed his mental lapses in agreement.  For a week past has been more than ordinarily depressed.  Last night awakened a friend in the house and after going to room kept walking about.  This morning was found in bed because, he said, many of his clothes were torn.  At first talked rationally of wife, later became very obscene and seemed not to grasp what was said.  These symptoms became so marked that physicians were called and when the police came to remove him he resisted violently.  On admission giving few answers as to his condition, says he has only been in bed a day.  Is quiet and apparently confused.  Heart action is accelerated but shows no murmur.  Lungs, abdomen, and limbs show no gross lesion.  On R shoulder there is a slight abrasion.
Sep 7, 1902.  Talks almost constantly of Mary [name redacted], of sexual relations with her at No. 13 Clayton House, “point of entrance” etc.  “see the green in my eye”.  Is very restless and restraint necessary.
Sep 9.  Kicked open door.  Tied in bed.
Sep 12.  Still talks of Mary [above], of being happy with her.  Can be made to talk rationally for a while and then recurs to Mary or to some foolish statement, laughing foolishly at times.  Sleeps fairly well.  Good appetite, bowels regular.  
Oct 7.  Acts fairly rationally, but on any [ill.] than a superficial conversation immediately begins to talk of his life history of which he is writing or of some unformed delusion.  Writes voluminously and disconnectedly on religion and personal matters, principally with Mary [above] toward whom he has erotic tendencies.   His writings are often decorated with locks and keys, cross and other symbols.  Eats well, sleeps fairly well.  Plays ball.  Sings and plays the organ.
Oct 16.  Often noisy at night.  [Name of another man] have been influencing him today.  The other day wrapped up rags, feces, and other dirt and packed same in a grip which he wished send to No. 13 Wilmington.
Dec 30.  Condition the same.
Mar 22, 1903.  For the last two weeks, patient has refused to eat, saying he was receiving nourishment from God.  Has been necessary to feed him by nasal tube.  Says he is in constant communication with the Stinking Woman.  Today he began to eat again, only light diet, refuses all meat.
Apr 1.  Today asked to be allowed to go over to the Pest House in order to be with Mary [above] who he thinks is over there.  Put on his shoes and hat and after waiting awhile insisted on going.  Says he is not insane, that he is under orders from God.  Was put in restraint and to bed.
Aug 16.  Is at present very quiet.  Talks rationally on most subjects except religion.  Health good.  
Sep 22.  Delusional.  Eats nothing but bread and milk and cereals.
Jan 6, 1904.  Very noisy and delusional, says he is sane and wants to be released from bondage.
January 1920.  Very little change mentally.  Has been in bed for some time, not so strong physically.
May 1920.  Has had one or two strokes of apoplexy and is unable to help himself.
Aug.  In entirely helpless, has to be fed and is in bed all the time.  
Sep.  Is steadily growing weaker.
Oct 17.  Has been failing rapidly for past week; has had several attacks of cerebral apoplexy.  Died this 7:40 a.m.
Oct 17, 1920.  Died of cerebral apoplexy.

Additional notes:
Clayton House was a long-time Wilmington Hotel on the corner of 5th and Market Streets.  From its opening in 1863 until 1916, it was a hotel.  Then it was turned into the Queen Theatre.


History and clinical notes:
History: First symptoms were noticed about 5 years.  Neglected her work, was living in Minnesota at the time and was taken to Hospt at St. Peters.  Was there about 3 years and come to Delaware about two years ago.  At times she is fairly well with exception of memory.  Has had several attacks when she is very cross and irritable.  Keeps to her bed and will not talk.  Keeps to herself and is very irritable if spoken to.  Has steadily lost flesh and strength.  Has a good appetite.  Sleeps good at night.
Feb 19, 1904.  Eats and sleeps well.  Talks rationally and nutrition good.
May 2.  Condition remains the same.  Is always writing letters.  Sews sometimes.  Is quiet and orderly.
Nov 14.  About the same.
Jun 5, 1905.  About the same.  Breath very offensive.  Occasionally untidy.
Feb 20, 1906.  No change in any way.
Jan 19, 1907.  Patient has been well to date; working in kitchen.  Was found ay 3 a.m. fallen out of bed, and unconscious.
Jan 20.  Some better, very stupid.  Does not know daughter.
Feb 1.  Is worse today, very stupid.  Extremities cold, pupils dilated.  Takes almost no nourishment.
Feb 2, 1907.  Patient unconscious.  Stertorus breathing.  Died at 1:30 a.m.  Cerebral hemorrhage.


History and clinical notes:
History: Brought by head nurse of Alms House.  Has had spells of irritability and believes that she is being robbed and that beer is being brought into the house.  Often wanders about the room at night.  
Sep 1, 1903.  No change in condition.  Still delusional.  Fairly good health.  Is quite deaf.  
Feb 19, 1904.  Very irrational.  Health good.  Sometimes noisy.
May 2.  Transferred to Ward I some weeks ago, because she was very noisy.  Irrational and melancholy.
Jun 20.  Transferred to tuberculosis building.
Jun 15.  Patient growing weaker, confined to bed.
Aug 20.  Patient noisy at times, drinks very little water and grows weaker.  Expectorates a great deal.
Sep 22, 1904.  Died 2:15 p.m.


History and clinical notes:
History: Two years ago was disappointed in not passing a school examination and since then has been depressed and listless.  Never violent or emotional, no delusions have been mentioned.  
Aug 16, 1903.  Condition unchanged.  Good health.  Always stubborn and sullen.  Once lately it was necessary to feed her by tube.
Feb 19, 1904.  Getting worse all the time.  Cataleptic.  Tooth ached a few days ago and was extracted.  Otherwise well.
Nov 14.  No change.  
Jun 5, 1905.  Noisy very often, transferred to III.  Screams at night.  Eats fairly well.  Is very anaemic.
Feb 20, 1906.  No change.
Nov 20, 1907.  Very disturbed at times.  Physical condition poor.
Jul 1, 1908.  Patient has a bad cough and examination of sputum reveals TBs.
Aug 1.  Patient has failed very much, is now in bed.  Coughs a great deal.
Sep 1.  Patient failing very rapidly.  Losing flesh; mother visited her a few days ago.
Sep 6, 1908.  Has failed rapidly since last note, died at 11:30 p.m.  Phthisis Pulmonalis.


History and clinical notes:
History: Was like other old people, doing chores about the place until a month ago when was suddenly taken with a weak spell.  Speech was undisturbed and R eye had an outward cast.  No paralysis of limbs.  Apparent recovery occurred in 2 days.  Since then has complained of pain in back of head and of rheumatic pains in limbs.  He has been too forgetful to work and often wanders away from home.  Has an idea that someone has done him injury.  Sleeps well.  Eats poorly of late.  Was untidy after attack; is better now.  
Nov 9, 1902.  Untidy.  Eats and sleeps well.
Aug 16, 1903.  Has been in bed for the last 2 weeks; general weakness.  Probably has myocarditis.  Marked atheroma.
Sep 22, 1903.  Some stronger physically.  Sits all day in same position and never speaks except to answer questions.
Sep 1, 1904.  Died.  Cerebral apoplexy.

Final disposition:
Died of cerebral apoplexy; buried at DSH #127


On certificate of:
Drs. Ezek. W. Cooper and E.J. Bracon (could be Bracken, or even Brown)

History and clinical notes:
History: Has been home only 4 days.  During that time has been very quiet.  Says a spot on his head is due to jumping out a window to escape the devil.  On admission is quiet and docile.
Oct 1, 1902.  At times is found crying, giving no intelligent answer for same.  At bidding will laugh and call for “papa” or any other foolish things suggested; slightly catalepsy (sic).  Vaccinated several days ago.  No take.
Oct 7.  Slight improvement.
Nov 9.  Cataleptoid; in good physical health.
Jun 3, 1903.  Has been in good health for several months.  About 2 weeks ago a swelling was noticed in the left side of neck.  This mass is not nodular; is hard, not adherent to the skin and tender slightly to touch.  Thought to be tubercular glands.
Jul 20.  Pus pockets (two in number) opened and about ℥ (ounce) ss evacuated.  
Aug 21.  Openings still discharging.  General condition and health fair.
Sep 22.  Sinuses still discharging slightly.
Jul 1, 1904.  Suffer from tubercular adenitis.
Jul 21.  Removed to TB (building).
Apr 10, 1906.  Eloped.
Jul 13, 1906.  Discharged recovered.
Postcard attached: Addressed to “Dr. Hancker, Farnhurst, Del.”  Dated Apr 14-06.  “Dear Sir, I write to inform you that my son came home and appears to be all right.  We would appreciate it if you would send his clothes he wants to stay home with me a while.  Yours truly, [Father’s signature].  P.S.  Send clothes to Wyoming, Del.”

Additional notes:
Last admission 10/19/1927; died at DSH 9/3/1963.  Escaped and went home; father sent note asking for his clothes.  In 1920 was living in a boarding house in Wilmington (ancestry.com)


History and clinical notes:
History: Brought by son who says he has been drinking for months.  Is quite nervous.  Physical examination shows no gross lesion beyond the tremor of lips and tongue.  Vaccinated today.
Sep 29.  Still slightly nervous.  Chloral necessary for sleep.
Oct 1.  Feeling well.  Still shows slight tremor.
Oct 7.  Apparently normal vaccination has not taken.
Oct 13, 1902.  Discharged recovered.


History and clinical notes:
History: Patient has been roaming about neighborhood for past 4 months doing odd jobs here and there.  He has done no harm, has merely acted as a homeless simpleton.  On admission acts as if demented. Gives irrational answers.  Says he has been in Blockley and V.E. (reference to Dr. Van Epps) and Nickle both remember having seen him there.  Examination shows livid birth mark of right cheek.  No other gross change.
Oct 7, 1902.  Quiet, cleanly, fair worker, habits apparently normal.  Has been vaccinated – no take.  
Nov 9.  Quiet, cleanly.  Good physical health.
Jan 20, 1903.  Condition unchanged mentally and physically.
May 1918.  No change in patient’s mental condition.  At times he is very talkative and destructive.  Physically well.  
Jan 1920.  No change in his condition.  Physically not as strong as he used to be.
Jul 5.  Patient suffering from bronchopneumonia.
Jul 13, 1920.  Patient died this morning at 8 a.m.  Bronchopneumonia (8 days).

Final disposition:
Died of bronchopneumonia; buried at DSH #316


History and clinical notes:
History: Was picked up in Wilmington 1 a.m. the 12th.  Supposed to have come from Phil.  Since being in City Hall has been very violent at times.  Patient says he came to Wilmington or about from Phila.  Does not know how long he was there.  Says his wife is in [ill. – looks like ‘loil’] and that she made him leave.  Phys. Examination shows a well-nourished white male about 5’5” in height.  No gross lesions of heart, lungs, or abdomen.  Reflexes and station normal.  
Oct 25, 1902.  History from wife: Patient has always been a temperate, quiet man.  Has been well liked by his employers.  Has been in morocco firms and has lost considerable money lately.  For months past has been negotiating the sale of some patent process.  For two days before coming here the patient talked continually of his patent, complained of head ache and was restless and sleepless.  He left home unknown to his wife who learned of his whereabouts through the news papers.  Patient recognized wife and is glad to see her.  Must be kept in restraint because he wishes to constantly tear clothes.  Eats well.  Makes some noise at night.  Is inclined to be facetious.  Two days ago wished to join the U.S. Army.  Arms are excoriated by restraining cords and wristlets.
Oct 29.  Has slept and eaten well since last note.  Is restless during day.  He will not talk much but appreciates everything that is said.  Yesterday and today believed there were bugs in his supper and under his shirt.  Has a slightly confused, dazed look.  Removed this a.m. today by mother and friend who intend to take him home and later to the Phila Hospt.
Oct 29, 1902.  Discharged.

Additional notes:
To be taken to a hospital in Philadelphia.  "Is inclined to be facetious."


History and clinical notes:
History: Dr. Barber who brought patient to Hospt. on the 10th [ill.] (was not admitted at that time on account of papers not being properly filled out) states that patient had been insane about 20 years ago and that this attack has lasted for about one month.  Has been so violent lately that they could not keep him home.  Has threatened to kill his wife and children.  The details of the case he could not give.
Nov 22, 1902.  Paroled.
Apr 13, 1903.  Discharged improved.
See later adm.  #2014, Vol. V, p. 434.


History and clinical notes:
History: The patient has a bad civil record having spent much time in various jails.  Last spring he confessed to a murder which he probably did not commit.  He has since been in jail and is remanded here by Court.  He has been sulky, morose, and at times has attacked those about him.  Physical examination shows no gross lesion of heart, lungs, or abdomen.  Reflexes normal.  Station normal.  Eyes: pupil 4 mm, equal, and react to L.A.C.  Tongue: small, moist, clean.  Pulse 80 regular.  Fair tension.  Is inclined to be stubborn.  Acts smart.  Says he does not want to harm anyone but wishes to get away from here and will hurt himself if he cannot.
Dec 30, 1902.  No change of condition.
Jan 25, 1903.  Condition the same, orderly and a good worker.
Feb 19.  Returned today from the pest house where patient has been for past 3 weeks with small pox.  While over there, patient escaped and was at large about one day.  Comes back in good condition.  Face plainly marked with scars.
Sep 22.  Still in restraint.  Confused in thought.  Stubbornly inclined.
Jun 12, 1907.  Losing flesh rapidly, has a cough and night sweats.
Aug 15.  Rapidly growing worse and is confined to bed, both lungs involved.
Sep 7, 1907.  Died.  Phthisis Pulmonalis.
Letter attached: Written on lined paper, header says “Sheriff’s Office of Sussex County, P.J. Hart, Sheriff.”  Georgetown, Del., Oct 7, 1902.  My dear Doctor Hancker.  This patient is a very low type and is a very dangerous one to the citizens of our state.  He has been in various jails for crimes committed because he has no judgment as to what is required of a man.  He is sulky, morose, and at times very dangerous; he attacked the deputy sheriff here without cause and did it unexpectedly to him.  He is a case that will bear watching at all times and while it may not be necessary to muff him I don’t think that wristlets would be out of place on him.  [signed] Dr. Hammond.

Final disposition:
Died of phthisis pulmonalis; buried at DSH #148

Additional notes:
Buried at DSH, Grave #148.  From the description, he sounds more like he is mentally retarded, perhaps mildly MR, rather than insane.


History and clinical notes:
History: First attack occurred 16 years ago; was very melancholy; lasted about 8 months.  2nd attack occurred 13 years ago, was again melancholy, caused by her child dying.  During this attack attempted suicide by jumping in river.  This attack occurred about 7 months ago, cause unknown.  Began by being very quiet, mumbles to herself.  Is gradually getting worse; says she is never going to get well.  Last night attempted suicide by drinking carbolic acid.  Said she did not want to live.  Will not eat much.  Sleeps but little at night.  Talks but little.  Appreciates her condition thoroughly.
Nov 19, 1902.  Patient went on parole against advice of Superintendent.  Has attempted suicide several times since and has tried to obtain poison at the drug stores.  Does not sleep and is continually rubbing his (her!) hands.
Nov 28, 1902.  Returned to hospital.
Dec 30, 1902.  Moody and depressed at times.
Jan 2, 1903 (says 1902).  Has improved somewhat since her readmission.  Was removed today by her sister-in-law [name redacted] with the consent of her husband.  See letter attached.
Jan 2, 1903.  Discharged improved.
Letter attached.  Written on letterhead of [name redacted], Pawnbroker and Jeweler, [number redacted] Market Street.  Wilmington, Del. Jan 2nd, 1903.  “Dr. Hancker, Superintendent Del. State Hospital.  Dear Sir: I hereby give my full consent to take my wife [name redacted] out of the Del. State Hospital into the charge of her brother [ill.] and sister-in-law of my wife [names redacted], knowing them to be able and believing they will take good care of her and see that she is restored to health if possible.  Respectfully, [husband’s signature].”

Final disposition:
Discharged improved into care of her brother and sister-in-law

Additional notes:
Two of her children apparently died young.  But the one who was 10 months old when she was admitted to DSH survived, and she had two more children.  In 1920, 1930, and 1940 censuses was still alive and living with husband until he died, and then with her two youngest sons, in Wilmington.  She was 69 in 1940.


On certificate of:
Drs. George W. Marshall and James G. Stanton

History and clinical notes:
History: Officer has known patient for 4 years past.  Until a year ago he was an industrious worker and of good habits.  For past year has done no work, has wandered about, talking on religion, the government, bidding at sales, etc, but has always been quiet and cleanly.  When officer sought to bring him to hospital today he stubbornly resisted and scratched officer’s face.  On admission is quiet and tractable.
Nov 9, 1902.  Talks of anarchists of they making men lazy (sic).  Says he has always done his duty.
Nov 17.  Steadily improving.
Jul 1, 1903.  Talks much of religion.  Wants to go as a missionary to a foreign country.  Conversation rambling and absurd.
Sep 22.  No change in condition.  Still talks of religion at every opportunity.
Jun 16, 1906.  Gradually failing mentally.
Nov 27.  No change since last report.
Oct 19, 1907.  Physical health poor, has a cough and occasional night sweats.
Feb 6, 1905.  Removed to TB.
May 12, 1905.  Confined to bed, rapidly emaciating.
Jun 19, 1905.  Died.  Phthisis Pulmonalis.


