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To detail minutely Mr. Guise's
medical history would require a volume;
I can only pretend to give a very general
View of it, which I hope will be sufficient
to inable a Physician of discernment
to form a knowledge of his constitution
and his present disorder.

Mr. Guise is at present about fifty
years of age, an Englishman of a stature
above the ordinary size, of a strong make
of body, of a cheerful gay disposition
when in health, and whose general
character is that of an inoffensive
good-natured man.

He has been an officer in the Army from
his early youth, married when young, and
has a numerous family of healthy children.
In the year 1752 he went with his regiment
to Gibralter, in which Garrison he remained
upwards of ten years. After enjoying good
health there for twelve months he became

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affected with great perturbations of mind,
which was occcasioned by what he deemed
an impropriety of behaviour after taking
the Sacrament. Various Nervous afflictions
and many symptoms of melancholia religiosa
followed which rendered him unfit for duty,
and at last terminated in what was called a
fever in the Nerves; from this he gradually
recovered, and returned to his duty, but was
subject to frequent fits of Enthusiasm.

After this he continued several years in
tolerable health and spirits, but was again
attacked with different Nervous Symptoms
in 1762; he grew weak, after turned sick and
faintish, his feet were at these times extremely
cold, and his thoughts were disturbed. After
enduring a Variety of distreses both in body
& mind, a consultation of the physicians
& surgeons of the Garrison was requested
and held; They imputed his disorder to the
climate, and recommended an immediate
change to a cold one, one of the Gentlemen

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declaring that if he remained there three months
longer he would either lose his senses, or
his life, if not both. A blister for the head
and nervous laxative pills were prescribed
and from these he experienced considerable
relief.

He now obtained leave to return to England,
where he arrived in October 1763, and from thence
he came to Montrose soon after.

Mr. Guise's health was soon reestablished
in Scotland, and nothing of consequence I am
informed, happened for several years, except
a sore in his leg which proceeded from a slight
external injury neglected; it was said to de¬
generate into a scorbutic ulcer. It was of
tedious cure, but at last healed up, & chiefly
as he thought, by the internal use of the Sulphur
& cream of Tartar. Mrs. Guise tells me that
Mr Guise was always supposed to be of a
Scorbutic habit of body, and that he long had
eruptions of that kind, particularly on his
back, which totally disappeared when he
laboured under his nervous disorder. Since
his residence in this place his chief amusements

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& employment have been walking, fishing &
Gardening. He has always had a good appetite,
been accustomed to a full animal diet, and now
and then indulged in a chearful glass. - When
I first attended him in 1773 he complained of a
pain & noise in his head with giddiness, uneasiness
at stomach & heartburn with costiveness. For
these he took a vomit, a purgative Volatile
Valerian drops & Magnesia. -- In 1774, be¬
sides the above complaints, he had, two or three
violent attacks of spasmodic Colic, which yeilded
to the usual remedies in such cases. In one
of these, after the violence of the Colic was abated,
a pain of the side, & some feverish symptoms, I
thought indicated bleeding, but which I did not
venture to perform till I had the advice of a very
old physician - it relieved him much.

After this I desired him to be more careful
respecting his diet - to abstain from all flatulent
food, cold fruits, acids & malt liquor, and to use
spirits & water instead of other strong drinks,
unless at times a glass of strong wine. This
he observed pretty carefully; the Spirits &
Water he liked very well, used freely, and

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sometimes before dinner, but as usual
the same proportion of spirits did not give
the same stimulus of strength when habituated
to it, he therefore drank it stronger & stronger.

In the years 1775, 1776-77 & 78, he was
much in the same way, not often seized with
the Colic, but frequently ailing. In the begin¬
ning of last year, the Head-ach, giddiness &
noise in his head became much worse; he
was often in danger of falling from the gid¬
diness, particularly after stooping; which
was often the case in his Garden. About this
time I was afraid of an Apoplexy seizing
him. He complained of pains in different
parts of his body, besides his head, particu¬
larly the breast; his eyes were at times
slightly inflamed, he slept ill and had
disagreeable dreams, lost all relish for his
Garden, and his usual amusements in his
own house. He became uneasy in his mind
and religious thoughts frequently disturbed
him. Various nethods of amusing him were

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tried, he now and then rode out in a chaise, turned
fond of Billiards, which as a diversion did very
well for some time, but he found his head much
affected by going round the table, & leaning over
it, and he was at last obliged to give them up. Ner¬
vous medicines as they are called, were given and
Laxatives. The Symptoms increasing I took
away some blood from the Arm, gave him purgatives
and recommended a spare diet.

In the month of June he turned much worse,
and was particularly uneasy in the night, he slept
little and was affraid to shut his eyes; when he
attempted to do so, he imagined that fire like flashes
of lightening darted from his eyes; he was in
considerable uneasiness of mind from melancholy
religious thoughts –– One day about this time
he rode out on horse back, the first time for
many years, about six miles from town and
returned in the evening. In going out his
spirits were much elevated, but when he came
home, he found himself exceedingly fatigued
& had a worse night than he had yet experienced.
Another Gentleman was now called in, who

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was intimately acquainted with Mr Guise, &
who, tho he did not formally attend him, knew
all his complaints, and often saw him. - We
applied several large leeches to the temples, and
his hair was cut out, the head shaved, and a
small blister applied to it, which was after¬
wards kept open by issue ointments. In a
few days a Seton was inserted in the neck,
he took some doses of Castor, and Camphor
and his belly was kept open. There was a
moderate discharge from the Seton, but it
was extremely painful to him; in a short time
after his neck swelled, and at last came to
suppuration in the neghbourhood of the
Seton; the latter lay deep, & was let out July
23d by the Scalpel; it was very offensive, the
discharge afterwards was never laudable, as
it is called, but had the appearance of serum
mixed with glue, with oily particles swimming
on the surface. It continued to run for several
weeks in considerable quantity, an Ounce or
two sometimes in 24 hours, which weakened
him much. On this account, and as Mr Guise
was considerably better the Seton was gradually

