The bacteriology of acute delirious mania. In 1881 Briand discovered micro organisms in considerable quantity in the urine. In 1884 Rezzonico found emboli of micrococei in the cerebral blood-vessels. Bianchi and Piecinino found bacilli in the blood of 2 cases, and these observers were able to isolate an autonomous bacillus, corresponding mor phologically to the bacillus subtilis, but they admitted later that this organism was not present in all the cases they had afterward examined. Out of 7 cases they found a streptococcus in 4 and a staphylococcus in 2. Rasori in 1893 found Bianchi's bacillus in the cerebrospinal fluid in 1 ease. Potts, Martinotti, and Cabitto found only or dinary micro-organisms. Ceni, in 1897, found constantly the staphylococcus pyogenes albus. Kotzowsky (189S) found a staphylococcus in 2 cases. Cappelleti (1899) confirmed the re searches of Ceni and Kotzowsky: in 3 cases he isolated the staphylococcus py ogenes aureus and albus and the bac terium coll. Again, in 1899, Bianchi and Piceinino published a memoir in which they claim to have found their special bacillus in 2 eases; in a third case only ordinary cocci, while in a fourth their researches were negative. The writers conclude that these researches by vari ous authorities tend to show that the complex symptoms of the disease may be due to various organisms, and that its gravity depends greatly upon the pathogenic character of these organ isms. Carrier and Martin (Archives de Neurol., Sept., 1901).
Prognosis.—liecovery occurs in about 70 per cent. of cases. When recovery fol lows it is usually only after several months, from six months to a year being the usual duration of an attack. The recovery is rarely sudden, or gradually progressive. More often the patient im proves for a time, to drop back in a day or two into a condition of excitement, fol lowed again by improvement, and thus recovery is reached by a series of stages of improvement overlapping a series of relapses. In other cases the passing off of the stage of excitement is followed by one of depression, out of which the patient gradually awakes to his normal mental activity.
Death from exhaustion usually occurs early. Ordinarily about 8 to 10 per cent. of cases of mania die from exhaustion. Under early and proper treatment, this proportion should be much diminished. Of the remainder the larger proportion results in progressive brain degeneration, presenting the characters of consecutive dementia.
Conclusions regarding prognosis of acute mania: (1) about 70 per cent. of all cases of acute mania are cured after running a course averaging several months; (2) early treatment in insanity hospitals has a favorable effect upon the course of the disease; (3) a family his tory of insanity does not necessarily make the prognosis unfavorable; (4) cases of mania occurring as sequelm to disease—alcoholism or pregnancy—have a favorable prognosis, both as regards duration and ultimate cure; (5) cases due to slight injury of the head usually recover; (6) the return of the men strual flow accompanying an improve ment in the mental condition is an indication of a speedy return to health; (7) the younger the patient, the greater is the hope of recovery; (8) recurrent mania presents a bad prognosis for complete and lasting cure; (9) where the disease is of long standing the prob ability of recovery is poor; (10) the sudden onset of great maniacal excite ment is an unfavorable symptom except in those cases following pregnancy or traumatism of the head; (11) sudden stoppage of the maniacal excitement must raise the fear of recurrent mania or of early relapse; (12) great increase in weight before the beginning of the quiet stage must be similarly inter preted; (13) the more severe the attack, the poorer is the prospect of complete re covery; (14) paralysis and convulsions must be looked upon as grave complica tions. Willerding (Review of Insanity
and Nervous Dis., Sept., '91).
\racuolation of the protoplasm of the nerve-cell and nucleus and pigmentary degeneration observed as phenomena present in cases of acute delirium. T. P. Prout (Med. News, Aug. IS, '94).
Treatment.—The treatment of mania often requires great tact, perseverance, coolness, and command of therapeutic resources. In the first place, in case of any gravity, home treatment is generally impracticable. The noise, the motor rest, the constant expert attention quired, and the violence toward others make it incumbent in most cases to re move the patient to an institution for the insane. It is customary in most hos pitals for the insane to isolate the ma niacal patient. In the writer's experi ence this sequestration is not to the patient's advantage. Keeping the pa tient in an open ward, preferably in bed, in the presence of other patients, constantly suggesting to him by precept and example that he is sick and requires treatment will usually soon quiet the most excitable maniac. It may be neces sary to keep one or more attendants by the bedside all the time, to prevent him from getting up and running about and so exhausting himself. A bath, clean linen, and quiet, tactful nursing will do wonders in calming the excitement and dissipating the delusions of the maniac.
In the treatment of mania no restraint and rest in bed recommended, except when the strong-room is absolutely necessary. Baths, bromide and chloral, may be given, but for severe excitement or great sleeplessness an injection of hyoscine is necessary. Good nourish ment should be given, but no beer, wine, or spirits. Baths at a temperature of about 23° C. given for two to five hours as a means of quieting the patient, with cold compresses to the neck. When the excitement is very great, instead of the baths a damp sheet should be used. In the evening 45 to 75 grains of bromide of potassium are given, and two to three hours later 30 to 45 grains of chloral. After ten days, if the patient is quieter, the bromide is lessened and the chloral is only given occasionally, and sulphonal or trioual are substituted. Where bro mide and chloral are useless, laudanum in increasing doses is given. Magnan (Rev. de Psych., July, '97).