History and clinical notes:
History: Was committed to the work house Oct 5, 1902 for striking a man in a restaurant with a vinegar bottle.  Has not yet been tried.  About two weeks ago became very quiet and refused to eat.  Said she had a great secret.  For two days past noisy and violent, has asked that they knock her in the head or shoot her and not to torture.  This a.m. was very violent.  On admission says people have deceived her, that her husband and she are not properly married and fears they will cut her throat an dig her eyes out tonight.  Does not resist going to ward and take chloral mixt. Willingly.
Dec 30, 1902.  Sleeps poorly.  Some nights very excitable.  Condition in general the same.
Apr 15, 1903.  Patient has been very noisy and untidy most of the time.  Tears her clothing and is difficult to care for.  Mother removed her today as she is a resident of Pennsylvania.
Apr 15, 1903.  Discharged unimproved.

Additional notes:
Tried to hit someone "with a vinegar bottle."  Died at Farnhurst 11/9/1940.


History and clinical notes:
History: Patient has been very religious all her life.  Menopause occurred at 53 with much disturbance; rheumatism and neuralgias associated.  Previous to this was always strong and worked very hard.  About Sept 1st had a diarrhea, which persisted for a week.  Typhoid fever was suspected and relatives say with this and nervous trouble she was in bed for four weeks.  Patient talks incessantly and changes from one subject to another.  Thought her husband was going to shoot her.  Suspected her food was poisoned and refused both liquids and solids; and numerous other delusions.  Hallucinations of sight: saw a large star beside bed.  For three or four weeks slept neither night or day.  Walks about the house waving hands and talking.
Dec 30, 1902.  Condition the same.
Mar 11, 1903.  Patient is more tractable than at time of admission.  Although at times is quite noisy and troublesome.  Sleeps better than she did.  Was visited by husband today who removed her against advice of Supt.  On parole.
Oct 7, 1903.  Discharged unimproved.


History and clinical notes:
History: Patient a former inmate of County Alms House.  A short time ago lost his wife through death and has acted peculiar since.  Superintendent of Alms House says he is uncleanly in habits and tears his clothes and destroyed articles of furniture.
Dec 30, 1902.  Condition the same.
Jan 5, 1903.  Ischio-rectal abscess.
Jan 23, 1903.  Died at 3:20 a.m.  Senile asthenia.


History and clinical notes:
History: Menstruated first at eleven, since then irregularly at times, twice a month.  First symptoms manifested about the middle of October.  Began talking of religious matters, more so than usual, though she was always of a religious nature.  Disposition always retiring, never associated with men, but kept by herself constantly.  Last Friday, she said men were working in an adjoining house, tried to flirt with her and used abusive language; also imagines that men are following her and that people are mesmerizing her.  Appetite good, sleeps well.  Has constant frontal headache.
Mar 1, 1903.  Has been almost constantly disturbed since she came here.  Is violent, noisy, and troublesome.  Says at times “I am Jesus Christ.  Do not touch me.  I wish not to be polluted.”  This is a very loud tone of voice.  At times will not speak to anyone.  Frequently stands against the wall, with her head thrown back with a superior air as if every one was beneath her, etc.
Mar 9, 1903.  Was removed on parole by father against advice of Supt.
Oct 7, 1903.  Discharged unimproved.  Memo attached, standard memo form from hospital.  Dated March 9, 1903.  “I remove my daughter from the Delaware State Hospt. against the advice of the Supt. who has informed me that she is not a proper person to be at large.  I hereby exempt the officers of said institution from any damage or depredation that might be committed by [patient] while in my custody.  Father [name redacted].

Final disposition:
Discharged unimproved; removed against medical advice


History and clinical notes:
History: Two years ago patient was hit on head and remained unconscious for some time over three weeks before he talked, his recovery at this time was not expected.  After this would drink whiskey and say a small amount would affect him.  Would abuse and beat his wife and try to provoke quarrels with fellow citizens.  Also drove through the country at all hours of the night, slept very little for past two weeks.  No hallucinations.  Thinks has a fortune and talks of it at times; to use his own expression he has “plenty of money”.  Takes articles from the house and sells them to obtain drink.  No food for some time.  
Dec 9, 1902.  Told Supt. his wife was drunk and created a disturbance which brought him here and stated since then that he sends letters to the angels and they converse with him.  At time is quite irrational.
Dec 16, 1902.  Removed on parole against advice of Superintendent.
Apr 13, 1903.  Discharged improved.  
Memo attached.  Standard DSH memo form, dated Dec 16, 1902.  “I, [name redacted], hereby removed my husband, [name redacted], from the Del State Hospital at Farnhurst against the advice of the Supt. who has informed me that he (the patient) is insane and not a proper person to be at large and that I will be responsible for his safe care and keeping and will exonerate the said Supt. from any damage or acts that might be due by my husband while under my care. [Signature of wife].”

Additional notes:
Was apparently fine; died in 1918 at age 66.


History and clinical notes:
History: Menstrual history not able to ascertain from brother.  About six months ago, patient began to dwell upon and talk about the scriptures.  Would talk continually and at times walk about singing.  Would eat or drink nothing and would stand for hours at the window looking outside.  Would not answer questions or converse on any subject.  Some talk lately of being disappointed in love affairs.  Bestows her blessing on members of the family.
Apr 17, 1903.  Has changed but little since admission.  Very noisy and restless at times.  When spoken to answers in a childish manner.  At times is quite cross and irritable.  Physical health has not suffered.
Feb 19, 1904.  Is very silly in her talk at all times, says she is Almighty God, and is offended at any orders given in wards.  Often talks in a language of her own.  In good physical condition.
Mar 31.  Condition unchanged.  Is incoherent, sometimes insubordinate, and always silly in her actions and conversation.  Health good.
Nov 14.  Lately patient has been more tractable and amiable; wristlets removed and she has assisted in work about ward and sews.
Jun 5, 1905.  Very quiet and well behaved.  Eats and sleeps well.
Feb 20, 1906.  Having attacked attendant and nearly killing her, was placed in restraint and has been kept in untidy room for several months.
Nov 20, 1907.  Very obstinate and impudent.  Physical condition poor.
Sep 20, 1909.  No improvement.  Has to be restrained constantly.  Very impudent, physical condition fair.
May 24, 1934.  Died.


History and clinical notes:
History: One month ago began to get excitable and restless.  For past week slept very little.  Symptoms have progressed to the present time.  
Dec 30, 1902.  Patient has periods of quiet and other times very excitable.  Some nights very noisy, talking loudly.  At times has to be kept in restraints.  Rx: Chloral Mixt., Hyoscyamus.
Jan 25, 1903.  Condition the same at this date; is quite (quiet) and orderly.  
Mar 4.  Has improved and is sleeping much better than he has been for some time.  Was allowed to go home on parole.
Mar 11.  Patient returned this morning by daughter.  Since leaving the institution he has been very worried about the illness of his wife and has slept very little.  Has failed and friends were unable to suitably care for him.
Mar 25.  Paroled.
Jul 2, 1903.  Discharged improved.


History and clinical notes:
History: Patient has been drinking steadily for past two week.
Nov 28, 1902.  On parole.
Dec 27, 1902.  Discharged recovered.


History and clinical notes:
History: One year ago patient began to get nervous and excitable.  Some hesitation of speech, trembling of lips.  For past two weeks patient has slept little or none.  Appetite good.  Belongs to hose company and wanders around house at night.  Steadily decreased in weight to present time.
Dec 30, 1902.  Condition has been one of gradual decline.  Patient has lost flesh and strength.  Sleeps poorly at night.  Appetite poor; at present diet consists mostly of milk and Wyeth’s beef juice.  While restraint was necessary at first at present patient is helpless.
Dec 30, 1902.  Paroled.  Removed by friends who prefer to take care of him (at) home as long as he is so feeble.
Apr 13, 1903.  Discharged unimproved.


History and clinical notes:
History:  Last March was insane for about one month; was quite excited and irrational.  Recovered and has been well until about middle of October.  Characterized by delusions peculiar to cases of melancholia.  Says she has committed a great many crimes and that she is going to be punished for them.  That she is going to hell.  Has constantly talked of suicide; about one month ago attempted suicide by hanging.  Walks the floor constantly – is getting worse constantly.  Eats well but at times does not sleep well.  Is suffering from prolapsed uterus, which husband thinks is the cause as no other reason is known except heredity.
Apr 17, 1903. At times is quite bright.  While again she is very much depressed; worries a great deal about her children; says she is afraid something is going to happen to her.  Very nervous and walks restlessly up and down the hall.
Jun 24.  Has improved since last note.  Husband visited her today and requested her parole.
Jun 24, 1903.  Paroled.
Oct 7, 1903.  Discharged recovered.

Additional notes:
Lived a long life.  Died in 1939 at the age of 72.  She had 3 children at time of admission to DSH, two sons and a daughter.  The younger son died in 1903 at age 5 of diphtheria.  The other lived until 1968.


History and clinical notes:
History: Patient discharged from this hospital Nov 17, 1901.  Improved for a time.  After a time used alcohol; was taken to Blockley, were (where) condition was said to be dementia paralytica.  At this time had nephritis.  Subsequently was brought home, gained strength for a time, mental condition the same.  At present is very excitable and nervous.  Slept very little.  Appetite fairly well.
Apr 17, 1903.  Has gained flesh and strength since admission.  Has hallucinations of hearing; says she hears men talking about her.  That they abuse her and talk vulgar talk about her at all times.
Jun 27.  Has improved very much physically; still has delusions, but does not express them as freely as formerly.  No change at this date.
Sep 22.  Is occasionally noisy at night.  Cries a great deal.
Feb 19, 1904.  Improving.
Nov 14.  Patient transferred some time since to Ward III.  Is sullen, and threatens violence.  Sometimes sews and reads.  Physical in good health.
Jun 5, 1905.  Very surly and threatens violence.  Eats and sleeps well.
Feb 20, 1906.  Fairly good physical condition.  Mentally unchanged.
Nov 7, 1914.  Was visited by her nephew today who desired to try her at home.  He was informed that her mental state was about the same and that he might have trouble with her.  She was allowed to go.  Paroled.
Nov 18, 1914.  Niece returned her today, said that they could not care for her.
Dec 16, 1931.  Died.

Additional notes:
Family tried her at home once for a few days in 1914, but returned her to hospital soon.


History and clinical notes:
History: For some time patient’s memory has been very poor.  Has delusions of persecution, imagines he is followed by persons who intend to do him injury.  Walks around the house at night, sleeps very little.  Friends have noticed a gradual change in his disposition.  Masturbation suspected by friends.
Jan 25, 1903.  No change in condition.  Masturbates.  Restraints applied at night.  Eats and sleeps well.
Apr 14.  Sits quietly nearly all day long in a state of Mutism.  Occasionally soils himself.  Has to be encouraged to eat his meals.
Jul 22.  No change.  At times shows tendency toward catalepsy.
Jan 21, 1904.  Gradually failing in health, eats and sleeps poorly, is untidy.
Jan 24.  Has developed a right-sided pleurisy with effusion; on left side [ill.] found a few rales, but no marked dullness.
Feb 19.  Effusion greatly diminished, dullness more marked, emaciating rapidly.
Mar 17, 1904.  Failed rapidly since last report.  Died at 9:45 p.m. today.  Tubercular pleurisy.


History and clinical notes:
History: Patient states he had epilepsy first at age of sixteen.  Attacks disappeared until about twelve years ago.  Is quiet and reserved.  Talks rational, but slow and meditative.  States his wife lives in Philadelphia because he is too poor to support her.  Says “Bless the God and Lord.”
Jan 25, 1903.  Conduct good.  Is employed about the wards.  Answers questions intelligently and respectfully.  No epileptic attacks for some time.
Jul 28.  Several days ago had a series of epileptic attacks.  Showed no viciousness.  Is not better and rational.
Sep 21.  For the past 4 days has been delusional and hallucinatory.  Says attendants and patients call him names.  Will not talk freely about his trouble, repeating that you surely know all about it.  Much confused.  Avoids the society of others.
Feb 19, 1904.  No epileptic attacks for some time; is quiet and respectful; works about wards and is quite rational.
Mar 6, 1907.  Condition remains unchanged.  Has occasional epileptic seizures and during these attacks he is violent.
Dec 19.  Fell during a “fit”, producing a lacerated wound on left temporal region.
Sep 11, 1921.  Died in hospital.


Brought by:
Superintendent of the Kent County Almshouse

History and clinical notes:
History: An inmate of Kent County Alms House for past twenty years.  All this time has been excitable and talkative and has made threats to female patients there.  Has been unruly and insolent.  Sleeps poorly; prays, sings, and pounds the floor.  Appetite fairly well.  
Jan 25, 1903.  Condition the same.
Mar 8.  Conduct very good.  Answers questions intelligently and at present seems very clear mentally.
Sep 21, 1903.  No change.  Good worker on ward.
Apr 2, 1912.  Has been physically well until today.  Went to bed and refused to eat; bowels constipated, skin dry and hot.  
Apr 10.  Continues to grow worse and refuses nourishment and is only voiding a small amount of urine.
Apr 21, 1912.  Died.  Uraemia.

Additional notes:
Buried at DSH, Grave #209.  Had been living at Kent Co. Alms House for 20 years before coming to DSH.  No correspondent. There was a second person of the same name admitted in 1926, died at DSH in 1939.


History and clinical notes:
History: Patient was first admitted Jan 17, 1900.  Was removed against advice of Supt June 9, 1900.  Dr. Hammond, who brings patient to Hospt. states that her husband has divorced her since she left.  That she has no property and that she claims that the farm her husband was living on belonged to her.  Every one was afraid of her and no one could control her.
Apr 17, 1903.  Since admission, patient is quite depressed.  Sits with her head bowed down and very seldom answers when spoken to.  Occasionally will assist in sewing on the wards.  Is in fair general health and sleeps good at night.
Jun 27.  No mental changes worthy of note.
Sep 21.  Very stupid and depressed.  Works a little on ward.
Jun 5, 1905.  Amenable, quiet.
Feb 20, 1906.  Just the same.
Nov 20, 1907.  No change.  Very industrious and amiable.
Sep 20, 1909.  No change in any way.
Jan 1, 1911.  Patient has been failing for some time; gradually losing flesh and strength.
Feb 12.  Has been in bed almost continuously since last note.  Expectorates a great deal, both lunch with cavities.  General condition poor.  Has been reduced to almost skin and bone.
Feb 25, 1911.  Rapidly growing worse and refuses nourishment.
Mar 2, 1911.  Died, phthisis pulm.
Same patient as 40361139.


Form:
imbecility (scratched out, replaced by const. psychopathic inferiority)

History and clinical notes:
History: Patient has always been weak-minded and has been harmless until about 2 weeks ago when he began to threaten his neighbors.  Said he would kill them.  They have always been in the habit of teasing him and he gets very angry on this account at times.  General health is good.
Jan 25, 1903.  Condition the same.
Mar 25.  Patient conduct good.  Quite contented.  Eats and sleep well.
Aug 16.  Works about the farm and ward.  Scarcely ever speaks except in monosyllables.  General health good.
Mar 28, 1933.  Died in DSH.


History and clinical notes:
History: Patient has shown conditions of dementia for some time past.  From last month has been troublesome and noisy, tried to set fire to the house.  Slept very poorly at night.
Jan 25, 1903.  Patient has been confined to bed for some days past, very feeble.  Had a severe attack of chronic bronchitis.  Milk diet.  Bowels constipated.
Mar 8.  Patient has been gradually failing since admission.  Today is very much worse.  Apparently had a chill – rise of temp to 103 and resp rate of 50.  Lungs seem clear except for evidences of an old bronchitis.  Very weak tonight.  Had had incontinence of urine and feces for weeks.
Mar 17, 1903.  Patient has gradually failed since last note and died this p.m. at 5:50 o’clock.


History and clinical notes:
History: For past year patient has acted peculiar as noticed by his friends.  Meet people in Georgetown, and said “You belong to me” and made other demonstrations and annoyed people by pointing a plumb bob at their chest and saying “I’ve got you.”  People became afraid of him and requested him sent to Hospital.
Jan 25, 1903.  Patient is quiet and orderly.
Mar 8.  Patient’s conduct very good.  General health good.  Has some difficulty of vision, having double ptosis.  Usually holds up one eyelid with his hand in order to see.
Jul 27.  General health good.  Mentally about the same.
Sep 22.  No change in condition.
Jul 16, 1924.  Died.


History and clinical notes:
History: No history could be obtained from officers other than being well known in Wilmington.  Has not lived with her husband for some time.  Is very religious.  Has acted peculiar for some five or six weeks.  On admittance patient seemed very excitable, talks of religious matters and gesticulates with the arms.
Jan 22, 1903.  Paroled.
Apr 13, 1903.  Patient has steadily improved since admission, was discharged recovered.

Additional notes:
Readmitted 7/16/1904, at DSH until her death 9/10/1941, buried at DSH, Grave #524.


