Urmmic Insanity.
Definition.—Insanity occurring in the course of Bright's disease and due to the non-elimination of toxic materials from the blood.
Symptoms and Course. — Christian, Alice Bennett, Bondurant, Tuttle, Bab cock, and others have shown statistically that a large proportion of the insane in hospitals and asylums in this country have chronic renal disease. Irrespective of the general etiological significance of this fact is the occurrence of cases of in sanity in the course of chronic Bright's disease and probably depending upon the same causative factors as other symp toms of uraemia. In a recent case ob served by the writer there were depres sive symptoms alternating with delusions of persecution; so that the diagnosis had, at different periods, fluctuated between melancholia and paranoia. The case ter minated in urtemic convulsions with amaurosis. Maniacal delirium some times occurs. Clouston refers to cases of violent urinmic delirium, ending rapidly in death. This CYCLORzEDIA (see BRIGHT'S DISEASE, volume i) contains abstracts of a number of cases that show the varying symptomatology.
Systematic examination of the urine should be part of the routine in all ex aminations of insane persons.
Satisfactory clinical observations, to gether with post-mortem findings, clearly demonstrate the occurrence of pro nounced insanity as a result of all forms of kidney inflammation as well as other renal disorders. In a great majority of these cases the mental disorder is to be attributed to tmemie intoxication. There is no special form of insanity from renal disease, though the different forms of melancholia are those most frequently observed. Auerbach (Allgemeine Zeit. f. Psych., etc., B. 52, H. 2, '95).
Only 2 cases of urmmic insanity seen among 3000 carefully observed lunatics.
It appears, how-ever, that ummia, both acute and chronic, may lead to insanity.
Bischoff (Wiener 1ain. Wdch., No. 25 '9S).
Treatment.—In addition to the usual remedies for the uriemic condition, mor phine is often necessary to quiet restless ness and delirium.
Post-febrile Insanity.
Definition. — Insanity arising in the course of or following infectious diseases.
The ordinary febrile delirium is not included here, although probably de pending upon the same essential cause: i.e., a toxaemia.
[Sydenham, over two centuries ago, described delirium and comatose stupor occurring in the course of small-pox. He also referred to "a sort of mania which succeeds long-continued intermit tent fevers and at last degenerates into idiocy." Here is evidently meant, not a transitory delirium, but a prolonged acute psychosis terminating in dementia. In the light of our present knowledge, the explanation of Sydenham—`"this comes from weakness and vapidity of the blood brought on by overlong fermenta tion"—seems almost prophetic. Benja min Rush mentions "fevers of all kinds" among the causes of insanity, and refers specifically to one case following measles. Murchison refers to eases of mania and imbecility following typhus and typhoid fevers. In ISSO Kraepelin collected over four hundred cases of insanity occur ring in connection with febrile diseases.
H. RonE.] Insanity has been observed during the course of or following typhoid, typhus, and malarial fevers, small-pox, measles, erysipelas, rheumatism, gout, cholera, and influenza. The last-named disease has preceded insanity in a large percent age of cases occurring within the past nine years.
It is a comparatively rare occurrence for actual insanity to develop during the course of bodily disease. Mental disease most commonly occurs after fevers, poisons, injuries and operations, and heart disease, and perhaps in this order of frequency. In the early stages of fevers and after injuries and opera tions, mania is the common form of in sanity, but in other conditions depression is more common, though the commonest form is an insanity with marked delu sions of persecution, often associated with auditory hallucinations. There is no special form of insanity connected with special bodily disease with the exception of the condition which accom panies alcoholic paralysis, and which is marked by a pronounced failure of mem ory for time and also for place. Insanity occurs with unusual frequency in bodily diseases associated with peripheral neu ritis, as in poisoning by alcohol or carbon monoxide. Where the cause is not con tinuous the mental symptoms in the great majority of cases disappear. Rey nolds (Jour. Mental Sci., Jan., '94).