Reprint from The Alienist and Neurologist, July, 1884. 
A Short Case Record in Psychiatry— 
With a Moral. 
A MORBIDLY SENSITIVE MORAL SENSE. 
C. H. Hughes, M. D., St. Louis, Mo. 
IX/TRS. M. E. W., of 111., aged twenty-six; married; 
one child. One evening in May, 1877, she worked 
late at night to finish a carpet, retiring after twelve o’clock. 
Soon after she got in bed it appeared to her that she had 
broken the sabbath, and must therefore destroy the carpet. 
She spent a considerable time in devotional exercises. 
She thought it was her duty to pray for each member of 
the family separately, and all the relatives and friends the 
same way. Since then her husband has known her to 
often be as late as two o’clock at night, before she would 
get to bed, in consequence of these devotions. 
In January, 1879, while some relatives were here visiting, 
from Indiana, one of the boys showed a collection of coins 
and other things, among them a piece of a coffin that he 
had picked up while crossing the Isthmus of 
She was soon impressed that she had done wrong in fo)>kr-' 
ing at it; that he had taken something that was r\ot .his, 
and that she ought not to have touched it. For' souie 
time after that she did not want to wear her sacque 'trrk 
that account, and would keep working her fingers as 
though she was rubbing something off them. 
“In 1879, while her mother was helping to wash the 
dishes, there was a plate setting in the cupboard that 
had had some beefsteak on it, and when it was taken 
off, some blood was on the plate. Mother washed this 
plate in the pan with the rest of the things. Then an 
idea came to her that it was wrong to use blood, and 
that she had used it. She thought afterward she should 2 
C. H. Hughes. 
have told mother to rinse the plate off before putting it in 
the dishwater. She thought this blood got on some of the 
milk vessels and set into them (as she said), and would 
only come out of them when used.” She still holds this 
last delusion. 
To her husband she seems too precise in distinguishing 
between right and wrong—morbidly sensitive in regard to 
wrong; theorizes too much about the right and wrong, and 
does not look at it practically. He says (which was a good 
conclusion), as all the doctors he consulted advised him 
to move away a while or altogether, he went from his 
farm to a neighboring town, and engaged, in two establish- 
ments, in the lumber business, conducting one place 
himself, forming a silent partnership with another, and he 
and his wife mutually arranged a scale of prices. This she 
regarded as practising deception on the public, and it gave 
her great mental distress. 
The sum of her mental condition is one of morbid activ- 
ity of the moral and religious feelings. She finds no way 
of extenuating any of her fancied sins. 
She has had several miscarriages. Her child is a 
suckling babe ; her appetite is poor; her skin sallow, liver 
torpid, and general appearance anaemic and neurasthenic. 
Her husband was advised to see that the babe was 
weaned; that she be put upon reconstructive and tranquil- 
izing nerve tonics, beef peptones and other similar 
nutrients, including cod-liver oil and iron; that she be 
separated, so soon as practicable, from babe and husband 
and all present surroundings, and placed among remote 
and congenial relatives in an invigorating climate, with 
injunction to friends not to introduce the subject upon 
which she is morbid, or take her to church, or allow her 
to read the Bible. 
A private home for the insane and nervous would be 
preferable to the plan advised, but the latter accorded 
more with her wishes and her husband’s desires, and was 
advised, as a temporary expedient, with the injunction to 
secure a distant hospital home for her in case mental A Short Case Record in Psychiatry. 
3 
recovery did not reappear with the return of her physi- 
cal vigor: The moral effect of a residence in a hospital 
would benefit her any way. 
This is one of the kind of cases a crowded public 
State hospital would not receive, because of its chronicity 
and apparent harmlessness. She ought to have been placed 
in a hospital for the insane several years ago, while the 
disease was recent. There is a possibility, but not a strong 
probability, of her recovery; but she should bear no more 
children. 
She needs also to be watched, lest a suicidal inclina- 
tion should develop, and lest the disposition already 
manifested to destroy the carpet because it was the cause 
of her offending, might become transformed into an im- 
pulse to self-mutilation or destruction. 
Prolonged absence from her husband and babe may give 
her over-taxed procreative and maternal functions the rest 
they need, and thus benefit her, while entire change of 
surroundings might, by new impressions, excite dormant 
ideational centers into agreeable action, and give the 
painfully and morbidly over-active portions the needed 
quiescence. 
The moral of this case is that she might have been 
saved if sent to the asylum for the insane, or to a pri- 
vate home for such persons, in the beginning of her 
malady, in 1877, or otherwise skillfully managed by a 
practical alienist. These are the cases in which delay 
in the beginning is most common and most dangerous.