On certificate of:
Drs. J.H. Hardcastle and Dorsey W. Lewis

History and clinical notes:
History: Ten or twelve years ago patient fell and struck on back of head; bothered him for some time, eventually disappeared.  First symptoms of insanity was manifested about 5 months ago a short time after having all his teeth extracted.  Has delusions of persecution, imagines that people are after him with a razor; and consequently relatives could not keep him at home as he would go away and hide himself.  On entrance, patient was in a semi-unconscious condition.  Spoke only a few words and these were muttered.  Spoke to clergyman and his wife.  Coughed some and did not have strength to raise expectorations.  Bowels constipated.  
Jan 12, 1903.  Patient’s condition the same; condition at this date is one of stupor.  Does not recognize his wife, takes food slowly, swallowing with difficulty.  Bowels have been inactive, requiring enemas.  Temperature has been from 101 -103 3/5.  Pulse rapid and diacrotic for past week.  Respirations rapid and superficial.  Percussion over thorax showed a marked dullness of left lung; also over right to a lesser degree.  Auscultation found sonorous rales.  All sounds were increased to a marked degree over left side.
Jan 17, 1903.  Temperature 103 3/5.  Pulse 120.  Respirations 34.  Patient has had a rapid decline.  Impossible to give nourishment.  A condition of chorea for past four days.  Died at 9 p.m.

Additional notes:
Note: did he get some sort of nasty lung infection from having his teeth pulled?


History and clinical notes:
History: Has been on a steady spree since Jan 1st, 1903.  On admission pulse quite weak and in a very enfeebled condition.
Jan 13, 1903.  Patient made a steady recovery and was paroled today.
Jul 2, 1903.  Discharged recovered.


History and clinical notes:
History: Drinking steadily for some time.  Last night was locked in the Wilmington Jail where he was noisy and slept very little.  Say he has eat very little for past week.  Examination shows bruises and echymoses on right side.  Deep inspiration gives pain and pressure over the bruised area also.  Patient does not know the manner why which he received the injury.  Rx: Iodine and adhesive strapping.  Slight nephritis shows fractured ribs.
Jan 25, 1903.  Sleeps better.  General condition good.  Coughs some.  
Mar 2.  Patient’s condition has cleared up.
Mar 7.  Paroled.
Apr 13, 1903.  Discharged; not insane.


History and clinical notes:
History: Has drank whiskey for some time.  Last night was taken by officers to Wilmington Jail, where he was noisy and disturbing.  Has eat very little for some time past.
Jan 19, 1903.  Patient steadily improved, and was paroled today.
Apr 13, 1903.  Discharged; not insane.


History and clinical notes:
Patient has been in the liquor business and had reverses; since, has gradually failed in mental capacity.  At present will sit for hours and think, scarcely talking.  Habits are good, patient being cleanly and tasty (??) but slow in movements and unable to dress himself properly.  If he goes from the house he is unable to find his way back.  Sleeps well; appetite good.  General appearance good for age.  Tongue slightly coated.  Bowels regular.  Urination normal.  No headaches.  
Jan 25, 1903.  Condition the same.  Eats and sleeps well.  General condition good.
Feb 25.  Patient very comfortable and happy.  Sits around quietly most of the time.  Expresses himself with some difficulty – his ideas coming very slowly.
Mar 6.  Patient has been troubled with bleeding hemorrhoids and has been kept in bed for past 4 days on restricted diet.  Better today and again up and about the ward.
Mar 14, 1903.  Paroled.
Jul 2, 1903.  Discharged; unimproved mentally.


History and clinical notes:
History: Patient was unable to walk into hospital, had to be carried.  No special symptoms other than being demented.  Sits constantly in the one place.  Sleeps poorly and makes noise, disturbing others.  Hearing is good.  Appetite poor of late.  On entrance examination two black eyes due to a fall.  Examination revealed a large right inguinal hernia about the size of a cocoanut.  Posteriorly was the testicle and a hydrocele.
Jan 21, 1903.  Patient died.


History and clinical notes:
History: Person who brought patient left her at depot, hence no history could be obtained.  Patient states she comes from Alms House, Sussex County, where she been (sic) for some time past.  
Apr 17, 1903.  Patient is weak minded and has been caught by attendant several times putting faeces in her mouth.  Is a fair worker in ward.
Jun 27.  No change.  Is untidy in her dress and habits.
Sep 20.  Works some about ward.  Weak mentally.  Slovenly.  
Feb 19, 1904.  Transferred to Ward III.  Very bad habits.
Sep 22.  Condition remains the same.  Patient works on ward and has grown somewhat thinner.  Very cheerful.
Nov 14.  No change.  
Feb 20, 1906.  In T.B.  No change.
Nov 20, 1907.  Emaciated.  No mental change.  Appetite good.
Jul 7, 1907.  Patient transferred to cottage.  No cough at present time.
Sep 21, 1929.  Died.

Final disposition:
Died in hospital.  Buried at DSH, Grave #384.


History and clinical notes:
History: Last Saturday afternoon patient was found on doorstep by officers, in a helpless condition.  Patient could neither talk or walk.  It is said he prays very much of the time.  This is all the history that could be obtained from officers.
Jan 25, 1903.  Some improvement.  Eats and sleeps well.  Bowels have been constipated.  Still weak and confined to bed.  Much emaciated.
Feb 1.  Has been in bed much of the time since he came here.  At times will talk and answer questions, while again he refuses to speak.  Has been steadily losing flesh.  Physical examination does not reveal any special organic trouble.
Feb 16.  Still in bed; takes nourishment at times but is slowly losing flesh and strength.
Feb 22.  Patient became suddenly worse yesterday afternoon, his temperature rising to 104°.  He complained of nothing.  Examination: Male of about 40 years.  Markedly emaciated, rather poorly developed.  Tongue dry, slightly coated.  Breath offensive.  Eyes: pupils equal and react.  Pulse rapid: poor volume, regular.  Lungs: chest poorly developed, limited expansion.  Seems to be an impairment of resonance.  No rales.  Vesicular murmur distant.  Heart not increased in size to percussion.  Sounds very distant; no murmurs noted.  Abdomen slightly distended.  No tenderness.  No oedema of extremities.  No paralysis.  Patient lies very quietly.  Refuses to talk or answer questions intelligently.  Urine decreased in amount.  Bowels very constipated.  Takes small quantities of nourishment.  
Feb 24.  Patient failing rapidly.  Pulse and respiration increasing.  Bowels moved freely.  There seems to be almost complete intestinal paresis.  Abdomen very much distended.  Not tender.  Urine examination shows albumin and hyaline and granular casts.
Feb 25, 1903.  Patient died at 7:20 a.m.  Chronic nephritis.


History and clinical notes:
History: Nov 1st, 1902 had typhoid fever, treated at Hospital Wilmington.  Never was strong afterward.  Became stupid and melancholic; mind could not be kept on any one topic but would dervert (divert) to others.  Speech is incoherent.  Imagines he has been dead and has come to life again.  In past few days has carried the Testament and says “Christ died for me” and such.  Appetite fair until past week, has taken only a small amount of milk the past few days.  Bowels regular, urination normal.  Sleep very well until last four days.  He will lie with his eyes open.  Calls his Father continually.  Has delusions of unseen agents (??) of persecution.  No hallucinations.  Eyesight normal.  Hearing normal, also of taste and smell.  Last spring was struck in the head with a club.  No superficial injury but he was rendered unconscious for a few minutes.
Jan 25, 1903.  Noisy and disturbing at irregular intervals.  Eats and sleeps fairly well.
Feb 26.  Patient is very restless and unhappy.  Is very much confused.  Wants to go home.  Wants to be killed.  Sleeps well.  
Mar 8.  Has been kept in bed for past week.  Much quieter.  Very stupid mentally.
Jul 1.  Very troublesome and mischievous.  On several occasions has assaulted fellow patients and restraint has been necessary at times.  Quite profane at times.
Aug 16.  Condition very much improved at present.  Talks rationally.  Works some about the ward.
Aug 24, 1903.  Clear mentally.  Paroled today to father.
Jan 21, 1904.  Discharged recovered.

Additional notes:
Readmitted 6/15/1910, died at DSH 2/18/1934 of pulmonary abscess and pericarditis with effusion.


History and clinical notes:
History: Patient has been weak-minded for about 6 years.  For past two weeks his friends have been unable to care for him on account of being noisy and troublesome at time.  General health has been steadily failing and he has lost flesh and strength.  Imagines that people are going to kill him, etc.  Has two large bed sores over left gluteal region – each about 2” in diameter.
Feb 10.  Patient has been steadily failing, is quite weak this a.m.  Has been on extra diet and tonics since admission. 
Feb 11.  Strychnine and whiskey were administered all day yesterday but without rallying patient.  Failed rapidly during the night and died at 4:55 a.m.
Feb 12, 1903.  Died from exhaustion from dementia.


On certificate of:
Drs. John B. Wales and Evan G. Shortlidge

History and clinical notes:
History: Officers state that he has been in the Hall for three days and at times is quite violent and difficult to control, attacks of this kind last but a short time.  Certificate states that he tried to kill a woman with an axe.
Feb 26, 1903.  Patient is a fairly developed and well nourished coloured man of about 50 years.  Gives no reason for coming here except that he “works here.”  Says that he gets $30.00 or $40.00 per week.  Assents to almost any question asked.  Cannot answer questions satisfactorily.  Speech slurring.  Tremor of muscle of tongue and lips.  Examination: Well muscled.  Eyes: good vision.  Pupils seem to react normally.  Tongue clean.  Pulse regular and full.  Some atheroma.  Chest good expansion and well formed.  Lungs seem normal.  Heart: No murmur, normal size.  Good muscle.  Abdomen negative, no oedema of extremities.  Small tumor about the size of a hickory nut beneath skin at margin of ribs in anterior axillary line, right side.  Knee jerks normal.  Station good.  Is happy and contented.
Aug 16, 1903.  Has failed markedly – almost a total dement.
Sep 20.  Sits all day in one place.  Takes little notice of surroundings.  Never speaks.  Untidy.
Jan 9, 1904.  Failing rapidly, refuses to eat solid food.  He developed a severe dermatitis on tuber-ischial regions due to involuntary urination and was put to bed so dermatitis could be treated.  Temperature suddenly rose to 106° Fahr. today.  He “grinds” his teeth for hours at a time.
Jan 18, 1904.  Died at 12 noon today.  General paresis.

Final disposition:
Died of general paresis.  Buried at DSH #120.


On certificate of:
Drs. J.H. Hardcastle and G. Burton Pearson

History and clinical notes:
History: Left here against the advice of the Superintendent January 29, 1901; was taken home by her sister.  Shortly after arriving home, she jumped from a window and broke her leg.  Since then, she again attempted suicide by jumping from a window.  Before her first admission (See Case Book #4, Page 132), she attempted suicide by taking laudanum.  When a child she was struck on the head by a brick.  She has been a masturbator for years.  Has not at all been well since she left here but since December last has been growing rapidly worse.  Has been taking drugs to make her sleep for the past 4 months and cannot sleep without the aid of them.  History does not state what drug or drugs she has been using.  Patient on admission was found to have a severe bruise under left eye.  She has stated to her attending physician at Middletown that she feels aura starting in her genitals, rectum, and bladder, passing upward to her brain and then she feels an irresistible desire to commit suicide.  Patient has lost flesh since she was here before and is very much emaciated.
Feb 11, 1903.  Patient has not sleep without aid of medication.  Says that she has peculiar feelings in her genitals and then she feels like committing suicide.  Confesses to having masturbated for years.  Examined per vagina today.  Found a shawl pin 2” long, point embedded in anterior portion of vagina.  We removed with some difficulty.  Patient states that it has been there for some time, but will give no dates.
Apr 17.  Still no change.  Delusions are becoming more systematized.  Says she has no stomach or bowels and that she is dying on account of poisonous gases that surround her.
Jun 27.  Is stronger and is up and about – delusions are of the same character and she is influenced by them to the same extent.
Mar 16, 1904.  Patient’s mental state unimproved.  Says she is no human being, but made of cement.  Physical state good.
Sep 22.  Physical condition good, mental unchanged.
Nov 14.  No change.
Jun 5, 1905.  No change.
Feb 20, 1906.  About the same.
Mar 20, 1907.  In good physical condition.
Mar 1, 1931 (could be 1937).  Died.


History and clinical notes:
History: Owing to being quarantined could no obtain a history of case.
Apr 17, 1903.  Ataxic symptoms are very marked.  Has hesitancy of speech, walks unsteadily.  Is in constant motion and when talked to becomes quite choreic in her movements.  Is becoming untidy in her appearance and actions.  Reflexes are increased.
Jun 27.  No mental improvement.  General paralysis more marked, especially so of speech and locomotion.
Sep 20.  Failing mentally and physically.
Feb 19, 1904.  Delusions.  Thinks her hair is cut by “dark boys” at night.  Sits in one place all day and talks to the ceiling.
Sep 22.  Very indecent in her habits.  Kept in corner room all the time.  Eats and sleeps well.
Nov 14.  Condition unchanged.
Apr 15, 1905.  Patient growing weak, unable to sit up.  Eats little.
May 10.  Patient becoming exhausted.  Eats nothing and is unconscious – much emaciated.
May 12, 1904.  Died at 1:45 p.m.  of General Paresis

Final disposition:
Died of general paresis (complications of syphilis).


History and clinical notes:
History: Certificate states that disease is increasing – could not obtain history on account of being in quarantine.  Has been “simple” for some time.  Had been annoying women; wants to be married again.  Says his children have not treated him well.
Feb 25, 1903.  Patient is a rather poorly developed and poorly nourished white man of 80 years.  General health seems good.  Gives no reason for his being here except that he was “sent” here.  Since admission he has been up and about the wards until yesterday, when we went to bed complaining of “weakness in his stomach and back.”  There is no marked constitutional disturbance.  Has some cough with scanty purulent expectoration.  Examination: Senile changes marked.  The skin hangs in folds all over body.  Arteries markedly atheromatous.  Pulse regular and full.  Tongue slightly furred and dry on dorsum.  Eyes not defective for age.  Pupils react normally.  Lungs: No improvement of resonance murmur, bronchio-vesicular in type.  No rales.  Heart fairly good muscle.  Second artic accentuated.  A soft mitral systolic murmur is noted.  Abdomen: negative.  No oedema of extremities.  Urine – no albumin or sugar.  Few hyaline and granular casts.  Patient seems very comfortable and happy.  Answers question intelligently.  Knee jerks normal.  Babinski not present.  Says he has had difficulty in voiding urine for some time.  Examination of sputum for Tubercle Bacilli is negative.
Feb 26, 1903.  Patient better today and is again up and about the wards.  
Feb 28.  Vaccinated – good take.
Aug 16.  Is contented and happy.  General health good for age.  Late examination of urine shows albumin and casts in numbers. 
Sep 22.  Contented.  Good health.
Dec 16, 1906.  Suffering from Idiopathic Erysipelas of head and face.
Feb 14, 1907.  Died.  Senile dementia and asthenia.


History and clinical notes:
History: Has been drinking for the past 6 months continuously.  Lately has been drinking very hard.  Has always been a used of alcohol in some form.  The patient is now quite tremulous.  Answers questions falteringly but intelligently.  Has a very much discolored leg from a fall, the patient states.  Does not sleep well.
Mar 8, 1903.  Patient much improved.  Out of bed and around the ward.  Eats and sleeps well.  Urine examination negative.
Mar 14, 1903.  Discharged recovered.


History and clinical notes:
History: Patient was paroled from this institution Sept 16th, 1902 and discharged Dec 27th, 1902.  Has been perfectly quiet since discharged until about 2 weeks ago when he became very restless.  Has been violent at times and threatened to kill his family.  On admission patient is quite excited, garrulous.  Does not know why he was brought here.  
Mar 20, 1903.  Vaccinated.  No take. 
May 23.  Is quiet and works about the ward and farm.
Aug 16.  Is quite rational and is trust to work, unattended, about the farm.
Sep 22.  Still works about the farm.  Is clear mentally.  Cheerful.
May 8, 1904.  Eloped.
Sep 12, 1904.  Discharged recovered.


History and clinical notes:
History: Officer who brought patient knew nothing of patient’s history.  Patient says her mother is insane and that she came out here to enter complaint against her.  Says her mother calls her names and insults her.  Patient says she hears voice and has vision.  Says she is a “medium” and can tell fortunes.  Says she has 3 or 4 children within her.  Says she talks to them and they answer.  Says she menstruates regularly.
Mar 20, 1903.  Vaccinated.  No take.
Apr 17.  No mental improvement.  Still says she has 3 or 4 children inside of her.  At times has been quite disturbed, requiring restraint for a day or so.
Jun 27.  No improvement mentally.  Still has delusions and at times is noisy and troublesome.
Sep 22.  Good physical condition.  No change mentally.  Slovenly in dress and manner.
Dec 21.  Struck attendant (Miss Betton) on head with a mop handle, inflicting a lacerated wound, which required two stitches.
Mar 31, 1904.  Patient quiet and rational.  Health good.
Sep 22.  Condition unchanged.
Nov 14.  No change in any way.
Jun 5, 1905.  Quiet and usually well behaved.  Eats and sleeps well.
Dec 15.  Removed by mother against advice of superintendent.
Dec 15, 1905.  Discharged unimproved.

Additional notes:
Was a patient at DSH during 1910, 1920, and 1940 censuses.  Could not find any death record.


