Prognosis.—The prognosis of post operative insanity is that of confusional insanity generally; i.e., while the death rate from exhaustion is large, amounting to 12 or 15 per cent., the recovery-rate of the remainder is also large. The cases that terminate in secondary dementia probably do not exceed 10 per cent.
The tardy cases of post-operative in sanity so-called—those that come on in women from six weeks to three or four months after removal of the uterus or appendages—give a less favorable prog nosis. The recovery-rate in these cases is not over 50 per cent.: about the same as that of undoubted climacteric insanity.
Mental disturbance, developing soon after operation, seldom proves serious, while, when it appears a few months later, the prognosis is usually unfavor able. Jacobs (La Policlinique, Apr., '96).
Reports of 109 cases in which of the internal organs of generation was.
undertaken for the cure of hysteria and insanity, or other neuropathic conditions. Only 17 were affected beneficially. The remaining 92 were either uninfluenced or affected injuriously. Insanity afterward developed in 44 of these women, 20 of whom had suffered from hysteria before the operation, while 24 had not. Twenty three others who were insane and hys terical prior to the operation were worse after it. Two not previously hysterical had become so. The remaining 23, who had been in part insane and in part hys terical, remained in the same state after operation. Angelueci and Pieraccini (Riv. Sper. di Freniatria, p. 290, '97).
A systematic examination of all female insane patients, aided in nearly every case by anaesthesia, gave the startling result that 93 out of 100 insane women had pelvic disease. Eighty-nine were operated upon with the result of 37.5 per cent. mental recoveries; 22.5 per cent. improved; 35 per cent. unchanged; 5 per cent. of deaths. A. T. Hobbs (Jour. Mental Science, Jan., '98).
Sixty per cent. of the insane women personally examined had some abnormal condition of the pelvic organs, distinctly pathological and easily recognized. The primary question is relief of local dis ease; the insane woman has the same right to treatment as the sane, and if such treatment is likely to benefit the mental condition it is our duty to carry it out. A summary of 34 cases shows 11 complete recoveries (mental and phys ical), 9 improved, 11 unimproved in men tal condition, and 3 deaths. Roh6 (Jour. Mental Science, Jan., '93).
Of 642 cases of hysterectomy and bilateral ovariotomy, only 4 personally observed in which the operation was fol lowed by psychoses, and in all of them the patients were predisposed by inher itance or other factors. M. Segond (Rev. de Chir., Apr. and May, '98).
Treatment.—In the developed psycho sis the treatment heretofore recom mended for confusional insanity is in dicated. Much may doubtless be done in the way of prophylaxis. Strict aseptic precautions during operation, removal of all sources of irritation, both physical and psychical, in persons of neuropathic constitution requiring operation, and careful. attention to nutrition in those broken down in health from long-con tinued, painful, or exhausting disease, will tend to diminish the number of cases of insanity following surgical operations. The use of chemical antiseptics and dis infectantsin this connection also de serves attention.
There are many cases of women who have become insane through irritation of the ovaries who might derive benefit from surgery. The argument that the operation entails sterility on the women is of no weight, as such women are likely to bear unhealthy children and thus propagate their neuroses. Kroemer (Therap. Monats., Apr., '96).
Insolational Insanity.
Definition.—Insanity following insola tion, or sun-stroke.
Symptoms.—After recovery from an attack of sun-stroke many persons suffer from certain indefinable changes in their character. They are more irritable, easily exhausted, especially in hot weather, and are liable to vertigo and other neurotic troubles. In a small per centage of cases insanity follows. This was already noted by Benjamin Rush, who reports two cases of madness caused by insolation.
The form in which insolational insan ity occurs may be maniacal or depressive. In the former there may be sexual excite ment with delusions of grandeur and un tidy habits. The depressive form is usually attended by suicidal tendencies, delusion of persecution, anxiety, and hal lucinations of sight and hearing. In some eases defective memory is the most notable psychical symptom. This may be accompanied by motor disturbances simulating general paresis.
Most writers who discuss insolational insanity class it with the traumatic in sanities, assuming the evidences of me ningeal inflammation, sometimes found, to be the causes of the mental disturb ance. It seems to the writer, however, that the condition of the blood and ves sels found post-mortem in cases dying of sun-stroke indicate such a profound change as can only be attributed to the action of a toxin. So it has seemed preferable to group the insolational psychoses with those due to toxaemia.
Prognosis.—Complete restoration of mental function is rare. A modified re covery, a partial dementia, is not infre quent.
Treatment.—This is purely symptom atic. Persons who have once suffered sun-stroke should avoid exposure during hot weather.