This clinical group has become well established, not only in its
recognition from the dominant symptoms as indicated above, but also
from rather definite causes. The immediate cause seems to be an
abnormal blood state, or so-called toxemia, which may result from
infectious diseases, or states of exhaustion, or autointoxications,
or foreign poisons; the poison acts as an irritant to the brain. In
states of exhaustion so-called “fatigue bodies” are formed and are
apparently toxic in character. The autointoxicants may have various
sources, such as chronic kidney disease, or diabetes, and the like.
The most important of the foreign poisons are alcohol and morphine.
This morbid group is further characterized not only by a toxic cause
and dominant symptom complex of delirium, or confusion, or stupor,
but by a similar onset and course. The onset is usually acute and
the course somewhat wave like, gradually reaching a climax and
subsiding, or resulting in death or becoming chronic. To emphasize the
clinical symptoms of confusion which is so important the term “acute
confusional insanity” has often been used, or “amentia,” according to
the common German terminology. Hallucinations also play a prominent
part, particularly those of vision; hence, another common appellation,
“acute hallucinatory confusion.” Heredity is mentioned at most as
creating a predisposition, though often the personal and family
histories show no such evidence whatsoever. Intellectually there is a
definite lack of orientation, the patient is unable to identify himself
or his surroundings in time and space. He cannot clearly understand
what goes on around him, that is, consciousness is “clouded;” the
clouding may be of such extreme degree the patient’s mind becomes
blank, due to complete psychic inhibition. This is referred to as
stupor. The emotional life plays a secondary role subordinate to the
intellectual content. The patient may be greatly excited for example,
resulting from a frightful hallucination. The hallucinations are mainly
of the visual type and are almost always present. The patient lives in
a perpetual state of sense deception as if he were constantly dreaming;
the hallucinations for the most part are of distressing, disagreeable
or even frightful character. These may give rise to delusions, which
are manifold, often fantastic and usually transitory.
Physical changes are always found associated with the disturbed mental
status. If it arises during the active stage of an infectious process
there is of course the high temperature and all other physical signs of
fever. In a certain number of cases with temperature no definite signs
can be found indicative of any of the well known fevers, hence has
been called by various names, such as “Bell’s Delirium,” “Acute Mania
Gravis,” or “Acute Febrile Delirium.” This ordinarily runs an acute
rapid course with very high temperature, very marked delirium, followed
by stupor and usually death from exhaustion. Even though no temperature
be present the physical condition reminds one very much of that found
in fever diseases. There is the lost appetite, resulting emaciation and
malnutrition, insomnia, exhaustion, etc.
=Osteopathic Theory.=—While it may be admitted that the various factors
mentioned above may take part as exciting or predisposing causes, it
is obvious that in numerous instances mental disorders do not arise
whatsoever, even when the patient is subjected to these factors. There
must necessarily be other elements essential to produce the psychosis.
The osteopathic theory comes in at this point to fill in and complete
the chain of causes and to initiate the onset by the introduction of
the idea of nutritional and circulatory disturbances resulting from the
spinal lesions.
The records of the Still-Hildreth Institution show 18 of the toxic
type, in which the poison is derived from without, who were treated,
with 17 recoveries. There were 25 cases connected with the infection
and exhaustion group, with 20 recoveries.