History and clinical notes:
History: When patient was two years of age had convulsions “caused by dyspepsia”.  From this time had repeated attacks of epilepsy until he was 10 years of age.  Supposed cause each time was overloading stomach.  Intervals between attacks not known.  No history of specific trouble.  At ten years of age had an attack of status epilepticus lasting 12 or 14 hours.  Recovered from that and has never had a convulsion since that time.  His mind improved up to the age of ten – that is he was able to grasp the ideas that a child of that age naturally would.  After this time there has been no development of mental faculties and lately he has grown more weak mentally.  Is very cross at times.  Has said that he wanted to die and has threatened to kill himself.  Is very cross and irritable if interfered with.  Has a voracious appetite.  Sleeps very good.
Mar 30, 1903.  Is quite talkative.  Simple minded – talking like a child.  Seems to have no gastrointestinal trouble.  Physical examination negative.
Apr 14.  Vaccinated today.
Jul 28.  Has been stubborn and very simple for the past week and sent from Ward 2 to Ward 6.
Sep 20.  Is quieter again.  General condition the same as on admission.
Jan 12, 1905.  Untidy, but general health remains about same as when last reported.
Feb 10.  About as usual, ate breakfast and about one hour afterwards he died.  Case reported to Coroner, who ordered us to issue a certificate.
Feb 10, 1905.  Died.  Valvular Disease of Heart.


On certificate of:
Drs. John Palmer Jr. and James L. France

History and clinical notes:
History: Peculiarities began about 3 years ago, at which time she began to talk incoherently.  Condition has grown gradually worse.  Has threatened to kill her daughter and has repeatedly struck her daughter and granddaughters.  Wanders away from home.  Continually wants to be taken home, even while in her own home.
Mar 30, 1903.  Conduct good.  Is quite talkative.  Says she is about 16 years of age.  General health good.  Works about the ward.
Apr 12.  Patient has been very noisy and abusive at times.  Has been sent to Ward 3.  Vaccinated today.  Good take.
May 20.  For the last several weeks patient has been very quiet and orderly.  Has been returned to Ward B.
Jun 27.  At times noisy and troublesome, especially when attendants dress and undress her and desire to give her a bath.
Jul 15.  But little change since last note.  Had a fainting spell this a.m.  Heart very irregular and small.  Face cyanotic. 
Jul 16.  Has failed rapidly since last note and died.
Jun 16, 1903.  Died 10 a.m.  Valvular Disease of Heart.


History and clinical notes:
History: Patient admitted from Alms House where he has been making disturbance at night.  Says people talk about him and call him names.  Says there is so much noise at night that he is unable to sleep.  Has tried to jump out of the windows and did break a window in such an attempt.
Mar 13, 1903.  Speaks of hearing voices at night.  Is quiet now and acts simply as a very sick old man.  Physical examination shows widely dilated nostrils.  No motion of alae.  Eyes: negative.  Pulse very irregular, making often 5 or 6 beats in one second and then going on at a 90-100 pace for a few seconds.  Lungs resonant except at R base, posteriorly.  [Ill.] moist rales at back base posteriorly on inspiration.  Numerous large dry rales all over lungs.  Heart: apex beat in 5th space, 1 ½” without nipple line, rather diffuse.  No murmurs.  Abdomen: contains no fluid, double fist sized, reducible.  R oblique inguinal hernia.  Limbs: marked oedema of legs up to body.  Rx: Tr Digitalis M XV Strychnine gr 1/30 qd.  Milk qs, whiskey prn.  
Mar 14.  Urine shows a few hyaline casts and one small epithelial.  No albumin.  Patient unimproved.
Mar 16.  Rapidly failing.  Some fluid in pleural sacs.
Mar 17.  Died at 12:45 a.m.  Post mortem showed dilated heart, muscles fatty and friable.  Chronic mixed nephritis.  Numerous firm old peritonous adhesions.  Slight chronic cystitis.  Marked pulmonary emphysema and a few small areas of consolidation.  Each pleural sac contained about 750 cc of clear amber-colored fluid.  Buried in Grave 113, Hospital Cemetery.


On certificate of:
Drs. Irvine M. Flinn and Harrison W. Howell

History and clinical notes:
History: Brought by officers who know nothing of patient’s history.  Patient has a very superior air and is quite indifferent.  Answers questions in monosyllables.  Says he does not know why he was brought here.  Says he has only turn out of the marine service one month.  Is wearing a very dressy military uniform of which he seems quite proud.  After last discharge he behaved quiet well, although he would do no work at home.  Soon after discharge he entered the Marine Service and served under Capt. Clark on the battle ship “Oregon.”  While in the service, his conduct was good.  His father secured his discharge through influence and he again began to associate with fast women.  His family has lately had no control over him and he was brought here again for safe keeping.
Apr 2, 1903.  While at the ball field today, patient made an attempt to escape.  He was taken to the ward and wristlets put on.  He then attempt to cut the strap and then muffs were ordered.  Has good vaccination scar.
Aug 18.  General condition the same.
Sep 2, 1903.  Condition the same.  Was removed today on parole by his father, who says he will give him another chance.
Jan 21, 1904.  Discharged, unimproved.

Additional notes:
Lived with his parents and siblings for many years, eventually married, no kids.  Moved to Florida, where he was living during 1940 census.


History and clinical notes:
History: Began acting strangely about 3 yrs ago.  Would stay in the house all the time, refusing to go any where.  Was quarrelsome at home and irritable with his own folks, but not so with strangers.  Has threatened to kill members of his family.  Has though that his folks have tried to poison him and has refused to take medicine for that reason.  Eats and sleeps well.
Apr 1, 1903.  Patient is poorly developed and nourished.  Quite anemic.  Lungs: no lesion noted, expansion of chest poor.  Heart: no murmurs, action accelerated.  Abdomen – nothing of note. Slight vencasities (??) of right leg.  Knee jerks almost absent.  Is a good patient, answers questions intelligently.  Was out to ball field today and took part in the game.
Apr 14.  Vaccinated today.  No take.
Apr 25.  Patient has been failing for several weeks and an examination of his chest showed evidences of pulmonary tuberculosis in region of the left axilla.
May 12.  Patient has been losing weight rapidly.  Refused the special diet ordered for him.  This morning was noticed with a fever of 103° and immediately sent to bed.  Examination of his chest showed crackling rales over entire areas of both lungs.  No distinct areas of consolidation were noted.
May 13.  Patient worse today.  Temp 102 ½.  Pulse 140-150.  Resp 40-55.  Refused to take nourishment or medicine.  Still no distinct consolidated areas noted in lungs.  Grew rapidly worse and died at 8:10 p.m.  Body removed at 11 p.m. by friends.
May 13, 1903.  Died at 8:10 p.m. from tubercular pneumonia.


History and clinical notes:
History: Officer who brought the patient states that he has always been weak minded.  For the last 15 months has had violent attacks during which he is very quarrelsome – threatening to kill members of his family.  This morning during a violent attack he assaulted his sister with a stick of wood, slightly injuring her.
Apr 12, 1903.  Conduct good.  Very respectful.  Physical condition good.
Apr 14.  Vaccinated today.
May 21.  Conduct good.  Good physical condition.  Helps about the ward and works on the farm.
Aug 16, 1903.  Suspicious of being poisoned.  Somewhat depressed.  Lazy – shirking work.  Physical condition good.
May 5, 1926.  Died.


History and clinical notes:
History: Was brought here by Mr. Blackburn, March 28th as she was so noisy and disturbed that he was afraid she would get out of the window or would otherwise injure herself.  Since she has been here, has been quiet and orderly.  Papers (commit [ill.]) arrived this a.m.  
Apr 17, 1903.  Vaccinated today.  Good take.  Has been very quiet and orderly since she came here.  Is feeble-minded and is constantly asking to go home.  Imagines that her husband is alive and waiting for her.
Jun 27.  No change in any respect.
Sep 20.  No change.  Is noisy occasionally.
Feb 19, 1904.  Eats and sleeps well.  Continually asks to go home and talks a good deal.  No change mentally.
Sep 22.  Very noisy at night.  Many delusions and begs to go home.  Good appetite.
Nov 14.  Health keeps good.  Is sometimes noisy.  Appetite good, sleeps better than awhile ago.  
Jun 5, 1905.  Seems to grow weaker every day, but will not stay in bed.  Appetite not very good.
Feb 20, 1906.  Fairly good physical condition.  Eats well.
Oct 15.  Patient was beaten and severely bruised during night by [name redacted], another patient.  Several cuts on head, bruises on back, chest, and arms.  Lost considerable blood.  Is now getting on fairly well, pulse pretty good, eats well.  But suffers much discomfort from wounds.  Patient [attacker] acknowledged to doctor and nurses that she has beat on [this patient] with the chamber.  Mrs. [name redacted], another patient sleeping in same room, said she saw the affair and that [attacker] had attacked the other woman with chamber.
Nov 20, 1907.  Very quiet except at night.  Eats and sleeps well.
Sept 20, 1909.  Quiet during the day, talks a great deal at night.  [Ill.] health, appetite good.
Feb 20, 1911.  Condition has changed but little.  For past few days is somewhat weaker.
Apr 1.  Has been in bed since last note.  Has steadily failed.  Heart’s action extremely irregular.  Bowels very loose and offensive.
Apr 23, 1911.  Has steadily failed since last note.  Bowel loose, which no medication could control.  This morning at 7 a.m. passed away without suffering.  Valvular disease of heart and enteritis.

Final disposition:
Died of valvular disease of the heart.  Buried at DSH Grave #200.


History and clinical notes:
History: Brought by son who states that he [patient] has been drinking heavily (whiskey) for the last 3 weeks.  Patient is nervous.  Son says his father eats little and sleeps well.
Apr 11, 1903.  Patient’s symptoms have entirely disappeared and is able to go home.  Paroled.
Apr 13, 1903.  Discharged recovered.


On certificate of:
Drs. Wilbur D. Burton and James S. Crassmon

History and clinical notes:
History: For the last 10 years has had occasional attacks in which she imagines she is going to die and talks continually.  Between attacks she is fairly rational and can do some light work.  She is now in attack – crying and talking continually.  Thinks she is going to be killed.  Sleep poorly and eats little.  Is untidy.
Apr 17, 1903.  Vaccinated today.  Complains constantly of pain in various part of body, says she is going to die unless she gets relief.  Is up and about the ward.  Sleeps well and has an excellent appetite.
Jun 27.  No improvement, complains constantly of everything and everybody.  At times is noisy at night, crying and moaning.
Aug 16.  Condition unchanged.  Attempted to hang herself in the ward several weeks ago.
Sep 20.  Good health.  Increasing in weight.  Hypochondriacal.
Mar 31, 1904.  Complains all the time of aches and pains.  Says she has scabs in her stomach, spits them out occasionally.  Is growing thinner, but eats and sleeps well.
Sep 22.  Still hypochondriacal.  Eats and sleeps well, but is much emaciated.
Nov 14.  Patient transferred to Tuberculosis Hospital a short time ago.  Is very emaciated.  Eats well.  Grumbles all the time.
Jun 5, 1905.  Confined to bed.  Screams incessantly unless under morphine.  Complains of pains in her feet, limbs, head, hair, teeth, anywhere and everywhere.  Does not change much physically from day to day, although much emaciated.
Feb 9, 1906.  Change for the worse.  Difficulty breathing and great pain.
Feb 10, 1906.  Died at 8:15 a.m. Phthisis.


History and clinical notes:
History: Patient is an imbecile.  Congenitally blind.  Is abusive.  Fits of anger.
Apr 17, 1903.  Vaccinated today.  Good take.
Sep 20.  Condition the same.  Masturbates if not watched.
Feb 19, 1904.  Very vicious and foul talking.  Transferred to Ward III for daytime and is to sleep on floor of washroom of A at night.  
Sep 22.  Patient is on Ward III.  Has bad habits.  Physical condition good.
Jun 5, 1905.  Quiet and well behaved.  Eats and sleeps well.
Feb 20, 1906.  No change in any way.

Final disposition:
Still in hospital.  Died at DSH 7/5/1963.

Additional notes:
Buried at DSH, Grave #703.  At DSH during the U.S. Census in 1910, 1920, 1930, and 1940 (when she would have been 61 years of age).


History and clinical notes:
History: Supt. of Kent Co. Alms House states that the patient has been under his charge one month.  During this time he has been tearing his clothing and talking almost continually.  Is untidy.
Apr 12, 1903.  Patient is a dement.  Tears up his bed clothing.  Restraint ordered.  Is untidy.  Has a badly united fracture of the right tibia at junction of middle and lower thirds – ankle and foot quite swollen and red.  Says he had the foot frozen at one time.
Apr 14.  Vaccinated today.  Good take.
May 13.  Three days ago a discoloration of the great toe of right food was noticed.  This rapidly developed into gangrene.  The patient rapidly sank and died this morning at 11:30.  
May 15.  Being unable to find friends the body was posted today and buried.  Post mortem showed emphysematous lungs with a number of old healed in calcareous tubercular foci.  The lower lobes of both showed hypostatic congestion.  The heart showed very marked calcareous deposits in both the mitral and aortic valves.  The muscle itself was soft and very flabby and friable.  Spleen, liver, and stomach negative.  The kidneys were typically fibroid – numerous cysts were noted.  The brain was not examined.  
May 13, 1903.  Died.  Senile gangrene and nephritis.

Final disposition:
Died; senile gangrene and nephritis, buried at DSH #114

Additional notes:
Telegram attached from “The Western Union Telegraph Company.”  Dated May 15, 1903.  Transmitted from Wyoming, Del.  to Dr. Hancker.  “Bury the body of [patient] there.” [Signature] – not clear how signer related to patient.  Signer James P. Aron, seems to have been an undertaker or medical examiner or clerk of some sort.  Buried at DSH, Buried at DSH, Grave #114.


History and clinical notes:
History: Present trouble began about one year ago at which time he complained of loss of sensation in his arms.  Soon after this, mental symptoms became evident.  Would not talk at times and occasionally would not answer questions intelligently.  During the last 3 months has been destructive at times and has wandered away from home in a semi-nude condition.  Is untidy occasionally.
Apr 12, 1903.  Patient is a total dement.  Can answer no questions intelligently.  Will not stay in bed.  Soils himself, defecates in the bed and on the floors.  Is in fairly good physical condition for a man of his years.
Apr 14.  Vaccinated today.  No take.
May 15.  Failing in health and strength.  Today sent to bed.  Very noisy at night.
Jun 2, 1903.  Has gradually failed mentally and physically since admission.  Has been in bed for the last week.  Yesterday about noon he began to sink and at 6 p.m. was unconscious.  Died 3:10 a.m. June 2, 1903.  Chronic nephritis.


History and clinical notes:
History: Dr. Wilson states that for about 2 months patient has not been exactly right, but could attend to her household duties. 
Apr 2, 1903.  Began to talk peculiar – out of her head.  Saturday she began to talk about someone coming after her, said she was in Florida.  Would not let her family come near her.  Said that her friends ought to be shot.  Has been quite violent since that time.  If anyone comes near her, will strike at her.  When admitted was under the influence of Hyoscine.  Dr. Wilson stated that he had given her a hypodermic of Hy. 1/100.  Has failed during the past week.  Will not eat or drink.  Seldom sleeps.
Apr 17.  Vaccinated today.  Has been in bed constantly since admission.  Has been fed daily with nasal tube and narcotics and other remedies that were indicated were administered in this manner.  Glands both sides of neck are very much inflamed.  Mouth and [ill. – looks like ‘fances’] have been very dry and lips and mouth have been mopped out with glycerin and water.  Patient talks more but conversation is quite irrational.  Is failing slowly.  Urinalysis shows marked nephritis.
Apr 23, 1903.  Has steadily failed since last note.  Died 9 a.m.


History and clinical notes:
History: Patient has been weak-minded since birth.  Officers who bring patient do not know particulars.
Apr 14, 1903.  Vaccinated today.
May 23.  Condition has greatly improved.  On admission, the patient was very noisy.  Now is quiet and orderly, helping around the ward.  Talks quite sensibly now.  Has incontinence of urine at night.
Jun 8.  Mental condition has quite cleared up and patient is paroled in care of his father.
Sep 10.  Returned today by officers.  Boy is confused.  Says he has experimented with leather (??) until he is famous.
Sep 20.  Is much confused.  Rambling in conversation.  Has a very tragic air about him.
Jan 10, 1904.  Shows marked signs of improvement.  In quiet, a good worker, and trustworthy.
Jul 23.  Very much improved since last report.  Paroled in care of father.
Jan 12, 1905.  Discharged improved.

Additional notes:
Was a patient at the DSH during the 1930 census.  Died 4/28/1951.  Newspaper article attached: CRAZY SMOKER’S QUEER STUNTS.  Turned on water from fire plugs, seizes milk wagon and chops ice.  Pranks land him behind bars.  His insanity said to be due to much cigarette smoking.  Will be examined and probably sent to Farnhurst.  Crazed by the incessant use of cigarettes, [name redacted], aged 18 years, of No. 1209 [street name redacted], was arrested this morning and placed behind bars in the police station to await an examination regarding his sanity.  Attention was first called to [patient] by his queer actions yesterday afternoon, and for a time he created considerable amusement by walking up and down Shipley street smoking an imaginary cigarette, having a short lead pencil sticking in his mouth.  The amount of “smoke” he blew out was remarkable, and he appeared to be a past master in the act of making rings.  Turned on water.  At Delaware Avenue and Van Buren street this morning [patient] turned on the water from a fire-plug and watched with keen delight the muddy color of the stream as it first issued from the hydrant.  When asked why he did it, he answered: “To make the water clear so people can drink it.”  Seeing an ice wagon passing [patient] quickly jumped on the rear step, and grabbing an axe industriously began to cut the blocks into small pieces.  When the iceman remonstrated, the demented youth said that as the weather was very warm the ice should be distributed and not carried around in a wagon.  [Patient] then turned his attention to a milk wagon standing in front of a house, and promptly jumping in it started to drive off.  The owner of the team suddenly appeared from an alley, and catching the horse by the bridle began to soundly berate the youth, you remained seated in the wagon enjoying himself.  He told the milkman that he intended to take the milk and cream in the wagon to the rightful owner.  [Patient] next showed up in the millinery store of Mrs. J.L. Roberts, in Eighth Street, between Washington and West Streets, and began to roll boxes around the floor and fling newly trimmed Easter bonnets about at random.  When asked by a reporter of the Evening Journal this morning where he lived, [patient] promptly answered “Union Fire Company.”  He said he joined the organization last night.  His actions clearly showed that he was suffering from a mild form of insanity, and he will probably be sent to the Delaware State Hospital for the Insane. [end]
Note: Internet research using Ancestry.com Library Edition turned up the information that this man was a patient at the DSH during the 1930 census.