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withdrawn, and allowed to heal. While both
places were upon the right leg became very pain¬
ful, and greatly swelled, but it had not an
Anasarcous appearance. At this time
three doses of bark were taken daily. In a
few weeks he mended considerably, and
then went to the country where he staid about
6 Weeks. He had now a very good appetite,
slept well, was in good spirits, & took a good
deal of exercise; he now & then indeed com¬
plained of the noise in his head, but he has
constantly had more or less of that ever since
he was first taken ill at Gibralter.

Towards the end of October his con¬
plaints gained ground again, he got a purgative,
a box of Asafoetida & Camphor pills, & nervous
Drops, a spare diet was again enjoined - the
pains in his left breast, and in different
parts of his body were very troublesome;
he complained likeways of pains & wind
in his bowels, and uneasy religious thoughts
disturbed him much, & as before these and

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all his complaints were worst in the
night. He could not amuse himself, nor
be amused: he was affraid to look into a
book, the letters of which he could scarcely
distinguish from each other, and was con¬
stantly absorbed in thought, his numerous
distempered Ideas always respecting
himself, his disease, & his salvation -
Every thing turning worse, and his pulse
being very full, some blood was taken from
him on 3d December & his purgative Electuary
again ordered. On the 6th a large blistering plaster
was applied between the shoulders,
he would not consent to its being put upon
the head least it should occasion the
swelling & knots in his neck again. The
blister discharged freely - he turned at
this time perfectly delerious; slept none
for two or three nights, and seemed to have
a degree of fever, his pulse being about 90
at times except at this time his pulse
never was above 80, generally about 70,
but always full, & very often strong. It was

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found necessary to have two or three men
always beside him, and it was often with
difficulty that they could keep him in the bed,
or in the room. It would be needless to men¬
tion the symptoms of a disturbed imagina¬
tion that now appeared; besides fancying
that hideous faces were constantly staring
at him, and spirits wanting to lay hold
of him, the least scratch upon the curtains
of the bed, or motion of them made him
startle & often spring out of bed with
amazing agility; he was sometimes in
terror at the sight of food, & when he
ventured to take it, it was voraciously
and suddenly as if in haste to get it out
of his sight - he took but little, & seldom
required a drink.

It was with difficulty that any thing
could be done to him, however Injections
were occasionally administered - On the
11th he was bled again, and had a Camphor
Bolus at night. On the 17th we

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took away about 14 ounces of blood; this
evidently calmed him, and he has never
since been furious. After this he gradually
mended. On the 26th his pulse was more
full, and his head more affected. 8 ounces
of blood were taken away. Recourse was
had to this, as being the only thing with
Abstinence that seemed to do him good.
He was now perfectly sensible, his appetite
returned, but all animal food was forbid,
and things of light nourishment and
easy digestion recommended, and a total
abstinenece from strong liquours of every
kind, for some time.

January 10th 1780 he felt himself worse
could not amuse himself, complained of
his head & as before, his pulse as usual
full - I took from the Arm 8 ounces blood.
His belly all this time was kept open
by the Electuary.

January 19th His daughter a married Lady

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called on me & desired I would go &
see her father; that a litte before he had
almost frightened her out of her wits, by his
screaming out violently all of a sudden
then running behind the bed, & attempting
to hide himself in a corner. I had now such
an idea of his distress, and the method of
cure that I could not help exclaiming
"Madam, this is terrible, we cannot
bleed him to death" - however when I
saw the condition he was in, and felt the
strength and fulness of his pulse, I thought
it absolutely necessary to take away a con¬
siderable quantity of blood about 12 or 14
Ounces. After putting him to bed I sat down
beside him, and observed that the pulse
instead of being weaker, rose considerably
in strength; dreading therefore that he
would become furious again, I untied the
ligature, and designed to take a cupful
more of blood away; I got only an ounce
or little more for two or three days. After

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this he was in considerable distress, talked
much to himself, but was easily managed.
In the night he got several sleeps, but often
shriek'd out, and sat up in the bed, but
did not offer to come out of it. He was
also able to lye with his head pretty
low, which was not the case in the
former violent attack.

On the 26th a blister was put upon the
head, & it is now open - for some days past
he has been easier & sensible, only he
complains of Vertigo & the loss of his
memory - that he cannot distinctly
recollect any house or place with which
he was formerly acquainted - that every
thing appears darkened, & his Mind
dark –– Besides what has been already
taken notice of, it may be proper to
mention that Mr Guise had a brother who
intirely lost his senses when at Colledge,
owing as was said to his companions

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bringing him to a mock trial, and passing
sentence of death upon him - he had also
another brother subject to low spirits &c.

As to the present case, perhaps most of
Mr Guise's former complaints might have
been referred to Hypochondriasis - of late
he has had the symptoms of more than
One Species of Vesania.

Whatever be the name or names of his
disorder, our principal aim for some time
past has been to obviate the determination
of the blood to go to the head; Other Indications
were attended to, as may be learned from
the foregoing narrative; this was most
in our power, and here we seemed to have
most success.

When Mr Guise is most composed
and sensible, he often says, that it is needless
to take medicines, and in vain to apply to
any physician, for it is his mind that is dis¬
eased, and no Doctor on earth

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can cure him.

✍
Case of
Captain Guise
February
1780
V. X. p. 157