The terms "acute confusional insan ity," "acute delirious mania." etc., show that observers generally recognize a dif ference between these cases and those of simple mania. In the latter the essen tial manifestations are the exaltation, flight of ideas, and rapidly changing hallucinations and delusions.
Acute delirium and acute mania are frequently mistaken for each other, and their diagnosis from each other is some what difficult to make. The tempera ture is elevated in acute delirium, and lowered in mania. The exhaustion is very rapid in acute delirium, while the maniac will continue to rave for months with little perceptible loss of strength. Mania is a conscious delirium, the pa tient being aware of what he is doing and taking every advantage of others; acute delirium is an unconscious de lirium, the patient never trying to take any advantage, and. although he recog nizes people, five minutes later he does not remember to have spoken to them. In mania the appetite is often enormous; in acute delirium it is always absent. Mania is preceded by marked pro dromata; the prodromata of acute de lirium are never very marked and are often absent. In mania the face is often flushed and the sclerotic injected; in acute delirium the face is pallid and there is no injection of the sclerotic. Acute delirium will terminate in death or recovery in two or three weeks; mania will require months. Coston (Nashville Jour. Med. and Surg., Aug., '96).
Causation.—Aside from the influence of heredity, which can be traced in one half or more of the cases, prolonged ex citement of the cerebral centres, work, and mental strain of various kinds may be regarded as etiological factors.
The infectious origin of acute delirium shown in eight cases, in seven cases of which recovery or considerable improve ment took place, eighth ending fatally. In the latter only did the blood reveal presence of bacilli. Bianchi and Piecino (Jour. of Nerv. and Mental Dis., Aug., '95).
Twenty of the 47 juvenile eases per sonally observed were boys and 14 girls; the sex of the others was not stated. Of the 13 cases, 3 were boys and 5 girls. Up to 7 years of age convulsions and arrest of intelligence are most commonly observed, although delirium is often seen as the result of febrile affections. From 7 to 14 years of age true mania and melancholia are most frequent, while hysteria shows itself very often as soon as the menses appear.
Among the psychical diseases met with dementia is frequently observed. Acute dementia, which is the most common form, frequently occurs betwen the ages of 10 and 16, and differs from senile de mentia "in that it seems to depend on the imperfect nutrition of the nervous system, and is generally curable by gen erous diet and other means that supply materials for construction." Juvenile dementia, as a result of in herited syphilis, is occasionally met with. Mental deficiency is noticed at the age of the second dentition, and from this time gradual degeneration ensues, with sometimes paralytic and epileptic seiz ures, and death occurs in three or four years.
Monomania, or delusional insanity, is commonly met with. Erotomania has been observed in early life. The expres sion of the face and the gestures have an amorous languor, but, as a rule, the children so affected are chaste. Far more important is nymphomania and satyriasis. clue no doubt to the influence of heredity and exaltation of the general sensibility.
Melancholia in early life may be sud den or insidious in its attack, a primary disorder, or the sequel of some other form of insanity. There are two forms: the first, a pure abstract indefinable de pression; the second, a despondent con dition, having relation to religious mat ters or a future state.
In mania delusions are more frequent than hallucinations. Of the 13 cases which have been under personal care, no less than 9 suffered from mania, and in 5 of these it came on after attacks of epi lepsy. Moral insanity is of frequent oc currence in childhood, and hysteria has been frequently noticed. Fletcher Beach (Jour. of :Mental Science, July, '98).
All forms of acute delirious mania are of toxic origin, some being caused by the introduction of a poison from without, others by the absorption of septic ma terial, while a third class is due to auto intoxication. As regards the action of a possible poison on the nerve-cell and its functions, the subject is too speculative for ally advantage to be derived from discussing it. In cases with high de lirium, and a rapidly fatal termination, there is generally a condition present in which all the giant cells are profoundly altered, and probably the inspection of a section in such cases would furnish a tolerably accurate diagnosis of the men tal state preceding death. John Turner (Brit. Med. Jour., Sept. 2:2, 1900).