On certificate of:
Drs. William G. Winner and James L. France

History and clinical notes:
History: Officers who bring patient know nothing of his history or condition.
Apr 14, 1903.  Vaccinated today.
Apr 15.  Told Supt. today that he worked in Camden, but was dismissed because the man said that he was a thief and no would come near him.  When he came back to Wilmington he had some trouble with his household goods and that his lawyer tried to “do him” and that the whole thing was a “put up job” and that there was politics at the bottom of the whole plot.
Aug 16, 1903.  Very quiet and obedient.  Works about the farms.  Health good.
Nov 12, 1904.  Quiet and respectful, works about grounds.
Nov 26.  Paroled.
May 9, 1905.  Discharged recovered.


History and clinical notes:
History: Had a stroke about one year ago at which time the right side was affected – some what recovered from the stroke but is still quite deaf.  Mental trouble began at that time.  He now imagines that people are trying to take his life.  Eats well and sleeps poorly.
Apr 14, 1903.  Vaccinated today.  Good take.
May 23.  Condition has not materially changed.  Eats and sleeps well.  
Aug 16.  Quiet but suspicious of injury.  Is untidy in dress and occasionally in habits.
Dec 18, 1904.  Condition remains unchanged.
Jan 20, 1905.  Struck [another patient] who in return struck him on face, inflicting a wound under left eye, which became infected.  
Jan 29.  Wound very much improved.
Feb 2.  Has developed multiple abscesses of body and is rapidly growing weaker, takes very little nourishment.
Feb 20, 1905.  Died of septicemia.

Final disposition:
Died of septicemia consequent to being struck in face by another patient.


History and clinical notes:
History: Patient has a malignant growth on inside of left cheek which he thinks is due to his having been poisoned while smoking a pipe.  Is very abusive at times.  Talks continuously about his having been poisoned.  On other subjects he talks quite intelligently.
Apr 14, 1903.  Vaccinated today.
May 13.  The carcinoma of cheek has grown very rapidly since admission.  Patient has been eating little and is steadily and rapidly failing.  Was today ordered to bed.
Jun 17.  Growth is increasingly rapidly in size and is ulcerating.  Several nights ago patient had a severe hemorrhage from out of the sinuses.  Patient swallows with difficulty.  Is rapidly losing weight and strength.  Has been sleeping poorly and morphine is being given nightly.
Jul 4, 1903.  Growth has increased rapidly in size and covers the whole left cheek and extending well down the neck.  For the last month he has had great difficulty in swallowing and for the last week took food with the greatest difficulty.  Has gradually wasted in strength and died this morning at 10:10.
Jul 4, 1903.  Died.  Carcinoma of cheek and neck.

History: Patient has a malignant growth on inside of left cheek which he thinks is due to his having been poisoned while smoking a pipe.  Is very abusive at times.  Talks continually about his having been poisoned.  On other subjects he talks quite intelligently. 
Apr 14, 1903.  Vaccinated today.
May 13.  The carcinoma of cheek has grown very rapidly since admission.  Patient has been eating little and is steadily and rapidly failing.  Was today ordered to bed.
Jun 17.  Growth is increasing rapidly in size and is ulcerating.  Several night ago patient had a severe hemorrhage from one of the sinuses.  Patient swallows with difficulty.  Is rapidly losing weight and strength.  Has been sleeping poorly and morphine is being given nightly.
Jul 4.  Growth has increased rapidly in size and covers the whole left cheek and extending well down the neck.  For the last month he has had great difficulty in swallowing and for the last week took food with the greatest difficulty.  Has gradually wasted in strength and died this morning at 10:10 a.m.
Jul 4, 1903.  Died.  Carcinoma of cheek and neck.

Final disposition:
Died; carcinoma of cheek and neck.  Gruesome description.  Buried at DSH #115


History and clinical notes:
History: Officers who brought patient know nothing of his history except that he has been drinking heavily.  Brought with handcuffs.  Patient was admitted here first Sep 29, 1895, discharged Oct 9, 1895.  Again admitted May 23, 1898, removed June 11, 1898.  Both admissions was on account of drink.
Apr 29, 1903.  Patient has been wearing wristlets since admission.  Has been quiet most of the time since admission, but has occasional outbreaks at which time he is dangerous.
May 13.  Condition has much improved.  Is quiet, orderly, and respectful.  Seems quite clear mentally.
May 13, 1903.  Paroled.
Jul 2, 1903.  Discharged recovered.


History and clinical notes:
History: Officers who brought patient say that he left the Alms House a few days ago.  Before going there he had lived at times at 16th and Walnut (“The One Hundred House”).  Aside from this the officers know nothing of patient.
Jun 17, 1903.  Patient is a good worker, helping about the ward and farm.  Is contented and obedient.
Jul 6.  Paroled.
Oct 7, 1903.  Discharged recovered.

Additional notes:
From Hoffecker's book.  P. 40, photo caption: "James Price Residence, 16th and French streets.  In 1928 when Frank R. Zebley took this photograph, the house had long since been converted into many small apartments and was known locally as the Hundred House because so many people lived there."  Photo of "Hundred House" in Carol Hoffecker's book "Brandywine Village," available at the UD Library.  "


History and clinical notes:
History: Patient is unable to walk.  Certificate states that patient has had locomotor ataxia for over a year and that this has caused the insanity.  Disease is steadily increasing.  Has violent attacks lasting 3 or 4 hours.  Patient has lost flesh and strength.  The person who brings patient knows nothing of history.
May 23, 1903.  Patient has failed rapidly.  Neither as well mentally or physically as on admission.  Is untidy almost every hour.
Jun 4.  Patient has been rapidly sinking for the last four days and died this morning at 3:30.  
Jun 4, 1903.  Died of chronic nephritis.


Occupation:
designer (at woolen mills of Lowell, MA)

History and clinical notes:
History: Patient was brought here May 2nd without certificate by Mr. Sanders, who states that patient lost his position at Woolen Mills of Lowell [Massachusetts] on account of drinking, where he was employed as a designer.  On admission, the patient showed evidence of a long debauch – very nervous.  Could not sleep and ate little.
May 11, 1903.  Condition has so improved that he is permitted to go home.  Eats and sleeps well.
May 11, 1903.  Paroled.
Jul 2, 1903.  Discharged recovered.

Additional notes:
In 1930 was an inmate at the Philadelphia Home for Indigent Men and Women; died 11/9/1930 in Philly.


History and clinical notes:
History: Patient is a neurasthenic; is not per se insane.  Is hypochondriacal at times.  Mother in a letter to Supt. states that she has always been a worry and annoyance to her family and that they are glad to be rid of her.
Mar 31, 1904.  Patient seems perfectly rational and shows no signs of insanity.  Has irritable disposition.  Physical health good.
Sep 12, 1904.  Discharged.  Not insane.

Additional notes:
Note:  “Neurasthenia” is a term that is no longer used.  It referred to “a psychological disorder characterized by chronic fatigue, weakness, loss of memory, and generalized aches and pains, thought to result from exhaustion of the nervous system.”  This sounds very much like the syndrome that is called “fibromyalgia” today.  Even in the early 1900s it was not considered to be “insanity,” but rather a form of hypochondria.
Note: This patient was a resident of the DSH at Farnhurst during the 1930 census.


History and clinical notes:
History: Brought by wife who says he has not worked for 5 weeks.  He has been a user of alcohol for the last 7 years and has been using drugs (probably absinthe) for the same period.  During the last 7 years there have been periods in which he has not used either alcohol or drugs.  Eats and sleeps poorly.
May 18, 1903.  Patient’s condition has greatly improved.  Eats and sleeps well.  Still somewhat tremulous.
May 18.  Paroled.
Jun 15, 1903.  Discharged improved.


History and clinical notes:
History: Brought by officers who state that patient has been drinking heavily and was found wandering on the streets of Wilmington.  Patient states that he was treated for delirium tremens once before in a New England Hospital.
May 28, 1903.  Symptoms have entirely disappeared and patient was allowed to go home today on parole.
Jul 2, 1903.  Discharged recovered.


History and clinical notes:
History: Patient has used alcohol moderately for years and during the last 6 months has used it to excess.  About one year (ago) her memory began to fail.  Has lately grown careless about her habits and speech.  Now thinks that there is electricity in the walls and that there are strange people and animals annoying her.  Is very suspicious of her people, especially of her husband’s devotion.
May 18, 1903.  Has been very restless since admission, restraint being necessary.  Sleeps little.  Hypnotics being required.  Picks at imaginary objects on the bed clothes.  Calls to and talks almost continually to her family.  Urinalysis shows a marked nephritis.
May 22.  Has been very violent.  Restrained in bed saddle most of the time.  Pulse rapid, no fever.  Picks at the clothing on her bed.  Talks to imaginary persons.  Hallucinations of sight and hearing.
Jun 4.  Has improved very rapidly.  Is much more lucid.  Is out of restraint.
Jun 10.  Still gaining.  Is now on Ward A.
Jun 18.  Is now well.  Was removed by husband today on parole.
Jul 2, 1903.  Discharged recovered.


History and clinical notes:
History: Admitted May 6, 1903 without certificate which was received May 14th.  Since the death of a child 2 years ago, patient has been peculiar.  Quite depressed at times.  For the last 2 weeks has been very troublesome and noisy and destructive.  Since admission to this Hospital 10 days ago has been very much confused – talking continually and has slept little.  Is rapidly failing in health.  Today is quite exhausted.  Imagines that people are trying to injure her.  Urinalysis show a nephritis.
May 17, 1903.  Has steadily failed since admission.  Is very restless, constantly tossing herself from side to side of bed.  Has to be restrained in bed to prevent her from falling and injuring herself.
May 21.  Much worse this a.m.  At 4 p.m. much worse, failed rapidly and died at 5:30 p.m.  
May 21, 1903.  Died from exhaustion from acute mania.


On certificate of:
Drs. Thomas Clements and Wilbur D. Burton

History and clinical notes:
History: Was sunstruck about 3 years ago.  After this time, was very forgetful of recent events.  Last fall became much worse; talked irrational and at times would not speak to any one.  For past 3 months tears his clothing and takes off his apparel.  Is steadily growing more feeble.  Does not appear to understand what is said to him.  Is gradually growing more feeble minded and is steadily losing flesh.
Jun 17, 1903.  Is untidy and restraint is necessary to keep him in bed.  Spends most of the day driving imaginary horses.
Jun 19.  Yesterday afternoon patient has a sudden rise of temperature (103 ½) with some delirium and symptoms of uraemia.  Today patient has been rapidly sinking and died at 5 p.m.
Jun 19, 1903.  Died at 5 p.m.  Chronic nephritis.


On certificate of:
Drs. Thomas O. Clemens and Wilbur D. Burton

History and clinical notes:
History: Office who brought patient knows nothing of him except that his family told him that he was “troublesome at night”.
Jun 2, 1903.  Is a very decrepit old man.  Left sided facial paralysis.  Very noisy at night.  Eats well.  
Jun 13.  Very noisy at night.  Is failing and is kept in bed most of the time.  A total dement.  Is untidy.
Jun 17.  Is failing rapidly.  Has some difficulty in swallowing.
Jun 25.  Patient has grown rapidly weaker and for the last several days has taken little nourishment.
Jun 25, 1903.  Died at 4 p.m.  Senile asthenia.


History and clinical notes:
History: About one year ago began to talk strangely and became restless.  After several months he so improved that he worked for about 6 months without any apparent peculiarities.  About 3 months ago his symptoms again appeared and he has been quite irritable and quarrelsome.  At times becomes silly.  Wanders about the house at night.  Eats little.
Jun 17, 1903.  Patient quiet and orderly.  Is in good spirits.  Eats and sleeps well.
Jul 5.  Is obstinate at times and on one occasion force was necessary on the part of an attendant to compel him to obey.  Is very untidy at table and has been placed at a table by himself.  
Jul 27.  Has been quiet and condition has improved somewhat.
Aug 8, 1903.  Paroled in care of father.
Oct 7, 1903.  Discharged unimproved.

Final disposition:
Discharged unimproved; but sent back to hospital by father 6 weeks later (see notes).

Additional notes:
Readmitted 11/27/03, died at DSH 6/3/10 of lobar pneumonia.  Note attached on small sheet of lined paper.  Written in pencil.  Dated Nov 27, 1903.  “Dr. Hancker.  Dear Sir, Please admit [patient’s name] in the Institution for the Insane as he has become very troublesome and I am afraid dangerous.  You have his record in Dr. Brown’s writing as he was over there in June.  Give him state board as his incarceration may be for an indefinite period.  Please see that he is [ill.] right, do all you can for him and I will see you at my earliest convenience.  Yours respectfully, [signature], (his father)."  Note actually belongs with second admission on November 27, 1903.  Patient 344541551.


On certificate of:
Drs. James A. Hopkins and Thomas A. Hitch

History and clinical notes:
History: Has been acting strangely for about one year.  Imagines that a machine agent with whom he had some dealings is trying to secure his property and break up his home.  Looks very much depressed.  Worries continually.  Eats and sleeps well. (Patient was received May 29th but as the paper were not correct, the case was not entered on that date).  
Jun 13, 1903.  Still depressed.  Thinks he has wronged someone.  Eats and sleeps well.
Jul 10.  Patient sill much depressed – no improvement.  For the last week has been kept in bed for physical and mental rest.  Physical condition and health fair.  Eats and sleeps fairly well.  Removed today from institution against the advice of the Superintendent by his wife [name redacted].  Paroled.
Sep 1, 1903.  Patient brought back today by his brother who state that he has turned against his wife and threatened to kill her.  Could not be taken care of nor controlled at home.
Sep 20.  Much depressed.  Thinks his children are about and that he cannot see them.
Jan 15, 1904.  Very nervous, ask for some form of poison to end “his misery.”  Has also asked for a razor, saying he wanted to cut his throat, that he did not care to live, etc.  Imagines the meat he eats is the flesh of a human being.
Nov 26.  Removed from institution today, contrary to advice of Supt. Hancker.  Paroled.
May 9, 1905.  Discharged improved.

Standard memo form, dated July 10, 1903.  “this is to certify that I am the wife of [patient], that I remove him from the Delaware State Hospital at Farnhurst against the advice of the Superintendent, who has informed me that said [patient] is not a proper person to be at large and that he is at anytime liable to commit suicide and thereby exonerate the Trustees of the said institution from any damage that said [patient] may do. [Wife’s signature redacted].”

Printed form with blanks to fill in, attached dated Nov 26, 1904.  “I hereby removed my husband from the Delaware State Hospital at Farnhurst against the wish and advice of the Superintendent, who has notified me that he is not a safe person to be at large, and that he is liable to do damage to himself or others, and in removing him I exonerate the officers and the Board of Trustees from any act or depredation that he may commit.  Witness, [signature]  [Signature of patient’s wife].


History and clinical notes:
History: Patient brought to hospital by officers, who state that he was arrested in Wilmington for being disorderly.  At the jail that he was going to kill all the coons/cows/crows (??) he could find.  Set fire to his clothing Saturday night and officers had a great deal of trouble with him.  Patient states that he has only been east for about one week, that he came here from San Francisco.
Jun 13, 1903.  Patient has been violent and destructive and constant restraint ordered.  Talks wildly and brags of the most absurd exploits.  Thinks he is very wealthy and that he is a great fighter.
Aug 16.  Very much improved at present.  Good patient and works about the ward.  Very anxious for discharge.
Jul 11, 1904.  Recovered.

Newspaper clipping attached: SET HIMSELF AFIRE.  Colored prisoner starts a blaze of his clothing for fun.  [Name redacted], colored, made things lively around the police station for a couple of hours last night.  John was arrested on a charge of disorderly conduct.  He was very talkative and represented himself as a great prize fighter.  [Patient] said he trained under the famous Fitzsimmons and Vanderbilt was his backer.  [Patient] was put in a cell next to another colored man and for a time they carried on a regular vaudeville turn, singing songs, dancing and doing other funny stunts.  Late in the evening, however, [patient’s] neighbor retired for a snooze.  The ex-prize fighter was wild for excitement and just for amusement he set fire to his clothes.  Then with his clothes burning he picked up a bucket filled with water and threw the contents on his neighbor who was fast asleep.  This caused enough excitement for even [patient] and too much for the police.  Several officers who were in the stationhouse saw the smoke and succeeded in smothering the flames before [patient] was badly burned.  After this Fitzsimmon’s pupil went to sleep.”


History and clinical notes:
History: Patient has steadily been drinking for years.  Had an attack of vertigo last Thursday and cut his lip.  Last Saturday began to “see things” and got so bad that he had to be arrested; no one could handle him.  General health is run down.  Is much worse at night.  Does not sleep.  Appetite is good.
Jun 13, 1903.  Patient has improved rapidly.  Was very noisy and restless just after admission and sedation was necessary.  Now eats and sleeps well.
Jun 22, 1903.  Patient has entirely cleared up mentally.  Eats and sleeps well.  Paroled.
Jul 2, 1903.  Discharged recovered.


