William Utting, 1815-70

Wiliam Utting 1815-1870

Case notes for William Utting, whilst under Dr Wm. Tayaton
Norwich Lunatic Asylum (later St. Andrew’s Hospital)
Records Case Book, Ref. SAH 264

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Case notes, pp.671-2

William Utting aged fifty three years married is an ostler living at Downham Market, is of no education and belongs to the Church of England.

Marginal Notes:
Epileptic Maniac
Admitted Novr 7th 1868.

History
For a period of six or nine months he has been the subject of Epilepsy, having from three or four seizures during the month, he has frequently complained of his head, and for some time has been strange in his manner, insamuch that he would put on his clothes wrongly and when spoken to appeared much bewildered, this last month he has been getting worse, his actions and conversation being very childish and inconsistent, he said that he had only two children whereas he has five, his memory is much affected, and he cannot give names to the most ordinary things, he also suffers from mental stupor, his wife says that he lets down his trousers before people and micturates in the presence of any person, and in his own kitchen he also jumps on the top of chairs and chests and tears his bedclothes.

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He has threatened to commit suicide and to strangle his wife, his habits are said to be dirty. This is the first attack and the only traceable cause is intemperance, there is no hereditary disposition and twelve months ago he suffered from Delirium Tremens. Both legs and his right elbow are bruised and he has a fractured rib on the right side.

[Nov] 14th [1868]
This man has been no trouble since his admission he has complained somewhat of his side but has expressed himself as feeling easier, he seems to be in a depressed condition of mind at present and remains very quiet; he sleeps well at night time and has had no signs of Epilepsy.

[Nov] 22nd [1868]
Remains in much the same condition, depressed in mind, he breathes with comfort now, his side being much better.

[Nov] 26th [1868]
Had an Epileptic seizure this morning.

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Decr 2nd [1868]
These last two days has been excited, yesterday evening he struggled with an attendant, when they fell together, the consequence of which was that this patient suffered a fracture of the lower end of the Tibia, is very restless and excited & this evening ordered Morph: Acet (1 - see Notes below): g½

[Dec] 5th [1868]
The leg is swollen and painful, ordered (? Lotis Spr: ? Rect) to be frequently applied the splints have been removed on account of large bulla (Note 2) having formed.

Jany 4th 1869
Up till now he has remained quiet in bed, but to day has become excited endeavouring to get out of bed and to walk with his fractured leg, ordered to be dry packed through the night

[Jan] 5 [1869]
Ordered to be again dry packed tonight and Morph: Acet: (?g) to be administered.

[Jan] 26th [1869]
Has progressed favourably up till this time, the fracture has fairly mended, and he is able to get about on it, is now in bed having had two or three Epileptic seizures lately

1870
May 6th
The fits occur at uncertain intervals between which he is useful on the Ward. A few days preceding and succeeding the attacks he is confused, restless, face congested, refuses food and disposed to hide the things &c

Septr 11th [1870]
Is very stupid and restless from Epilepsy, in the padded room, complains of pain in the left side

Case notes, p.678 continued from p.671

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Septr 12th 1870
One rib discovered to be fractured on the left side. Supposed to have been caused from a fall during a fit, upon the side of the bedstead & plaster and flannel roller applied & removed to bed on the infirmary – 19th He has remained very quiet, but suffers from dyspnoea (Note 3) and wishes to have the bandage taken off, he has not had another fit yet.

[Sep] 24th [1870]
Had an attack of severe dyspnoea this evening. [various medication listed] … the bandage to be removed. 26th was restless yesterday and out of bed frequently. 27th. A stethoscopic examination of his chest was made this day, and besides slight Bronchitis he was found to be suffering from extensive disease of the heart a loud aortic bruit (Note 4) being distinctly audible, his pulse also intermits about once in seven or eight beats. The dyspnoea seems increasing, and he very congested at times.

