Last admission.  

Name of Patient.

Edwin Ernest Howard

Age.

18

Admitted.

May 20, 1892

Residence at or immediately previous to date.

13 Edith Road, Peckham, S.E.

Rank, Profession or Occupation.

Clerk

Degree of Education.

Fair

Religious Persuasion.

Church of England

Married, Single or Widowed.

Single

Number of Children.

Age of youngest Child.

Whether the first Attack.

No - Third

Age on first Attack.

15 and 3 months

Duration of existing Attack.

Fifteen days

How many previous Attacks.

2

Confined in any Lunatic Asylum.

Yes

Where.

Bethlem Royal Hospital

When.

January 1890 and July 1890

And how long.

Supposed cause of Insanity.

Weakness following inflammation of the bowels

Exciting.

Predisposing.

??

Whether Suicidal.

No

Whether dangerous to others, and in what way.

Not vicious to attack anyone, but he turns on gas jets and he has taken down a length of gas-pipe, and has got on the roof of the house, dropping down flower pots into the garden below.

State of Bodily Health.

Bad

Whether of sober habits.

Relatives afflicted with Insanity.

No

1st Medical Certificate.           H.G. Turney, St. Thomas’ Hospital, S.E.
a. Facts indicating Insanity observed by myself at the time of Examination, viz.—
He asserts that he is the possessor of ?? of “?? force” and electricity. He is very voluble and excited, his talk consisting largely of a jumble of the multiplication table, with a few coherent sentences.

b. Facts communicated by others.
Urban Howard (father of the above) compositor of the same address tells me that his son has absurdly exalted ideas of his own strength and other qualities, that he is very destructive, tearing up his clothes.

2nd Medical Certificate.       
a. Facts indicating Insanity observed by myself at the time of Examination, viz.—
Same as Urgency.

b. Facts communicated by others.
Same as Urgency.

Discharged.

Left the Hospital.

Died.

Relation of Informant to Patient:   Mother.

Family History.
Insanity or other Diseases of Nervous System:  
Grandfather childish 90 years old. All sisters very nervous and neuralgic, most have had teething convulsions, father asthmatical.

Phthsis:   No.
Alcoholism:   No.
Diabetes:   No.
Other Diseases:   One sister had rheumatic fever.

Previous History.
Neuroses in Patient:   Always very nervous. Headaches. Neuralgia.
Acute Rheumatism or Chorea:   No.
Fits – epileptic or hysterical:   No.
Fits – infantile:   Yes.
Fevers, &c.:   Most of fevers of childhood.
Syphilis:   -
Other Diseases:   -
Sober:   Yes.
Number and nature of previous attacks:  
2 in Bethlem Royal Hospital. Excited and noisy.

Injuries or shocks:   Peritonitis inflammation.

Present Attack.   Relation of informant – Father.
Time of earliest symptoms:   3 weeks ago.
Nature of earliest symptoms:   Excited. Quarrelsome.

Progress of case:
Exalted ideas of his own cleverness. Wanted to put an advertisement in the ‘Times’ offering to cure the son of the Duke of Norfolk. Pretended to mesmerize lamp-posts.

Suicidal or Dangerous (facts):   No.

Tendency to leave home:   Yes.

Hallucinations (observed before admission).
of Sight:   No.
of Hearing:   No.
of Taste:   No.
of Smell:   No.
of Common Sensation:   No.

On Admission.

Presence or Absence of Bruises:   None.
Tongue:   Slight fur.
Palate and Teeth:   Arched.
Appetite:   Good.
Bowels:  
Hallucinations of Taste and Smell:   None.
Delusions related to Digestion or Food:   None.
Poison:   None.
Obstruction:   None.
Abdominal Viscera:  
Pelvic Viscera:  

Urine, sp. gr.:   1030 Clear. No albumen or sugar.
Heart, Pulse, etc.:   110. No murmur.

Lungs:   Normal.

Eyes and Sight:   Good.
Pupils:   React to light and accommodation.
Hallucinations of Sight:   None.
Irides:  
Ears and Hearing:   Good.
Hallucinations of Hearing:   None.
Common Sensation:   Good.
Temperature:   98°f.
Hallucinations of Common Sensation:   None.
Delusions, Exaltation:   General feeling of mental and physical superiority.
Delusions, Depression:   None.
Suicidal:   No.

Memory, Recent:   Good.
Remote:   Good.
Reaction to questions:   Fair, inattentive.
Sleep:  
Dreams:  
Walk:   Good.
Reflexes:   Knee jerks slightly exaggerated.
Dynamometer:  
Weight:  
Handwriting:  
Speech:   Clear.

Diagnosis:   Acute mania.
Prognosis:   Chronic instability.

May 21 – Patient is a short pale thin youth with black hair which he says is electric. It certainly feels dry but does not crackle. Is very restless and talkative, with out regard for propriety, makes remarks of patients and doctors personal appearance. Says that Dr. Cromer has grown and “filled out” since he was here last. Says that he is extremely well read, and talks very fast, occasionally pausing and passing rapidly from one subject to another. Gave me his views about Darwin, the Moors, the American War of Independence and many other subjects; showing a considerable knowledge of the subjects. Asked how he knew about these things says that he reads the Encyclopaedia Britannica a great deal. Asked what has been the matter with him, replies “Oh! satyriasis.” Thinks that he is quite sane at present and that anyone who differs from him must be insane. Appears to think a great deal of his own knowledge and abilities. Says he has made a special study of insanity with a view of getting the release from asylums of sane people who are wrongly confined in them, and is thus following the steps of his namesake, Howard the Gaol reformer. Talks about the Duke of Norfolk’s son, and also about Lord Howard of Effingham who commanded the English Fleet against the Spanish Armada.
May 23 – Condition unchanged. Tears up articles of clothing “because they belong to Bethlem Hospital” but his own clothes he is careful not to destroy – Sleeps fairly – Takes well.
May 28 – Very excited and restless, walks around Airing Court with trousers turned up to knees, rolls about on grass. Tears up bed at night. This morning said to me, “Hello Dr. Jekyll, anyone going to Hyde Park this morning?”
Jun. 4 – Less destructive, but talks as fast as ever. Is said to be consorting a lot with another patient to murder.
Jun. 21 – No change.
Jul. 2 – Complains much of toothache to day, and has some very bad teeth. The suffering seems to have somewhat improved the mental condition.
Jul. 20 – Much better, is quite clean, does not talk nearly so much, and occupies himself with the work of the ward, is quite tidy in his appearance.
Aug. 16 – To Witley.
Aug. 24 – 3 months extension.
Sep. 1 – Escaped from Witley, and walked home to Beckenham, from whence he was brought here again. Had been some trouble at Witley before his escape, upsetting other patients.
Oct. 5 – No change.
Oct. 12 – Leave of absence 1 month.
Nov. 9 – Extension 1 month.
Dec. 7 – Discharged well.