History and clinical notes:
History: Officer who brought patient knows nothing of her history.
Jun 30, 1903.  Patient is a very much undersized and poorly developed coloured female.  Does not talk except to answer questions and then in monosyllables.  On admission patient had a severe glossitis and gingivitis and ate little.
Sep 20, 1903.  Good general health.  Very indifferent and lazy.
Feb 19, 1904.  Very quiet.  Physical condition good.  Sits idle all day.
Nov 14.  Very lazy.  Eats and sleeps well.
Jun 5, 1905.  Lazy and stupid.  Eats and sleeps well.
Feb 20, 1906.  No change.
Feb 26.  Complains of stomach and head/heart; looks sick.  Sent to bed.
Feb 27.  Vomiting and continued pain, moderate fever.
Feb 28.  No better.  Abdominal muscles rigid.  Vomited bile.  High enema.  
Mar 1, 1906.  Patient continued stercoraceous vomiting, complained of great pain in abdomen.  No bowel movement followed enema.  Died at 3:30 a.m.  Autopsy revealed general peritonitis.  Gallstones in intestines, one had perforated intestines and was lodged in mesentery.  About a quart of peritoneal pus in abdomen.

Final disposition:
Died; complications of perforated intestines due to gallstones; infection.  Buried at DSH #141.

Additional notes:
Buried at DSH, Grave #141.  Note: “Glossitis” is inflammation of the tongue, involving swelling, changes in color, and loss of taste bud papillae which makes tongue appear smooth.  “Stercoraceous vomiting” refers to cases where partially-digested food from the intestines backs up into stomach and is vomited out the mouth.  Although it smells offensive, and is often described as “throwing up feces,” in fact the material has not yet been processed by the intestinal tract to the point where it can technically be referred to as fecal matter.


History and clinical notes:
History: Patient brought by father who states that he has been drinking heavily for one week.  Is very nervous.  Says he has not been sleeping and that he eats little.  Tremulous.  Pupils dilated.  Has the appearance of a man that has been drinking for a month.  Says he has never used drugs.  
Jun 27, 1903.  Patient slept but a few minutes the first 36 hours after admission.  Did not respond to hypnotics and when closely questioned admitted having used chloral and morphia.  A hot pack was given (20 minutes) and soon after patient began to sleep.  After this improvement was rapid and symptoms disappeared.  Paroled.
Jul 2, 1903.  Discharged recovered.  Newspaper clipping attached, seems to be from a Philadelphia newspaper: Dated July 11, 1903.  “TRIED SUICIDE IN CELL.  Charged with robbery, prisoner plunged knife in chest.  Remorse over being arrested on the charge of robbing the J.B. Thomas stationery store, at the northwest corner of Fifth and Commerce streets, where he was once a trusted employee, caused [name redacted], 20, of Milford, Del., to attempt suicide by stabbing himself in the right breast while confined in a cell awaiting trial at the Fifth and Race streets station.  He is now in the Pennsylvania Hospital in a serious condition.  Two burglaries were perpetrated at the establishment within as many days, and the manner in which they were carried out led the police to believe that someone well acquainted with the place was responsible.  Special Policeman Redding was detailed on the case and last evening arrested [name redacted].  The latter felt the disgrace of his arrest keenly, and after being placed in the cell he wept continually.  While the turnkey was absent [he] took a knife which he had concealed in his stocking, and opening his shirt plunged it deep into his breast.  He then stretched himself out on the bench in his cell, where he awaited death.  He was found some time later by the turnkey in a semi-conscious condition, with the blood flowing freely from the deep wound.  He was placed in the patrol and hurried to the hospital, where his condition was pronounced serious.

Note: According to the 1930 census, someone of the same name and approximate age was living in an asylum in Philadelphia, run by Catholic nuns.

Additional notes:
Was discharged supposedly recovered, but two weeks later was arrested for burglary and tried to commit suicide in jail.  Was sent to PA Hospital.


On certificate of:
Drs. Leonard Kittinger and Harrison Howell

History and clinical notes:
History: Patient was here for treatment about one month ago – stayed one week.  Wife states that he has been taking drugs and liquor since his discharge one month ago.  Wanders about the house at night.  Has been eating and sleeping, poorly.
Jun 28, 1903.  Condition has improved greatly since admission.  Eats and sleeps well.  Still considerable muscular tremor.  No delusions.  Wife called today to remove patient.  Paroled improved.
Jan 21, 1904.  Discharged recovered.
Mar 22, 1904.  Paroled.  (sic)


History and clinical notes:
History: Brought by friend who states that patient has been in The Home of Merciful Rest, Wilmington, for the last 2 months; that she became so troublesome and noisy that she could not be controlled.  Suspicions of ill treatment.  Patient is a complete paralytic and entirely unable to take care of herself.  
Jun 28, 1903.  Patient is a paralytic.  In bed all of the time; cannot help herself.  Has to be cared for as a child.  Articulation very indistinct.
Sep 20.  No change in condition.
Oct 19.  Has failed rapidly.  Bed sores appearing some time ago over dependent postures of body and considerable sloughing.  Died today 10:55 p.m. from exhaustion.
Legal paper attached, printed form with blanks filled in.  At top says “State of Delaware, New Castle County – SS.  On this 24th day of June 1903, before me the subscriber George R. Hollis, Justice of the Peace personally appeared [name of husband redacted] who being duly sworn according to law doth depose and say: That [wife’s name redacted] is his wife and that she was forty-nine years old on the Sixth day of October, 1902.”  Signed by husband.  “Sworn to and subscribed before me this day and year aforesaid, witness my hand.”  Signed by George H. Hollis, Notary Public.  Embossed with Notary seal.  
Note: If true, this makes the patient’s age 50 years at time of admission to DSH, not 60, as it says in the ledger.  Also for this patient the date of death is clearly October 19, 1903, but written twice below history is the information that she died November 19, 1903.


History and clinical notes:
History: About 3 weeks ago she began to act strangely.  Wants to go “visiting” all the time.  Sings and acts silly.  Has been in poor health for about two years.  Is untidy in dress and habits.  Says she is very wealthy and owns the whole world.  Has been eating poorly.
Jul 20, 1903.  Has improved steadily.  At first she was noisy and troublesome, frequently removing her clothing.
Aug 1.  Is apparently well and her friends were notified to remove her.  
Aug 16.  Was removed on parole by friends today.
Aug 18.  Returned.
Feb 19, 1904.  Very much improved.  Conversation rational and behavior quiet.  Health good.
Apr 2, 1904.  Was removed on parole by her son today who removed her to her home at Dover, Del.
Jun 13, 1904.  Discharged recovered.


On certificate of:
Drs. James A. Draper and Daniel I. McColly

History and clinical notes:
History: Patient has been an invalid for twelve years.  Somewhat violent at times, attacks lasting about thirty minutes.
Sep 1, 1903.  Garrulous.  Talks in a silly manner at times.  Good health.  Willing worker on Ward I dining room.
Feb 19, 1904.  Works well – health good.  Somewhat simple in conversation.
Nov 17.  Patient writes letters to men patients and sometimes has thrown them out windows on men (who) were passing.  Works about dining room.  Is in good health, save for a prolapsus uteri which sometimes gives trouble.
Jan, 1905.  Patient in good physical condition.  Gives some trouble with her kleptomaniac tendencies.  Is very untruthful and tries to flirt with attendants.
Apr 10, 1905.  Daughter came to take her away.  Discharged improved.


History and clinical notes:
History: Patient had La Grippe about 4 months ago.  This was followed by a period of insomnia.  Two months ago she began to imagine that she was surrounded by electricity and that poisons were put in her food in order to destroy her mind.  Has been eating and sleeping poorly for the last weeks.  Has had little interest in her child lately.  Has had irregular and painful menstrual periods for some months.  Attempted suicide about 1 month ago by cutting throat.  
Jul 23, 1903.  Has been eating little – nasal feeding being necessary.  Has been noisy at night and constantly called for the drugs.  For the last 3 nights has been quiet and has slept better.
Sep 20.  Much quieter at this date.  Eats and sleeps well.  Occasionally displays temper.  Several days ago she nearly ruined a good gown in a fit of temper.
Oct 15.  Has improved in health.  And mentally much brighter.  Is still surly.  Removed today against the advice of the Supt. by husband.  Paroled Oct 15, 1903.
Nov 30.  [Patient] returned today in custody of Sheriff and Dr. Conwell.  On Nov 11, 1903 while at her home in Camden, Del., she shot and instantly killed her husband, [name redacted].  She was arrested and a jury of inquisition found her insane and bail was accepted for the amount of $10,000.  Dr. Conwell, her brother-in-law, was appointed guardian of her child and trustee of her property, and as stated above (patient) was returned to this institution on this date.
Dec 22, 1903.  Transferred to Ward A today.
Jan 1, 1904.  [Patient] has been helping in dining room for past week, is bright and cheerful, attends dances and shows signs of marked improvement.
Jan 21.  [Patient] was removed from dining room several days ago because of wandering about corridor and engaging in conversation with male attendants.  Last night she tore her blankets into several pieces and was transferred this morning to Ward B.  
Apr 27.  True bill found today by Grand Jury of murder in the first degree against patient.
Apr 28.  The patient, accompanied by the Superintendent and Attendant Anne Downs, was summoned to Dover today to attend trial.  Patient found not guilty of killing her husband, by Jury, on grounds of insanity, and judges committed her to this Institution to remain until further order of Court.  For this order of court see original commitment papers.
Oct 29, 1904.  Patient was taken to Dr. by Dr. Davis and Miss Downs, evidence heard by Court, and ordered discharged.

Memo attached on standard memo form, dated Oct 15, 1903.  “I hereby remove my wife [name redacted] from the Del. State Hospital at Farnhurst against the advice of the Superintendent, who has informed me that she is liable to do damage or injury to herself or others.  I hereby exonerate the Board of Trustees of said Hospital from any blame or criticism in case my wife should commit or attempt any injury to herself or others.”  Signed [husband’s signature].

Note:  According to census record, patient was living at Delaware State Hospital during the 1910, 1920, and 1930 censuses.  The daughter was raised by her aunt and uncle to maturity.

Final disposition:
Taken to Dr. by Dr. Davis and Miss Downs, evidence heard by court and ordered discharged.

Additional notes:
Note:  According to census record, patient was at DSH until her death from cancer of breast in 1960.  Buried in Odd Fellows Cemetery.  The daughter was raised by her aunt and uncle to maturity.


History and clinical notes:
History: Dr. Stewart, who brings this patient, cannot give a detailed account of her trouble.  States that when her last child was born 14 years ago she was quite melancholy and depressed for a number of months.  This attack lasted for 6 months and since that she is very depressed and at times has spoken of suicide.  Has no ambition, suffers from insomnia and has a poor appetite.
Jul 31, 1903.  Has not improved, very melancholy and depressed, moans and frets most of the time.  Has not taken nourishment since yesterday, was fed with nasal tube today.  
Aug 2.  Was visited by husband today who removed her on parole against advice of Supt.  Parole Aug 2, 1903.
Aug 16.  Was returned by her husband at 8 pm, who stated that he sent her to her brothers at Wyoming, but that she did not improve and that she has tried to throw herself in front of an express train.  Moans and cries a great deal of the time.
Sep 20.  Very noisy and restless.  Tears her hair when not in restraint.  Will not answer questions.
Oct 12.  Some quiet at this date.
Nov 10.  Still much depressed.  Will talk little.  Visited this evening by her husband, who removed her on parole.  Husband said that Dr. Black advised removal.  Paroled.
Nov 10.  Removed against advice of Dr. Brown.
Jan 23, 1904.  Returned today, brought by son.  She is still very melancholy and physically weak.
Feb 19.  Moans unceasingly and cries out that “she has nothing in this world.”  Transferred to Ward III and given deodorized tincture of opium.  Improved slightly.  Treatment changed to Paraldehyde, and patient has become much quieter.  Eats well usually.  Tears her hair occasionally.  
Aug 5.  Patient has an attack of typhoid fever.  Temp. range 102.2° -- 102.6 ° F.  Pulse weak.  Muttering delirium part of the time.  Cold sponges, liquid diet, and [ill. – looks like ‘Salol’].  Stools frequent, loose, and yellow.
Aug 6, 1904.  Died, 3:30 pm.  Memo attached, standard form, dated Nov 10, 1903.  “To Whom it May Concern, I hereby removed my wife [name redacted] from the Del. State Hospital against the advice of the Supt., who informs me that she is suicidal and may do injury to others.  In removing my wife I assume full responsibility and hereby exonerate the Trustees of the said Hospital from any blame or criticism in case my wife injures herself or other.”  Signed [husband’s signature]


History and clinical notes:
History: Officer Evans who brings patient states that she has been insane for 2 years.  But lately she is much more violent.  At times is very much excited and will tear her clothing and strike those around her.  Certificate states that cause of insanity is due to uterine troubles, that the disease is steadily progressing.
Sep 1, 1903.  Very quiet on ward.
Feb 19, 1904.  Works daily in Ward I.  Health good.
Nov 14.  In good condition.
Jun 5, 1905.  No change mentally or physically.
Feb 26 (no year).  No change.
Nov 20, 1948.  Died.


History and clinical notes:
History: Has been acting strangely at times for months.  About 3 weeks ago was very violent but recovered sufficiently to help harvesting.  Yesterday he left the field and was in hiding all day.  Refuses to eat and his answer to all questions is “I don’t know.”  Has been very violent at times, trying to bite anyone in his way.
Jul 23, 1903.  Was kept in bed for 3 days after admission during which time he quieted down and became quite rational.  Now works about the ward.
Sep 8.  Has quite recovered and was paroled today to Mr. Hamm of Dover, who came for him.
Jan 21, 1904.  Discharged recovered.

Additional notes:
Mr. Hamm was his employer on the farm where he worked.


On certificate of:
Drs. John C. Fahey and Henry R. Spruance

History and clinical notes:
History: Has always been more or less sickly.  First symptoms first manifested last Sept.  Complained of his head a great deal.  Had ideas that people were placing poison in his food and that his own family were after him and that he would kill them before they would injure him.  Very profane and vulgar in his talk.  Is gradually growing more disturbed.  Has talked of suicide and has repeatedly threatened his own family.  Has not slept well – usually has a good appetite.
Jul 23, 1903.  Was much depressed for a few days after admission and tried to hang himself with a handkerchief.  Is now much brighter and in better physical condition.  Heart and lungs seems normal.  Wears muffs at night.
Sep 20.  Much depressed.  Takes no interest in anything.  Has to be encouraged at every meal to eat.
Oct 12, 1903.  No change.
Jun 24, 1905.  Very slovenly but quiet.
Apr 1, 1914.  No change whatever.  Was removed by his relatives today.
Oct 7, 1914.  Discharged unimproved.

Additional notes:
Seems to have recovered, married, had several children.  Still alive in 1940 census.  Died 10/21/1954 at DSH.


History and clinical notes:
History: Patient depressed – a case of melancholia and comes to the Institution voluntarily for treatment daily.
Jul 20, 1903.  Has been given baths and electricity but for the last several days has not put in an appearance.
Aug 16, 1903.  Has not been here for treatment for the last month.
Jan 21, 1904.  Discharged unimproved.


History and clinical notes:
History: Dr. Hammond states that patient came from the Sussex Co Alms House.  She began about six months ago to have hallucinations.  Thought that people were talking about her and persecuting her.  Is quite noisy at times.  
Jul 23, 1903.  Says she hears people talking to her and about her over a telephone.  Thinks people have attempted to poison her.  
Sep 20.  Complains of people talking about her.  Says she cannot sleep at times for the noise of telephones.
Feb 19, 1904.  Hallucinations constant.  Witches persecute her all the time.  Helps in dining room.  Health fair.
Jun 28.  Transferred to Tuberculosis Building.  
Nov 14.  Growing very emaciated.  Works in kitchen and dining room.  Eats and sleeps well.
Jun 5, 1905.  Is troubled with rheumatism, spends much time in bed.
Feb 20, 1906.  About the same.  Coughs a great deal and expectorates.
Dec 1, 1915.  No marked changes in any respect.  Has been (in) T.B. Building since it has been built.
Jan 2, 1916.  Complains of pain in chest.  Exam reveals both lungs almost hepatized.
Jan 5.  Breathing very difficult.  No improvement in any respect.
Jan 12.  Patient has failed very rapidly.  Died this 8:10 p.m.  Pneumonia lobar.
Note: “Hepatized” means consolidation of the lung tissue into a substance the consistency of liver tissue, often seen in lobar pneumonia.


