Patients - Explore Bethlem

Name of Patient.

Ada Jane Warren

Gender.

Female

Age.

28

Admitted.

November 11th, 1892

Residence at or immediately previous to date.

13 Caldervale Road, Clapham

Rank, Profession or Occupation.

Wife

Degree of Education.

Good

Religious Persuasion.

Church of England

Married, Single or Widowed.

Married

Number of Children.

Four

Age of youngest Child.

5 weeks

Whether the first Attack.

Yes

Age on first Attack.

28

Duration of existing Attack.

Since Sunday, November 6th, 1892

How many previous Attacks.

None

Confined in any Lunatic Asylum.

Nowhere

Where.

-

When.

-

And how long.

-

Supposed cause of Insanity.

After child birth

Exciting.

Puerperal

Predisposing.

Heredity

Whether Suicidal.

Yes

Whether dangerous to others, and in what way.

Yes

State of Bodily Health.

Good

Whether of sober habits.

Yes

Relatives afflicted with Insanity.

None known

Urgency Certificate. (if any).           Gavin Stiell, 27 Elms Road, Clapham Common, S.W.
a. Facts indicating Insanity observed by myself at the time of Examination, viz.—
She informed me that she was dying and that she had been dead and that her child was dead and that I was dying. She threw the toilet jay full of water at the nurse and myself. She is very violent and requires great restraint to observe her.

b. Facts communicated by others.
Julia Redding, 2 Bulstrode Street, W. Nurse. Says she set fire to the curtains, that she has tried to jump out of the window and that she is quite unmanageable. She refuses to take food.
November 11th, 1892.

1st Medical Certificate.         Howard Distin, 153 Kennington Road, S.E.
a. Facts indicating Insanity observed by myself at the time of Examination, viz.—
I found her talking loudly to herself and shouting at intervals. She said God had just opened the door of her room. On being asked a question she replied by incoherent shouting and suddenly knelt down in a corner and began praying.

b. Facts communicated by others.
Mary Crutchfield, Attendant, Bethlem Royal Hospital, informs me is sleepless and very noisy and said that her mother was in the bed-room with her all last night, which was not the case.
November 12th, 1892.

2nd Medical Certificate.        Gavin Stiell, 27 Elms Road, Clapham Common, S.W.
a. Facts indicating Insanity observed by myself at the time of Examination, viz.—
She informed me that she was dying, that she had been dead and that I was dying. She threw the toilet jay at the nurse and myself. She refused to take food. She was extremely violent throwing things all about the room.

b. Facts communicated by others.
Julia Redding, 2 Bulstrode Street, W. Nurse. Informed me that she tried to get out of the window, that she set fire to the curtains, that she tried to swallow her rings and the nails in the wall.
November 11th, 1892.

Discharged.

Left the Hospital.

Died.

Relation of Informant to Patient:   Husband.

Family History.
All children healthy and well.
Insanity or other Diseases of Nervous System:
Mother had an attack of Puerperal Insanity with her 4th child.
Phthsis:   No.
Alcoholism:   No. (Mother takes fair amount of alcohol).
Diabetes:   No.
Other Diseases:   No.

Previous History.
Neuroses in Patient:   None known. Hair comes out all her life.
Acute Rheumatism or Chorea:   No.
Fits – epileptic or hysterical:   No.
Fits – infantile:   No.
Fevers, &c.:   No.
Syphilis:   No.
Other Diseases:  
? Influenza 7 years ago. Had tooth out under CHCl3 ([Chloroform]), and she was very bad after it.
Sober:   Yes.
Number and nature of previous attacks:   First attack.
Injuries or shocks:  
Just before child was born a curtain took fire, and frightened her very much.
Catamenia:   Yes.

Present Attack.
Time of earliest symptoms:  
Had worried a little after the confinement but Nov. 6, 1st symptoms.
Nature of earliest symptoms:  
‘Burst out crying at dinner.’ Had CHCl3 and is ?? at Confinement.
Progress of case:
Had not been sleeping after CHCl3, she thought that she was dead, she has mentioned that again. Sunday she was ill. Hysterical on Monday (7th), thought that she was dying, then that she was dead, then that everyone else was dead. On Tuesday (8th) was much better. Said her husband was dying and gave him Brandy etc. Wednesday (9th) was very violent and refused food. Sang for 4 hours on Thursday. Said that she was Patti. Tried to swallow things.
Suicidal or Dangerous (facts):  
Said that she would kill the children and her husband.
Tendency to leave home:   No.

Hallucinations (observed before admission).
of Sight:   No.
of Hearing:   Heard friends under the bed and in the next room.
of Taste:   No.
of Smell:   No.
of Common Sensation:   No.

ON ADMISSION.

