Cerebral and mental symptoms in relation to somatic disease, anaesthetics and toxic agents, traumata and surgical procedures : with a review of the treatment of some cerebral and mental symptoms by operation ... / by James Christian Simpson.

  • Simpson, J. Christian (James Christian)
Date:
1898
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Licence: Public Domain Mark

Credit: Cerebral and mental symptoms in relation to somatic disease, anaesthetics and toxic agents, traumata and surgical procedures : with a review of the treatment of some cerebral and mental symptoms by operation ... / by James Christian Simpson. Source: Wellcome Collection.

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    but the frequency with which such symptoms happen, if is practicahy impossible to determine accurately. (3) Actual insanity may develop, either with or without traumatic epilepsy, and the number of such decided cases can be more accurately stated, though still there is considerable margin. Thus Schlager, of Vienna, puts it at 10 per cent, after analysing 500 cases ; Krafft-Ebing, out of 462 cases puts it at 1 per cent. In the reports of the Indiana Hospital for the Insane, out of 3,034 cases admitted in four years, 4 per cent, are said to be traumatic. This latter figure is more in accordance with British experience, for in the ten years, 1878 to 1887, in all English and Welsh asylums and houses, accident or injury was the cause in 5'2 per cent, of males, and 1 per cent, of females, which is equal to about 3 per cent, all over, and in Scotland Annandale put the figure at 2 per cent. These figures, so far as I can make out, do not include cases of idiocy and its congeners, resulting from injury to the child either before or during natural labour or after instruments, and the surgery of such cranial conditions has already been mostly treated of under microcephaly. (4) The time after the injury at which mental symptoms develop varies greatly. Thus Christian found that in 100 traumatic cases, 54 had an interval of from one to five years before any definite symptoms appeared ; in 21 it varied from five to ten years, in 11 it was from ten to twenty years, in 7 from twenty to thirty, and in 7 it was more than thirty years since the accident happened which was credited as the cause of the mental condition. As a rule the more remote the injury, and the less gross the lesion found, the more doubt one can have that some other cause such as induced alcohohsm, or a latent lesion or diathesis, may be a concomitant excitement to the insanity. (5) The form of insanity which occurs varies and comprises idiocy, recurrent mania, dementia, mania e potu, dementia with epilepsy, and senile dementia. Crichton Browne noted that in 42 cases, 18 were mania of various types, 13 dementia, 5 dementia with epilepsy, 3 general para- lysis, and 3 melancholia. Christian in 104 cases, found 16 dements, 29 maniacs, 47 general paralytics, and 12 epileptics; while Eccheveria particularly emphasised the prevalence of moral changes, and found that in 19 cases 2 had satyriasis, 1 nymphomania, 1 kleptomania, 3 pyroniania, and 16 homicidal impulses. Christian's percentage of general paralysis is probably excessive, if apphed to this country, for in 341 cases of general paralysis in Devon county asylum.