History and clinical notes:
History: Sheriff states that patient had some kind of a heat stroke 10 months ago and that he has been lately discharged from the Wilmington Hospital.  Two days ago he ran away from home and has since been running wild in the woods in a partially nude condition.  Was very violent when captured.  Slept none last night and has eaten very little.
Aug 16, 1903.  Has lost considerable flesh since admission.  Has been very much confused and restraint has been necessary much of the time.  Urine exam shows slight nephritis.  For the last week has been a little more rational.  Heart and lunch normal.
Sep 20.  Has been very violent for the last week.  Restrained.  Catheterization necessary.  At time will not eat.  Hypnotics required nightly.
Oct 12.  No change in general condition.  Still very violent.  Sleeps little at night.  Hypnotics having little effect.
Jan 15, 1904.  Still remains very restless, requiring restraints, mutters continually, rational for short intervals.  Appetite good.
May 16.  While attendants were removing [another patient’s] restraint this a.m. [the other patient] seized strap and struck [this patient] in eye with buckle.  Supt. was notified and on examination the eye was entirely destroyed.  Consulting Oculist Dr. Tybout was immediately notified by phone.  At 10 a.m. Dr. Tybout enucleated the eye.
May 19.  Dressing removed today, condition of wound was found to be good.
Sep 8.  Has been failing in health, appetite poor and is emaciating rapidly.
Oct 13, 1904.  Died at 7:13 a.m.  Pulmonary gangrene.

Final disposition:
Died of pulmonary gangrene.  Buried at DSH, #128


History and clinical notes:
History: For the last 3 years there has been noticed: loss of memory, visual hallucinations; untidy in dress and habits.  Has an aversion to bathing.  Is quite garrulous at times.  Eats and sleeps well.
Sep 20.  General health good.  Very quiet and is contented.  Is delusional.  Untidy occasionally.
Oct 12.  No change.
Feb 19, 1904.  Attack of acne a short time ago, recovered.  Otherwise condition unchanged.
Feb 27.  Has an attack of bronchitis.  Temperature yesterday 102.5 F.  Today 100.7.  Cough looser.  Pulse strong.  Treatment – camphorated oil inunctions.  Brown mixture.
Mar 6.  In good condition.
Nov 14.  Patient has been in bed for about ten days.  Very feeble.  Takes nourishment.  Is now laying on water bed, several bedsores developed.  Failing generally.
Jan 30, 1905.  Bed sores in bad shape.  Condition mentally unchanged.  Greatly emaciated.  Eats fairly well, and sleeps much of the time.
Feb 5.  In stupor most of the time.  Refuses nourishment.  Moans with pain when moved, but is unable to articulate.
Feb 6.  Sinking.  Breathing stertorus, eyes fixed, rarely conscious.
Feb 7, 1905.  Died 4 p.m.  Senile asthenia.
Note: “Inunctions” means to rub an oil or ointment into the skin for therapeutic purposes.

Additional notes:
Was perhaps a housekeeper of Mrs. Victor Dupont?  (Victor and Alice).  Victor died in 1888 and Alice died in 1904, a year after housekeeper was sent to DSH.


On certificate of:
Drs. George W. Pleasanton and J.L. Pratt

History and clinical notes:
History: Officer who brought patient says he knows nothing of his history or condition.  Patient is a very infirm old man and comes to the Hospital from the train in an untidy condition.
Jul 27, 1903.  Patient has been quite restless and has been kept in bed with difficulty.  Cannot answer questions intelligently and talks in a rambling fashion.  This morning he became worse and examination showed some pulmonary oedema with a failing heart.  Urine examination showed presence of albumin and casts.  Can not swallow well.
Jul 28.  Patient has gradually failed and died this morning 12:20.  Chronic parenchymatous nephritis.

Final disposition:
Died of chronic parenchymatous nephritis

Additional notes:
"Came from train in an untidy condition."


Insane Relatives:
one brother died at DSH, another committed suicide

History and clinical notes:
History: About July of last year was very nervous and at times quite violent.  Recovered to a certain extent from this attack, but was quite melancholy until last Sunday, when she became very restless, walked the floor, could not remember, and acted as if her sight was affected.  Frequently said it was dark and that the lights were out.  Has been steadily growing worse.  Sleeps but little, but appetite is good.  Talks a great deal about religion.  Says she is going to hell and that she has committed a great many sins.
Sep 24, 1903.  Has steadily improved both mentally and physically and went on parole today.
Jan 2, 1904.  Discharged recovered.


History and clinical notes:
History: First symptoms in Feb last, religious excitement.  Got better in 2 or 3 weeks, but not entirely well.  For past week much worse, noisy, destructive, and troublesome.  Chased his family out of the house.  Was always a hard worker.  Officer who brings patient knows but little of his history.
Aug 16, 1903.  Says a man for whom he has been working owed him a dollar and that he stole his horse for payment.  Eats and sleeps well.  Is quiet and answers questions respectfully and at times rationally.
Nov 5, 1903.  Has been a very good patient and seems quite clear mentally.  For the last two weeks has been working in the kitchen unattended and this morning took advantage of the privilege and eloped.
Jan 21, 1904.  Discharged recovered.

Final disposition:
Discharged recovered (several months after eloping)


History and clinical notes:
History: About 2 years ago first symptoms were noticed, began to talk irrational and has gradually grown worse.  Appetite is good.  Sleeps well at times.  During examination would not answer questions put to him.  Formerly, patient was much addicted to liquor.  Is gradually growing more feeble bodily and mentally.
Sep 5, 1903.  Has developed senile gangrene in toes of left foot.  Both legs show marked vencasities
Sep 19.  Failing rapidly in strength.  Left foot largely involved at this date.  Offensive odor.  Physical condition and age do not warrant amputation.
Oct 12.  Failing rapidly.  Gangrene extending, now half way between ankle and knees, no “line of demarcation.”  
Oct 26.  Gangrene above knee.  Is much weaker.  Right foot also gangrenous, also large gangrenous bedsore over both ileums.  Died 3:10 p.m.


History and clinical notes:
History: Patient is deaf and dumb.  She left this institution about a year ago.  Until about 8 weeks ago she worked and seemed quite well and since that has been irritable and will no go out of the house.  Sleeps little but walks about her room at night.
Sep 19, 1903.  Very quiet on ward.  Sits all day taking little notice of surroundings.  Good general health.
Feb 19, 1904.  Works in laundry.  Health good.  Amiable disposition.
Nov 14.  In good physical condition.
Feb 20, 1906.  No change in any way.
Feb 7, 1910.  Has been working steadily in the laundry, until today when she was not able to go to work.  Has had a cough.
Feb 9.  Confined to bed, very weak, expectorates frequently.
Feb 10.  Dullness over right lung.  Examination of sputum – T.B.  
Feb 28.  Respirations very rapid, and breathing only from left lung.  
[penciled note: entered under name of (different last name) page 81, June 30, 1900]
Mar 3, 1910.  Refuses all nourishment except beef juice.
Mar 5.  Moans and tries to get out of bed.  Takes her milk better.
Mar 6.  Growing weaker.
Mar 7.  Died at 9:20 a.m.

Final disposition:
Died, complications of TB.  Buried at DSH #184.

Additional notes:
Buried at DSH, Grave #184. Pencil note in margin says they sent a telegram to the correspondent at old address, but she was no longer there (in Philly).


On certificate of:
Drs. H.G. Buckmaster and George W.K. Forrest

History and clinical notes:
History: About 3 months ago, patient came home from work “tired out” was placed in bed.  Was not unconscious but in a few days his relatives noticed that he could not move his lower limbs and has not been able to do so since that time and at times his hands and fingers appear to be affected.  No history of syphilis but has a history of rheumatism.  Two months ago his mind became affected, talked silly.  Mind is gradually growing more feeble, imagines that he is on fire occasionally.  Appetite very poor.  Sleeps good at night.  Had steadily lost flesh; has probably lost 50 lbs.
Sep 10, 1903.  Failing mentally and physically.  Eats fairly well.  Is helpless and untidy.  Restraint is required to keep him in bed.
Sep 19.  Failing rapidly; very stupid.
Oct 7, 1903.  Has failed rapidly and died today.  Exhaustion from paralysis, general atheroma.

Final disposition:
Died of exhaustion from paralysis and general atheroma (?)


History and clinical notes:
History: For two months has been peculiar and 2 weeks ago became much worse.  Is much depressed.  Fears that his family will starve.  Says that all his old friends have turned against him.  Talks in a very rambling way of events – going into the most minute and irrelevant details.  Dr. Johns states that patient’s extremities have been oedematous due to valvular heart disease.  Family has had difficulty to keep him in bed at night.
Sep 5, 1903.  Very much depressed.  Numerous delusions among them is that he is to be burned at the stake.  Examination discloses no valvular lesion of heart.
Oct 14.  Still much depressed.  Will not eat except when urged.
Dec 15.  Refuses to eat and states that every meal he eats increases his indebtedness to State of Delaware, necessary to resort to nasal feeding.
Jan 15, 1904.  Eats his meals, but says he does so against his wish.
Feb 5, 1904.  Became suddenly ill, complaining of pain over region of heart; grew worse rapidly and died at 6:30 p.m.  Pericarditis and senility.


History and clinical notes:
History: Has had epilepsy all his life – attacks every day.  Has spells of temper and mother is now unable to control him.  Is unable to dress himself and is untidy at night.  Is quite demented and can scarcely be understood when talking.
Sep 19, 1903.  Has frequent epileptic seizures.  Good general health.
Oct 5.  Is irritable and has bad temper.  Attempted to strike the physician with a chain several days ago.  Muffs were ordered and afterwards removed.  Seemed to have a good effect on his disposition as he has since been quieter and more respectful.
Apr 4, 1904.  Condition same as when last reported.
Jan 24, 1905.  Condition remains unchanged.
Mar 23, 1911.  Died.

Final disposition:
Died; On March 16, 1911 mother wrote and requested he be buried at DSH.  Grave #198.


History and clinical notes:
History: On admission was very profane and violent.  Condition thought to be due to self abuse.  Very confusional.  
Sep 19, 1903.  Has much improved.  Is up about the ward and is quiet.  Seems quite clear at this date.
Oct 9.  Condition has improved steadily since admission and patient is today paroled in care of his father, who came for him.
Jan 21, 1904.  Discharged recovered.


History and clinical notes:
History: Officer knows nothing of patient except that he has delusions in regards to snakes.  Think patient had been drinking but was not drunk at the time he saw snakes.  Is quite confused.  Does not know where he is.  Thinks strange people are his relations.
Sep 19, 1903.  Very quiet and orderly.  Always respectful and obedient.  Good worker.  Is delusional at times.
Oct 12.  Good health.  Willing working on ward and about the farm.
Jan 15, 1904.  Quiet and respectful, works in laundry and is quite rational.
May 18, 1904.  Paroled.
Sep 12, 1904.  Discharged recovered.


History and clinical notes:
History: Patient brought here from County House with no history.  Seems weak and when walking requires assistance.
Sep 20, 1903.  Is weak and appears much older than 52 years.
Oct 12.  No change.
Feb 19, 1904.  Has been failing for past four days and has been in bed.  Takes but little nourishment, respirations are increased and heart’s action feeble.
Feb 29, 1904.  Has failed rapidly and died 10:15 a.m.


History and clinical notes:
History: Brought here from County House with no history.  
Sep 20, 1903.  Very quiet.  No evidence of mental disease at this date.
Oct 12.  No change in condition.
Feb 19, 1904.  Quiet and cheerful.
Nov 14.  Very feeble, in bed, eats well.
May 24, 1908.  Has been in bed almost continuously since last note and has been slowly failing.  Very feeble the last few days.  Her friends have been notified of her condition but they have failed to respond.
May 25, 1908.  Patient passed away at 9:30 p.m. last night.  Senile asthenia.

Final disposition:
Died of senile asthenia; buried at DSH #144


History and clinical notes:
History: First symptoms were noticed about 3 weeks – began to talk peculiar and somewhat incoherent.  Has delusions of persecution; talks about people wanting to kill him and also at times wants to preach.  He is steadily getting worse.  Eats fairly well but does not sleep any.  At times very much excited and nervous.
Sep 20, 1903.  Quite excited after admission.  Thought attendants were going to kill him.  Is quieter now.  Eats well and at this date is contented.
Oct 12.  Very quiet now.  Helps about the ward.  Seems feeble minded.
Nov 27, 1903.  Has improved and seems brighter since last note; has been working in kitchen and eloped today.
Jan 21, 1904.  Discharged recovered.


History and clinical notes:
History: Husband states that patient has been unwell physically for about 2 years and during that time has had several abscesses on her neck – probably tubercular.  Two weeks ago the first mental symptoms were noticed.  She became very restless, disarranged the house, her conversation was disconnected.  Has expressed a desire to die and has threatened suicide.  Has had irregular menstruation for one year and for the last 3 weeks has been menstruating continuously.  Cries and wrings her hands a great deal.  Is delusional and hallucinatory.  Eats fairly well.  Sleeps for about 3 hours per night.
Sep 20, 1903.  Very restless and confused last night.  Would not take chloral and Hyoscine and Morphia given hypodermically.
Oct 12.  Has been much confused and restless – a jacket being required at times to prevent her tearing off her clothing.  At this date is somewhat quieter.
Feb 19, 1904.  Paroled on Feb 15, 1904.
Jun 13, 1904.  Discharged recovered.


History and clinical notes:
History: Has been acting in a peculiar manner for about 3 months.  The first thing noticed was depression and what were thought to be hysterical attacks.  Is becoming more and more depressed.  Does not answer questions except in monosyllables.  Refuses to take medicine.  Has been treated several times at the Polyclinic in Phila.  Has thought that her people were trying to poison her.  Has to be closely watched to keep her from wandering away from home.  Eats and sleeps well.
Dec 25, 1903.  Occasionally attempts to disrobe while on ward.
Jan 8, 1904.  Kicked attendant (Mrs. D. Collins) in abdomen producing severe contusion over right ovarian region; she was transferred to Ward 3 and restraint ordered.  Successfully vaccinated.
Jan 21.  [Patient] returned to Ward B some days ago.  Since return has been more talkative.  On the 19th had a severe maniacal attack lasting about 3 hours.  Imagine she was being “scalded to death on the Rock on Salvation,” sang hymns, and reproached “Everett” for falling in love with someone else.  Since this attack has been quiet as usual.  
Feb 19.  Gynaecological examination on suspicion of pregnancy.  Negative.  Mental condition grows worse daily.
Mar 30.  Patient is very silly, laughing all the time, and talking incoherently.  Physical condition very good.
Aug 4.  Patient has been ill with typhoid fever for about two days.  Resistance good.  Temperature range 100.2° F – 103.6 ° F.  Pulse good.  Treatment, baths, cold packs, liquid diet and salol.
Nov 14.  Patient made good recovery from typhoid.  Hair came out profusely, remainder cut off.  Patient even more foolish than formerly.
Jun 5, 1905.  No change.  Physical condition good, hardly a flicker of intelligence.
Feb 20, 1906.  No improvement mentally.  Physically well.
Nov 20, 1907.  Slovenly in habits.  Lies around on couches.  Eats well.  No mental change.
Sep 20, 1909.  No change mentally.  Very silly.  Mentally in good condition.
Nov 16, 1948.  Died.

Note: Patient listed as an inmate of DSH in census records for 1910, 1920, 1930, and 1940.
Note: “Salol” is a medicine, phenyl salicylate, used as a pain kill and fever reducer.


History and clinical notes:
History:  Has been acting strangely for about two years.  His wife left him some time ago and since that time has threatened and on several occasions has attempted assault on women.  Brought to institution in an intoxicated condition.
Oct 12, 1903.  Always complaining of something.  Does not sleep well at night and ordinary hypnotics do not seem to act.
Jan 15, 1904.  Says he wants to go home and “offers” one hundred dollars for a release; stands at windows and converses with some imaginary being.
Mar 2.  While working about grounds, he attempted to escape but was caught by Supervisor Nickle.  
Apr 12.  Attempted to masturbate and was placed in restraint.
May 2.  Struck on head by [another patient], producing an incised wound.
Jun 27.  Very much demented.
May 24, 1905.  Physical health good, mental condition not improved.
Aug 6, 1907.  Suffered from carbuncle but is improving.
Mar 3, 1909.  Limbs and scrotum oedematous with dyspnea.
May 12.  Paracentesis performed on scrotum. 
May 30.  Fluid rapidly accumulating in abdomen.
Jun 26.  Failing rapidly.
Jun 29, 1909.  Died.  Valvular disease of the heart.
Note: Paracentesis means to insert a needle to drain off fluid.  Usually refers to removing fluid from the peritoneal cavity, but in this case was done to the scrotum.


History and clinical notes:
History:  Has been having some sorts of attacks (epileptic?) for about 2 years.  Wanders about the community.  Very poor memory.  Quite demented.
Oct 12, 1903.  Very quiet and is contented.
Feb 28, 1904.  Condition about the same as when admitted, work about ward and is quite contented.
May 2, 1904.  Marked decline in mental state, attempts to masturbate when out of restraint.
Sep 16, 1925.  Died


History and clinical notes:
History: On the 5th of September was intoxicated and while in an altercation with another man was struck on the back of head with fist.  Was taken home and has never been right mentally since that time.  At times is dazed and again talks irrationally and incessantly, no special subject noticed.  Is steadily losing flesh and strength since he was hurt.  Head showed no signs of bruise after he was struck.  Sleeps fairly good at night.  Appetite is good.
Oct 10, 1903.  Much confused.  Declares he is but 29 years old.  Today slipped on the stairway and injured his left wrist.  No fracture found.
Feb 28, 1904.  Very much debilitated.
May 18.  Rapidly failing in health, occasionally has attacks of enteritis.
Jul 20.  Very weak and confined to bed, severe enteric disturbance.
Jul 27, 1904.  Died today.  Enteritis – senile dementia.