Presence or Absence of Bruises:   Free from bruises.
Tongue:   Clean.
Palate and Teeth:  
Appetite:   Good.
Bowels:   Constipated.
Hallucinations of Taste and Smell:   No.
Delusions related to Digestion or Food:  
Used to think that the food was poisoned when she was at home, she said, and that is not the case now.
Poison:  
Obstruction:  
Abdominal Viscera:  
Pelvic Viscera:  
Catamenia:
Urine:   1020. Acid. No sugar or albumen.
Heart, Pulse, etc.:   Normal (Difficult to examine. Noisy and violent).
Lungs:   Normal.
Eyes and Sight:   Good.
Pupils:   Dilated.
Hallucinations of Sight:   No.
Irides:  
Ears and Hearing:   No.
Hallucinations of Hearing:   No.
Common Sensation:   Normal.
Temperature:   Normal.
Hallucinations of Common Sensation:   No.
Delusions, Exaltation:  
Delusions, Depression:  
Suicidal:  
Homicidal:  
Memory, Recent:   Fair.
Remote:  
Reaction to questions:   Always repeats questions first but will answer them.
Sleep:   Very badly.
Dreams:  
Walk:   Good.
Reflexes:   Exaggerated.
Dynamometer:  
Weight:  
Handwriting:  
Speech:  
Diagnosis:   Puerperal melancholia.
Prognosis:   Good.

Mrs. Warren is a fair-haired, well nourished woman. Her manner is very dramatic. She has been very violent and excited, striking the walls with her fists; at other times kneels down with her head bowed, and hand covering her face. Her reaction to questions is decidedly slow, and she always repeats the question before answering it. She tells me that she has not heard any voices but that last night she saw her mother in the room watching her. She also tells me that her food was poisoned before she came in and that she believes that it was her husband who put the poison in. She says that her food is not poisoned now, and that it was only her husband who means to kill her. Later on she told me that she was dead. While talking she suddenly becomes very violent and orders you to leave her room. She is clean in her habits. Her general health is very good and she takes her food well.

Nov. 14 – Mrs. Warren is still sleeping very badly, shouting a great deal at night. She mistook me for her husband this morning and was very violent. She kept put[ting] up her right hand in defence as if expecting a blow; when asked why she did it, she told me that she knew that I meant to kill her. Her clothes (bed-clothes) were all packed up in the corner of the room as she said that ‘she was leaving soon.’ She is taking food well, and her bowels are regular.

Nov. 19 – Her excitement has passed off and she is depressed and crying frequently. She will not answer questions readily. Is sleeping badly and does not take her food well.

Nov. 20 – Today has been very excited again.

Nov. 22 – Has been sleeping better; not so excited; takes food well. Rather depressed.

Nov. 25 – Mrs. Warren has been having the Continuous bath daily for 3 hours. She has greatly improved with it. While in the bath she is perfectly rational and will talk and answer questions well. She tells me that she enjoys them. She is sleeping very much better, 6 and 7 hours a night. Takes food well.

Dec. 2 – Continues to sleep better and has ceased to take night sleeping draught; last night was not so good being only 3 hours. Her general condition is improving. Takes food very well. She is still having this prolonged bath. Still a little confused and restless.

Dec. 11 – Mrs. Warren is in about the same condition. Sleeping better. Is depressed and silent at times.

Dec. 18 – Is still depressed and silent. Refuses to speak to her husband. Taking food well.

Dec. 26 – Still depressed, will not converse. Has left off having the Continuous bathes. Sleeps well.

Dec. 31 – Still full of delusions and depressed.
1893.
Jan. 8 – Has been very depressed lately, and will not talk but is sleeping well and takes food.
Jan. 19 – Continues in much the same condition.

Feb. 2 – Has been more excited lately; general health slowly improving.

Feb. 14 – More cheerful. Now sleeps well without a draught. Still full of delusions, and ordered her husband away on his last visit.
Mar. 15 – Is very quiet and seems quite lost, though when spoken to she talks more than she used to.
Apr. 5 – Has now been regular at her monthly periods for 3 months. Is still very confused and full of delusions. Is dirty in her habits.
May 4 – Continues in much the same condition.

May 30 – No change. Still dirty in habits. Has got much stouter.
Jun. 20 – No change.
Jul. 11 – Very little improvement. Still dirty in habits. Very confused and lost.
Aug. 6 – Has been more excited lately but still very confused.
Sep. 16 – Seems brighter, but still very confused. Does not dress herself.
Oct. 18 – No change.
Dec. 14 – No change. Is apparently becoming demented. Talks to herself. Stands in fanciful attitudes. Untidy in dress and course in appearance.
1894.
Jan. 26 – Appears to take more interest in her husband and his affairs, was quite affectionate at her last interview with him. Is, however, apparently rather demented.
Mar. 30 – No change.
Is still deluded as to identity. Has halls?? hearing. General excitability and does not seem to advance toward recovery.
Apr. 18 – Discharged uncured.