Manchester, 2 May 1864 

Dear Moor, 

The outlook for Lupus grows daily worse. His state of delirium 
is getting more and more chronic. He still recognises the people 
who come to see him quite well, but in between times he talks in a 
completely ramerinc fashion and it is only after taking a strong 
dose of stimulants that he has his more lucid moments. However, 
these moments are becoming dimmer and briefer all the time. 
Gumpert has very little hope now; his diagnosis is softening of the 
brain as a result of the prolonged headaches brought on by 
cerebral hyperaemia and of the insomnia thus induced. There’s no 
longer any question of Borchardt’s meningitis; he has accepted 
G.’s diagnosis and generally does everything G. suggests, though 
he seems to have very hazy ideas about the origin of the 
headaches. 

Each day Lupus spends in this stupor, from which stimulants 
are incapable of rousing him, naturally makes matters Worse and, 
if the next 3-4 days bring no improvement, the poor devil will go 
under either from debility or apoplexy or, if he pulls through, 
he’ll be an idiot. This alternative—death or imbecility—is really 
too frightful. Gumpert, of course, is extremely guarded when 
talking about his colleague but I’m sure of the fact that L. could 
have been saved if the headache had been properly treated and if, 
in particular, something had been done to enable L. to sleep. But it 
was not until last Thursday, after five weeks of insomnia, that B. 

gave him some opium. On top of that the blood-letting on 
Wednesday. He has persisted in treating him for gout, prescribing 
nothing but colchicum and the like. It was only the onset of 
delirium that evidently caused him to have second thoughts. 

There is another consultation at 9 tomorrow morning which I 
shall also attend to see what he does. B. intends to get a male nurse 
for him today. If only the poor fellow pulls through! 

Your