History and clinical notes:
History: Officers who bring patient know nothing of his history except that he was arrested in Wilmington on request of his mother.  Is violent at times and has threatened and assaulted his mother.  (Note: [paraphrasing] someone with the same first name and a similar last name, spelled differently, was admitted to this institution 2-24-94 and discharged 10-11-94).
Oct 12, 1903.  Very quiet.  Contented.  Respectful.  Eats and sleeps well.  
Feb 6, 1904.  Is very quiet, works about ward and buildings.
Jan 24, 1905.  Condition remains same as when last reported.
Mar 12, 1910.  Suffered from diarrhea for past two days; is confined to bed and is very weak.  
Mar 14.  Has developed a lobar pneumonia. L.S. and is rapidly reclining.
Mar 15, 1910.  Died 9:45 a.m. Lobar pneumonia.


Brought by:
Mr. Blackburn (Supt. of County Almshouse)

History and clinical notes:
History: Patient brought from County House by Supt. Blackburn who states that he has been an inmate of that institution for years.  For 5 or 6 weeks he has been acting strangely.  Thinks that people are trying to kill him by poison and other various ways.  Has epileptic attacks, about every month.
Feb 28, 1904.  Has frequent epileptic seizures, occurring normally during the night.
Aug 21, 1904.  Developed a strangulated hernia (inguinal).  Radical operation performed on Aug 22, 1904.
Aug 29, 1904.  Patient improving rapidly.
Dec 26, 1921.  Died.


History and clinical notes:
History: For eight or nine years patient has not been right.  Been more or less melancholy at intervals.  Do not know the cause of his trouble.  Has spoken frequently of injuring his people but never attempted it until yesterday, when he attempted to kill his father.  Has worked steadily until 2 years ago but has done nothing since.  Has lost flesh lately.
Apr 22, 1904.  Has been confined to bed for past two days suffering from a gastric disturbance.
Oct 15, 1915.  Has been confined to bed for past week, complains of severe lumbar pains, cough and expectoration, breath very foetid.  Temperature normal.
May 4, 1940.  Died.


History and clinical notes:
History: Patient was discharged from this institution 3-23-1900.  Has been quite clear mentally until a month ago.  Has strange ideas in regard religion – thinks she has a great mission to perform.  Thinks that her people have tried to get her property and have tried to poison her.  For the last few days has been very noisy and violent.  Has wandered from home.  Does not sleep very well.
Nov 12, 1903.  Improved steadily since admission.  Very rational.  Was transferred from Ward 3 to B.
Dec 15, 1903.  Was allowed to go home today by herself to her son in Salisbury, Maryland.
Jan 21, 1904.  Discharged recovered.


History and clinical notes:
History: Officer who brings patient knows nothing of her history – she was locked in Hall all night and he was ordered to bring her here.
Feb 19, 1904.  Quiet, health good.  
Nov 14, 1904.  Was violent the other day and attacked attendant with rocking chair, and bit a piece of flesh from her hand.  Was kept in restraint for several days.  Physical condition good.
Jun 5, 1905.  No change in any way.
Aug 2, 1905.  Patient stricken with pneumonia.  Right lung.  Coarse rales and some solidification.  Temp 104° F, pulse 120, resp. 60.
Aug 10, 1905.  Both lungs involved.  Fine bubbling rales left lung.  Temp 103°, pulse 118, resp 58.  Complains of great pain, delirious most of the time, prognosis grave.
Aug 20.  Temp. lower, pulse and respiration still high.  No delirium.
Sep 2.  Pulse 118.  Resp. 38, Temp 101° F.
Sep 13.  Patient rapidly sinking.  Very disagreeable odor from lungs, complains of great pain.
Sep 15, 1905.  Worse.  Odour more unpleasant, temp. subnormal.  Died at 3:40 p.m., pulmonary abscess.

Final disposition:
Died at DSH from pulmonary abscess.  Buried at DSH #136.


History and clinical notes:
History: Patient brought by officer who states that patient wanders about the streets.  Thinks he is an inventor.  Has been violent at times, breaking furniture, etc.  Thinks he is very wealthy and has other delusions of grandeur.
Nov 14, 1903.  Was visited by wife a few days ago.  After her visit, became so much worse that he was restrained.  During evening broke his strap and threatened to kill any one that came near him – was overcome and transferred to Ward 6.
Nov 20.  Has attacked attendant Hurly twice since being on this ward and is so violent at times that it is necessary to keep him in crib bed, especially at night.
Nov 23.  For past few days is more quiet and tractable, but is still kept in restraint, was visited by wife today.
Nov 27.  [Wife] called today to remove her husband from institution against advice of Superintendent, but Superintendent would not allow him to be removed.
Nov 29.  Very noisy, bowels moved in bed and he marked the walls with same.
Dec 8.  Today he said to Dr. Hancker and assistant that he wanted to go home and start in the “milk and cider business,” claiming you could not lose money in said business.
Feb 6, 1904.  He saw an advertisement in newspaper and wrote a letter applying for position.
Feb 17.  Insists on going home, says he prayed to the Lord and the Lord told him that his mind had been restored.
Mar 2.  Transferred to Ward 6 today and placed in “muffs.”  Has been very disagreeable for past week and says he will get “square” with officers of this institution when released.
Apr 4.  Has been quiet for past ten days.
May 2.  A gold watch and guard belonging to patient was given to his wife today.
Jun 12.  Has been extremely quiet for past 10 days and seems very much depressed.
Aug 6, 1904.  Paroled.
Aug 10, 1904.  Returned.  
May 20, 1905.  Is very noisy and has on several occasions struck his attendants.  Placed in restraint.
Aug 12, 1907.  Has lost considerable weight and is more quiet.
Mar 21, 1908.  Is confined to bed suffering from acute enteritis and does not respond to treatment.
May 3, 1908.  Died.  Exhaustion from chronic mania.


History and clinical notes:
History: Patient was paroled from this institution Dec 29, 1902 and discharged April 13, 1903 unimproved.  Wife states that since he went on parole he has had periodical attacks on an average of every 7 or 8 weeks.  Has been very troublesome, stubborn and irritable.  Is garrulous.  Sleeps fairly well.  Is untidy in person and habits.
Dec 25, 1903.  Has been very quiet for past 3 weeks.
Jan 5, 1904.  Is again noisy, fell on floor and received a contusion of scalp.
Feb 6.  Has been very quiet for past two weeks, eats and sleeps well.
Apr 4.  Condition about the same as when last reported.
Apr 3, 1905.  Has been confined to bed for past few days suffering from a growth on supra-clavicular region, probably malignant.
May 28.  Able to be up again and is somewhat improved physically.
Jun 2, 1905.  Paroled.
May 7, 1906.  Discharged unimproved.


History and clinical notes:
History: Father states that the patient has been an excessive cigarette smoker for 6 years.  He also masturbated.  Has done no work for 3 or 4 years.  Has been violent at times and has broken furniture and dishes.  Restless at night and would wander about the house.  Eats well.
Dec 31, 1903.  Condition mentally remains unchanged; he always refers to his genitals and seems to be his main topic when conversing.  Eats and sleeps well.
Feb 17, 1904.  Condition remains unchanged.  Sometimes he will stand near a window looking out for hours.  Physical condition good.  Although in restraint, he makes attempts to masturbate.
Apr 12.  Gaining in flesh.
May 11.  Paroled in care of father.
Jul 10.  Returned to institution today in care of officers, who state that he again became unmanageable at home.
Nov 12.  Quiet and works about ward.
May 23, 1905.  Condition remains unchanged, habits not improved.
Jun 2.  Paroled.
Aug 27.  Returned today.
Oct 18.  Has been quiet since admitted, slight mental improvement.
Dec 6, 1905.  Condition remains about the same as when last reported.
Dec 23, 1905.  Paroled.
Jul 13, 1906.  Discharged improved.

Additional notes:
In 1910, 1920, and 1930 Censuses, patient was at DSH; not found in 1940 census, no death information.Was paroled and returned several times during the course of this stay.


History and clinical notes:
History: Dr. Farlow states that patient was delivered of a living child about 2 months ago and that recovery was uneventful for two weeks and that patient was up and around the home when suddenly, without apparent cause, she attempted to jump out a window.  Religiously inclined – trying to preach and holding prayer meetings.  Wanders about the house at night, sleeping little.  Has been nursing the baby until yesterday.  Is affectionate toward the baby.  Has menstruated twice since birth of baby.
Nov 18, 1903.  Very noisy, imagines her children have been murdered.  Removed to Ward 3 today.
Dec 31.  Continually asks for her children and is noisy at times.
Feb 19, 1904.  Wants to be “persecuted for righteousness’ sake” by (??) continually or horsenhepper, put in a den of rattlesnakes, vaccinated all over, and various other methods of torture.  Grows thinner.  Eats well and is not noisy at night.
Mar 25.  Gynaecological examination – sensitive right ovary, marked anteroversion of uterus, cervix oedematous and red.  Sound passed 2 inches (sic), old laceration of perineum, healed.  Nurse states that she has not menstruated since admission.  Delusions continue.  Begs that her children may die with her, occasionally tries to commit suicide.
May 6.  Dr. Hancker obtained permission from patient’s husband to have an oophorectomy, to see if it will benefit her condition.  Yesterday patient tried to commit suicide by jumping off fire-escape.  Blood examination yesterday showed hemoglobin 70%, red count 5,640,000.  White count 13,000  Urine normal.  
May 12.  Patient operated on at 3:30 p.m.  [Ill.] well,  operation ended at 4:30 p.m.  Pulse 58, Resp 25.  Given hypodermic Strych and morphine.  Regained consciousness at 5:17 p.m.  
Jun 24, 1904.  Patient made uneventful recovery.  Stitches removed the 22nd of May.  Mind clear, memory good, no delusions, and to all appearances sane.  Paroled.
Jan 18, 1905.  Discharged recovered.  

Note attached on lined paper.  “Laurel, Del.  May 3, 1904.  Dr. Hancker, Dear Sir, I received your letter asking my consent to perform and (sic) operation on my wife and if you think it will be any benefit to her condition, you have it done and after the operation is performed you have her properly cared for, and if you perform the operation let me know immediately after it is done.  I remain, [husband’s signature].

Additional notes:
Readmitted 5/9/1931, at DSH until her death 1/7/1943 of uraemia and gen'l. arteriosclerosis.  Surgery to remove her ovaries to see if it would help her condition.  No entry for her and husband in 1910 census (to see if she had more kids).  But the two of them were alive and well at the 1930 census, but by the 1940 census, she was back at DSH as a patient, listed as married, so her husband was still alive.


On certificate of:
Drs. John B. Butler and Francis L. Springer

History and clinical notes:
History: Four years ago patient began to show signs of an unbalanced mind.  She does not seem able to recognize her friends and relatives, her main topic of conversation is in reference to the departed.  She is also untidy and breaks dishes occasionally.  On admission, patient had numerous contusions of body, caused by falling, also trophic sores on back.
Nov 17, 1903.  Has been in bed since admission.  Has been steadily failing and is very weak and feeble.
Nov 22, 1903.  Has failed rapidly and died this 5 p.m.  Senility.


History and clinical notes:
History: Patient was brought by officer who states that patient has been in jail for two days and was very quiet; aside from above statement, officer could give no history of case.
Dec 25, 1903.  Has been very quiet, has given no trouble since admission, works about ward and is rational.
Feb 6, 1904.  Very quiet and a good worker and seems very rational at all times.
Feb 26.  Condition remains the same as when last reported.  
Apr 12.  Always quiet and respectful.
May 28, 1905.  Quiet and respectful.  Works about kitchen.
Jun 12, 1914.  Is always quiet and well behaved.  Works in boiler room.
Jul 31, 1915.  Fell on floor in boiler room, producing fracture of tibia in close proximity to maleollus left leg.
Apr 29, 1925.  Died.

Additional notes:
Not at all clear why he lived at DSH for so many years.


History and clinical notes:
History: Patient was brought to hospital by husband, who states that he first noticed his wife’s mental condition about nine years ago.  She became troublesome, would quarrel with her husband and children, in fact any person she conversed with, she also wanted to gain possession of her husband’s real estate and wanted all the members of the family to leave the premises.  Husband also states that she will wander away from home and go to her father’s home and remain for 3 or 4 months.  She has never destroyed any article of  furniture or dishes.  At one time, husband states that she struck her mother without provocation.  Her appetite has been good, but she does not sleep well.  The father of patient was also insane but we could not obtain history relative to form, etc.
Nov 25, 1903.  Patient constantly asks about her children and says she will kill herself if not permitted to go home.  She also cries frequently.
Feb 19, 1904.  Patient walks up and down weeping and crying for her children, who are starving in the woods.  Is often profane and usually noisy at night.  Physical condition poor.  
Mar 31.  Patient is better.  Eats little and is very noisy at night.  Growing very thin and emaciated.
May 6.  Condition the same.  Very noisy, moans and cries continually for her children.  Physical condition bad.  Eats fairly well, but sleeps poorly.
Nov 14.  Patient continues to moan and cry for her children.  Is very emaciated.  Eats well, but is often noisy at night.
Jun 5, 1905.  Patient tramps up and down, yelling, all day long.  Had good appetite, noisy at night.  Very untidy.  Extremely emaciated.
Feb 20, 1906.  Still walks constantly.  Eats well.  Noisy at night.
Nov 20, 1907.  Very disturbed and noisy.  Eats and sleeps well.
Sep 25, 1909.  Patient walks up and down continuously, doesn’t sleep well, otherwise well.
Dec 8, 1939.  Died.


History and clinical notes:
History: Has been acting in a peculiar manner since June 1st.  At that time began to stand around in a dazed manner.  Would wander about the house at night, sleeping little.  Does not recognize, at times, either her home or relatives.  There is a history of her being injured in a runaway accident about one year ago.  Mind has been somewhat affected since the accident.  Is untidy and at times tears her clothing.  Eats well.  Body covered with scratches said to have been done by patient herself.
Dec 22, 1903.  Forced feeding has been necessary for past ten days but patient is again taking nourishment.
Feb 19, 1904.  Tears her hair out by the handful.  Transferred to Ward III.
Mar 6.  Brought back to Ward B.  Very violent and untidy.  Kept in restraint sheet pending removal to Tuberculosis Hospital.  Expectorates on floor and bed.  T.B.  present in sputum.
May 6.  Patient is now sitting up, expectorates a great deal and grows more emaciated daily.  Had a large boil back of left ear, which was opened and a large amount of pus and blood exuded.  Eats well.  Says “Mrs. [her own last name] is not here, she has gone on a stream of light to the Sunny South.”  
Jun 20.  Transferred to Tuberculosis Hospital.
Jul 10.  Patient’s condition has been about the same until early this morning, when attendant found her sitting in chair, muscles very rigid and entire body very cold.  Heart action rapid but regular.  Patient put to bed and artificial heat applied.
Jul 28.  Patient’s condition much improved.
Aug 20.  Patient growing rapidly more emaciated.  Has several obstinate bed sores.  Eats nothing but milk.
Sep 10.  Bedsores very bad.  Patient failing gradually, moans as if in pain frequently.  Emaciation extreme.
Oct 5.  Patient can hardly speak.  Is very weak, coughs a great deal, feet and hand much [ill.].  Seems to be in pain.  Morphine administered.
Oct 10.  Morphine ordered three times a day.  Bed sores in very bad condition.  Patient much weaker.  [Ill. – looks like ‘cecclynotic’] patches on wrists and forearm, one ruptured.  
Oct 13, 1904.  Patient died at 4:50 p.m.  Phthisis Pulmonalis.


On certificate of:
Drs. Jefferson M. Luff and Samuel T. Cubbage

History and clinical notes:
History: Patient was removed from hospital against the advice of the superintendent, on January 3, 1895.  She was brought back to institution on November 18, 1903, condition not improved.  Dr. Cubbage states that patient has been a nuisance ever since discharged, she would wander about streets at all hours.  She talks at random and is very vulgar.  Patient does not sleep well, but appetite is fair.  She is said to be a kleptomaniac.
Nov 20, 1907.  Patient industrious, quiet and well behaved.  Eats and sleeps well.
Sep 20, 1909.  No change.  Very silly.  In good condition physically.  
Oct 10, 1910.  No very marked change until today; became very stupid and somewhat staggering in her gait.  
Aug 11.  Is in bed, much weaker, cannot stand at all, nor understand what is said to her.  Is very noisy and delirious.
Oct 14.  Pupils widely dilated; will not respond to light.  Head hot, muttering delirium.
Oct 15.  Failed rapidly and died 3:15 a.m.  
Oct 15, 1910.  Died.  Pachymeningitis interna hemorrhagica.
Note attached, typed on letter head paper from Offices of Harvey F. Cooper, Attorney-at-Law, Suite No. 1, Law Building, Telephone No. 21.  Ridgely, MD, Dec. 12, 1903.  Dr. Hancker, Supt., Farnhurst, Delaware.  My dear Sir: We forward to you this letter than you may know the residence of the mother and sister of [patient] and would ask that in the event anyone attempts to have her released from your custody that you will communicate with us before same is done.  She was released from the asylum about five years ago under a guarantee of [name redacted] of Wilmington and a Mrs. [name redacted], whom we do not know.  The family was not consulted about the matter.  If you will grant us this favor, we will greatly appreciate it.  Very truly [signatures of mother and sister].  
At the bottom is a hand-written note that says: “This is to certify that I signed the name of [one of signers of letters] above written as per her request.  She being so nearly blind that she cannot see to write at all.” [Signature of someone with same last name].

Final disposition:
Died of pachymeningitis interna hemorrhagica

Additional notes:
Letter from relatives saying not to let strangers check her out of the hospital!