Octbr 4th [1870]
Is suffering much, his Bronchitis having increased. He is now subject to frequent and severe attacks of extreme dyspnoea, occurring most often towards night. For the last day or two he has been more restless and the expression of his face confused, it is to be feared a paroxysm of epilepsy to be approaching.

Case notes, p.664 continued from p.678

Octr 11th 1870[1870]
Has not yet had a seizure, but is stupid and restless he tore down his bed curtain to day folded it up placing it under the mattress, in other respects he remains the same.

[Oct] 18th [1870]
His breathing is more oppressed, and the paroxysms of orthopucea (Note 5) occur more frequently. His respiration is chiefly abdominal and there is great bulging of the chest, percussion gives an unnaturally resonant sound, and the vesicular murmur (Note 6) is very indistinct, large crepitation (Note 7) also can be heard in the lower portions of each lung, the diagnosis formed therefore from these signs is that both lungs are emphysematous (Note 8).

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[Oct] 24th [1870]
He has had a most severe fit to day, in consequence he is much distressed, all his thoracic symptoms being greatly aggravated.

[Oct] 26th [1870]
Has had another fit, but of a milder description, the paroxysms of dyspnoea are becoming more frequent and severe, and his strength is failing, he continues to take the Æth: Sulph: Tinct: Salla & Senega (Note 9)

[Oct] 30th [1870]
In the last three days his breathing has been more even, and he expresses himself as feeling better

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Novr 5th. [1870]
No material change for the worse took place, but he died quietly in the presence of Wm Wells. A post mortem examination of the contents of the chest was made (The cavity of the abdomen was full of serum, as also the l/h side of the chest). Heart much enlarged and dilated. The Aortic valves being much greatly disorganized, and the seat of excessive ossific deposit. The lower portions of both lungs were collapsed the remaining part of each being emphysematous, the air cells and tubes contained a frothy mucus.
Wm Tayaton

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The inspiration to look for William's medical record was a comment in a letter from his granddaughter, Lily POPE (nee MORLEY) that "His life was tragic and Grandma [Sarah SMITH] told me he was out exercising one of his father's racehorses and it threw him which affected him later. It hurt his brain. He was home with Grandma for a time the doctors said he could be dangerous so he must go away and he was sent to a mental home at Holt in Norfolk. Grandma was allowed to go and see him sometimes but he was too ill to be seen, and he died there. Grandma told me this when I was a schoolgirl and used to go and stay with her so Auntie Hannah could go to London for a holiday."

The asylum wasn't at Holt, although not a million miles away, but it was only a search for a suitable death record (an UTTING born in 1815 who died in Norfolk after 1861 (he appears in the 1861 Census) but before 1871 (he doesn't appear in the 1871 Census) that eventually located William's death in the Blofield Registration District, just outside Norwich. A copy of his death certificate showed the place of death as 'Lunatic Asylum, Thorpe'.

Nigel Utting, March 2010

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Notes:

(1) From Journal of Mental Science (1879): “Dr.McIntosh, the Superintendent of the Perth Asylum, writes:- The statement made seventeen years ago in advocacy of the retricted use of the injection of acetate of morphia in every asylum as one of the “most effective opiates, as calmative to the depressed and despairing,” and the expression of its great value “where restlessness, excitement and dirty habits occur at paroxysmal periods,” can now be endorsed and extended by ample experience.

(2) ‘bulla’ - a large fluid-filled blister

(3) ‘dyspnoea’ = marked shortness of breath

(4) ‘bruit’ = an abnormal blowing or swishing sound or murmur resulting from blood flowing through a narrow or partially occluded artery.

(5) ‘orthopucea’ = marked shortness of breath

(6) ‘vesicular murmur’ = normal breathing sounds

(7) ‘crepitation’ = a crackling sound heard in (infected) lungs

(8) ‘emphysematous’ = emphysema is an abnormal increase in the size of the air spaces (alveoli) within the lungs, resulting in laboured breathing, reduced oxygen absorption and an increased susceptibility to infection

(9) Senega officinalis = Snake Wort, extract used in homeopathic medicine for treatment of bronchial problems