V. Psychoses due to gross lesions in the brain. To this class belong syphilitic insanity, post-apoplectic insanity, in sanity from tumors and abscesses, and in sanity from cranial traumatisms.
Four cases of insanity following fract ures at the base of the skull. A patient is not out of danger when a wound in the skull is healed. He may develop in sanity as a result of the depression of the skull or splinters of bone, or from a thickening of the bone or from cysts. Seventy-seven such eases have been re corded, in which operation was performed for the resulting insanity, with 5 deaths. Of the 57 cases reported in the last seven teen years, only 2 patients died. Mental recoveries occurred in 51; great improve ment in 12; slight improvement in 5; and no improvement in only 4 cases. Two of these 4 were temporarily im proved. Harrison (Med. News; Univ. Med. Mag., Jan., '99).
VI. Psychoses due to toxic substances circulating in the brain. In this class are included acute confusional insanity, puerperal insanity; alcoholic, plumbic, and other chronic drug intoxications; uriemic insanity, post-febrile and most cases of post-operative insanity, and in solational insanity.
Specific infection must be included among the causes of mental symptoms. Analogies with nervous affections known to be of microbic origin favor the view that insanities with similar or related Phenomena or lesions are also microbic in origin. Mental disorders of pregnancy and puerperal state are probably in a considerable portion of cases toxmmic. C. K. Mills (Amer. Jour. Med. Sci., Nov., '94).
It is of comparatively rare occurrence for actual insanity to develop during course of bodily disease. When the cause is not continuous,— such as poisons, fevers, and traumata,—mental symptoms, in the great majority of cases, disappear; in heart disease and phthisis they may disappear and reappear from time to time; in some cases, such as in sanity connected with gouty kidney, they only disappear with death. Reynolds (Brit. Med. Jour., Sept. 28, '95).
Tuberculosis is not believed to be a cause of insanity, but the results of tuberculosis in any of their forms—in other words. tuberculous dyserasia of
any kind—is, just as any other dys erasia, one of the causes of disease of the mind, or insanity. Ales Hrdlicka (Al Shifa, Jan., '96).
Conclusions as to the possible relation of intestinal autointoxication to mental disturbance: 1. Urines rich in indican contain very little or no preformed sul phuric acid, and are toxic. 2. When the sulphate ratio is materially changed, it is likely to indicate autotoxis in connec tion with an increase in the amount of combined or ethereal sulphates. 3. Such indications are generally found with acute insanities, in which rapidly developing symptoms occur. 4. Fuga cious and changing illusions and hallu cinations, unsystematized delusions, con fusion, and verbigeration in connection with insomnia, pallor, intestinal indiges tion, constipation, and rapid exhaustion, are due to autotoxis. 5. Paranoiac states, or those in which concepts are the features; chronic stuporous condi tions, and certain forms of dementia have little to do with the formation of intestinal products of putrefaction. 6. Various post-febrile, traumatic, alcoholic. or drug insanities are those in which autotoxis is most constant. 7. The vari ations in the excretion of combined sul phates keep pace with the changes in the progress of an established insanity, acnes and epileptoid attacks being di rectly connected with the putrefactive processes. 8. The most successful treat ment consists in lavage; intestinal douches; gastric and intestinal antisep sis by means of hydrochloric acid, borax, sodium salicylate, charcoal, guaiacol, or naphthalin in small, repeated doses; and the administration of a combination of the red marrow from the small bones, blood, and glycerin. A. McL. Hamilton (N. Y. Med. Jour., Nov. 14, '96).
In post-febrile insanity abnormal metabolism is a chief etiological factor. Heredity bears a tentative relation, in providing a neurotic weakness and phys ical instability easily influenced by febrile diseases. Prognosis should be guarded, although recovery is usual in the average case. Norbury (Jour. Amer. lied. Assoc., July 28, 1900).