Prognosis.—In the early stages if ap propriate treatment is promptly insti tuted the prognosis is not unfavorable. If, however, the morbid process has ad vanced, and brain-tissue has been de stroyed by the neoplastic infiltration, or by the endarteritic process, no hope of restoring the normal condition can be entertained.
inunction and potassium iodide in large doses should be employed as soon as a probable diagnosis is made. The iodide may be given in doses of to 1 ounce daily, pushing it to the limit of tolerance. The effects of mercury must be watched, and care taken to keep the patient's nutrition at a proper standard. Ferruginous tonics will generally be required.
In paralytic cases the development of bed-sores should be carefully guarded against.
Post-apoplectic Insanity.
Definition. — Insanity following de struction of an area of brain-tissue, due to cerebral hmmorrhage or embolism.
Symptoms.—In addition to the usual physical symptoms following gross brain lesions,—aphasia, hemiplegia, etc.,— there are loss of memory, dementia, and occasional attacks of emotional disturb ance or outbreaks of maniacal violence.
Treatment.—This can only be symp tomatic. Securing good nutrition and sleep, guarding against bed-sores, keep ing the patient as comfortable as possible, is all that can reasonably be striven after. Mental restoration is not to be expected.
Insanity from Cerebral Tumors and Abscesses.
In many cases of brain-tumor or brain abscess no psychical symptoms are pres ent. In others, however, there is loss of memory, apathy, dullness of perception, occasionally of intellectual perversion. Hallucinations and delusions may be present. When the neoplasm encroaches upon the visual sphere, hallucinations of vision may complicate loss of sight. In one case of a large abscess in the occipital lobe there was almost entire loss of vision, with delusions of personality, probably depending upon visual hallucinations. Christian and Raymond have reported cases of hallucinations of vision ap parently depending upon intercranial growths.
the only treat ment that can be considered is palliation of the symptoms and surgical interfer ence.
Insanity from Cranial Traumatism.
Insanity follows cranial injuries much more frequently than is commonly sup posed. The delirium attending concus sion of the brain or traumatic meningitis may be ignored here entirely as apper taining entirely to surgery. But many of the cases recovering from the acute mental disturbances following shock and inflammation later become permanently insane.
Over 36,000 clinical histories examined with the view of determining whether there is such a form as traumatic in sanity or whether the psychical disturb ances following traumatism only excep tionally present characters of a special psychosis in the stricter sense of the term. There were found 23 females, 6
still living, and 102 men, 23 of whom were still under treatment. In 2S eases there was an heredity; in 97, none. The prevalent form of injuries was a fall on the head. In both sexes the con sequences were epilepsy, melancholia, dementia, mania, imbecility, and moral insanity. The psychical phenomena ap peared in some cases a few days after the injury, and in others their first ap pearance varied from a few months to a few years. Gonzales (Archivio Ital. per he Mal. Nervose e pia Partic. per le Alien. Mentale, Milan, '92).
It has been pointed out by Sir J. Batty Tuke and others that a condition closely resembling, if not identical with, gen eral paresis follows injury to the brain.
[A case of this sort is at present under my observation. The patient, a painter, sustained a severe shock by falling from a scaffold and striking upon his head. Unconsciousness and delirium contin ued for ten days succeeded the injury. On recovering consciousness there were delusions of grandeur, which lasted for nearly a year, gradually becoming less marked. The pupils were for a long time contracted and fixed, not reacting at all to light and pain and only very slightly to accommodation. After a year the expansive delusions disappeared and there remained a moderate state of de mentia, which appears stationary.
Localizing symptoms of focal disease have never been present. GEORGE H. ROHE.] cases of fracture of the skull the recognized surgical pro cedures are indicated. In contusion, opening of the skull at a point opposite to the site of injury will often show evi dences of inflammation of the meninges and contusion of the brain. It is prob able that trephining and drainage would here sometimes prevent the subsequent development of insanity.
Case of insanity and epilepsy nineteen years after causative injury. Trephining followed by complete recovery. Binet and Rabatel (Lyon Med., May 12, '95).
Insanity due to injuries of head of rather infrequent occurrence. Two cases in which cure followed trephining. Cale (N. Y. Med. Jour., Oct. 12, '05).
In the secondary demential following brain-injuries, operative procedures, un less demanded by focal symptoms, are not likely to be beneficial.
Trephining cannot as yet be reckoned among methods of treatment. Excision of parts of cortex seems altogether un acceptable. Semelaigne (Annales Med. psyehol., May, '95).