In acute mania the blood-pressure is low, whereas in the majority of cases of melancholia it is high, due to an altera tion in the tonicity of the vasomotor system. Low blood-pressure produces restlessness: a constant symptom in mania. Restlessness in cases of mania relieved by rectal injections of from S to 10 ounces of water. M. Craig (Brit. Med. Jour., Sept. 22, 1900).
Fever is not rare in acute states. It is most frequent in states of mental con fusion and exaltation, but may also be present in depressive states. Fever is usually a symptom of grave significance and should always lead to a careful phys ical examination. It may signify a men ingitis, a visceral inflammation, or an essential fever.
Observations on the daily oscillations of temperature in functional psychoses. In passive melancholia the temperature is generally diminished. The evening rise is not very pronounced. The same is true of agitated melancholia. In mania there is a rise of 4.5° to 0° F. dur ing the height of the disease. In para noia the temperature-curve is normal. In stupor it is below normal. Hysterical psychoses show irregular oscillations. ln general paresis and dementia the tem perature is sometimes much below nor mal. Th. Ziehen (Dent. med.-Zeit., Aug. 23, '94).
Among the prominent symptoms ref erable to the digestive system is ano rexia, often leading to absolute refusal of food. This is frequently due to gastro intestinal disorders, but in many cases the refusal of food is the consequence of hallucinations or delusions. The patient has a fear of food (sitiophobia), either because he thinks the food will not be digested, or that there is obstruction of the bowels, or total absence or decay of the abdominal viscera, or because he is afraid of being poisoned. The fear of poisoning, due to hallucinations of taste is a frequent symptom of paranoia. De lusions of obstruction or absence of ab dominal viscera are often present in melancholia. Want of appetite is also sometimes an expression of the extreme indifference to all subjective sensations or objective impressions in advanced de mentia.
In maniacal states there is often an abnormal desire for food. This may al ternate with absolute anorexia.
Of 109 cases of visceral diseases, Si suffered at one time or another from re ferred pain associated with superficial tenderness. Mental disturbance seemed to stand in direct relation to the in tensity of pain. Depression seemed to be
associated mainly with the presence of areas over lower part of chest and over the abdomen. Hallucinations are only present where scalp-tenderness is a marked feature of the sensory disturb ance. Henry Head (Brit. Med. Jour., Sept. 2S, '95).
Gall-stones found to be twice as fre quent in the insane as they are stated to be in the sane. Snell (Brit. Med. Jour., Aug. 12, 19, '93).
Malignant disease is a well-recognized cause of refusal of food by an insane pa tient, but less attention appears to have been given to gastritis, a common dis order among the sane, and assuredly more so among the insane. Gastritis ap pears in some cases to be the most prob able cause of food-refusal. Many of these cases would, no doubt, recover by simple Seeding, but, even in these, lavage before feeding would probably hasten re covery. H. Harold Greenwood (Jour. Mental Science, Jan., '98).
Persistent constipation is frequent in melancholia. Diarrhoea is comparatively rare. In many acute forms of mania and melancholia, and in the early stages of general paresis, the patient passes faeces into his clothing or the bed. This is not always due to loss of control of the sphincters, but is sometimes intentional. In advanced dementia, paretic or con secutive, the loss of sphincterie control is usually paralytic.
The perspiratory secretion is usually diminished in melancholia. In mania salivation is often present. Manifestations on the part of the genitourinary system are frequent in in sanity. In maniacal conditions there is sometimes polyuria. Incontinence is fre quent in acute mania and in dementia. Involuntary passage of urine often occurs during epileptic attacks. Sometimes the urine is retained owing to indiffer ence, while its retention may be due to a delusion, as in the case of a doctor tioned by Chapin, who retained his urine day after day "lest its discharge might endanger the building and human life." Results of inquiry into the relations of acetone, sugar, and albumin in the urine of insane patients suffering from diarrhoea due to degeneration of the solar plexus. In ordinary intestinal catarrh none of the above are present; but in diarrhoea due to degeneration of the solar plexus sometimes sugar, some times albumin, and sometimes both were found. This may aid in diagnosis in some cases. Cristiani (Jour. de Died., Feb. 12, '93).