Symptoms and Course.—The clinical forms of mental disturbance described as following febrile diseases may be confu sional insanity, melancholia, and mania. Purely exalted conditions seldom occur. When there is melancholia, it is usually associated with hallucinations and sions. The hallucinations and delusions of the acute stage often persist in the stage of dementia.
[I have known a case of confusional insanity following erysipelas in which, seven years after the acute outbreak, the hallucinations of hearing and de lusions of persecution and personality are present in their original force. In a case of depression following influenza delusions of personality with persistent mutism (not stuporose) still remain, five years after the beginning of the attack. Thayer has reported a case following typhoid fever in which there were de pressive symptoms with hallucinations of sight and hearing. GEORGE H. IloHE.] Incoherence with hallucinations, illu sions, and delusions are usually marked symptoms of post-febrile insanity. In heavy drinkers a violent maniacal de lirium sometimes occurs during the height of the febrile process.
Febrile delirium, during an infectious disease, is an acute attack of insanity. There are the febrile mental derange ments proper to the fever (psychoses [Wiles), and there is the delirium of convalescence (psychoses astUniques). Toward the end of acute infectious dis eases there is the "delirium of inanition," which may go on to the delirium of collapse. Weber (Medico-Chirur. Trans., '65).
Though astbenic delirium is the most common kind during convalescence, other kinds are met with, sensorial illusions being often present. There is, probably, in such eases, a cerebral intoxication due to mierohie products of the virus which has set up the disease. One great dis tinction between the psychoses of con valescence and the delirium of fever lies in the evident influence of heredity and the personal antecedents of the patient, upon the character of the delirium in the former case (Kraepeliu, Savage), in con trast to its uniform course in the latter; in fact, heredity appears to play the chief part, and the acute disease is often only the accidental cause of the mental alienation. Christian (Archives Gen. de
Med., Sept., '73).
Two cases complicating pneumonia have come under my notice. Clouston has laid especial stress upon the mental depression succeeding influenza. He says the last epidemic "left the mental and nervous tone of Europe lower by some degrees than it found it," and "no epidemic of any disease on record has had such mental effects." However true this may or may not be of Europe, there is, in my opinion, no evidence that similar disastrous effects have followed the epi demic in America.
Prognosis.—This is usually favorable. If the patient escapes the dangers of ex haustion in the acute stage, recovery takes place in from 70 to SO per cent.
Treatment.—The treatment of post febrile insanity usually requires careful attention to the nutritive functions. Tonics and stimulants arc nearly always indicated. When hypnotics are neces sary, the depressive drugs—chloral, bro mides, sulphonal — should be avoided. Opium and cannabis Indica are often of great value.
Post-operative Insanity.
Definition.—Insanity following, im mediately or remotely, operations upon the body.
Varieties.—The occurrence of insanity as a sequel of surgical operations has long been known. The more transitory forms of mental aberration, termed "trau matic" or "nervous" delirium, are recog nized by all surgeons, although probably less frequently seen since the general adoption of aseptic methods in surgery. Within the past few years especial atten tion has been drawn to insanity follow ing operations upon the female genera tive organs, and by some this occasional occurrence of mental disturbance has been held to be a contra-indication to the performance of such operations. It has been maintained that insanity follows removal of the uterine appendages with especial frequency, and that therefore the possibility of this unfortunate com plication should demand particular at tention before subjecting a patient to operation.
There is no proof that genital irrita tion in the male or female can cause nervous or mental disease, except in a predisposed person. The proof is not yet absolute that genital irritation can pro duce nervous and mental disease even in a predisposed person. L. C. Gray (Trans. Med. Soc. of State of N. Y., '93).