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772 EPITOME. [Oct.,rarely presents that spontaneous excitement by which some types ofconfusion seem to m erge into true m ania ; so that the term " am entia,"in Meynert's sense, seems appropriate for it. A . W . WILCOX.On Insanity after Acute and Chronic Infectious Diseases \Uberpsychoses nach akuten und chronischen Infektionskrankheiten}.(A llgem . Zeitschr.f. P sychiat., H . i, 1904,/. 185.) Siem erling.Professor Siemerling, at the Annual Meeting of the PsychiatricA ssociation at K iel, read a paper on this subject. H e observes that thereis no infectious disease in the course of w hich m ental derangem ent m aynot supervene. Typhoid fever appears to head the list as a cause ofinsanity. A fter an epidemic of this malady in Knigsberg out of176 patients there were eight cases of m ental derangem ent4/5 percent. After this Siemerling ranks acute articular rheum atism andinfluenza. Insanity also sometimes follows attacks of pneumonia,p le uris y, m ala ria l fe ve r, sma ll-p ox , m ea sle s, s ca rla tin a, a nd d ip hth eria ,e ry sip ela s, p hth is is, w ho op in g-c ou gh , m umps , c ho le ra , d ys en te ry , le pra ,h yd ro ph ob ia , g on orrho ea, erg otism , an d p ellagra. T he last tw o in to xications, which have been so ably studied by Tuczek, may be here left outof consideration. T he delirium attending fevers generally passes aw aywith convalescence. In a few cases, the mental affection continuesunder the form of neurasthenia or acute insanity w ith hallucinations(am entia), katatonia, paranoia, m ania, or m elancholia. There are nocharacteristic sym ptom s to distinguish insanity follow ing infectiousdiseases from other forms. It is in the decline of the febrile action orin the period of convalescence that we m ost frequently m eet w ith casesof insanity. T he asthnieype is the commonest, w ith incoherency anddream y confused m ental states, shifting hallucinations, and illusions,wandering delusions, and emotional weakness. Sometimes stuporand excitement succeed one another. Siemerling has observed inchildren perm anent w eakness of m ind dow n to idiocy follow ing upon

the exanthem ata, erysipelas, diphtheria, and parotitis epidem ica, influ en za, an d w ho op in g-co ug h, sometim es ta king a stu po rose fo rm , sometimes that of acute dementia. Simple mania and melancholia are rarewith children. Siemerling remarks that we can no more speak of atub ercu lar in sa nity th an o f a ty ph ou s insan ity ; bu t it sometim es h ap pen sthat in the course of phthisis and in the deepest stages of inanitionthe mental derangement entirely disappears. It also occurs, thoughrarely, that after typhus, influenza, or erysipelas the sym ptom s of insanity improve or there is a complete recovery. This has given hopesof effecting a cure through infection, as with the cocci of erysipelaso r some other c ommu nicate d disease.A s re ga rd s p ro gn osis , in sa nity fo llowin g in fe ctio n is g en era lly o f sh ortduration, though in a few cases it does last from several months toyears. Siemerling has found those following pneumonia the mostpersistent.The prognosis is bad in severe delirium , in typhoid and acutea rtic ula r rh euma tism (ty ph o-m an ia , c ere bro -rh euma tism us), w ith a h ig htem peratu re (from 4 1 o 4 4 C .) w hen d eath m ay fo llo w in a few h ou rs.This happens in half the cases. Nothing special in the treatment is

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I9O4-] CLINICAL NEUROLOGY AND PSYCHIATRY. 773recommended by Siemerling save that under some circumstances herecommends lum bar punctures w hen there are sym ptom s of m eningitis.W ILLIAM W. IRELAND .C rim in ality in S ard in ia n L un atic s \L a d elin qu en za n eg li a lie na ti sa ra i] .(A rch , d i P sich ia t., vo l. xxv, fase, i //, 1 90 4.) S ann a-S alaris.The author analyses 62 cases55 m en and 7 wom enof lunaticsw ho had com mitted crim inal offences and were sent for observation toh is a sy lum .H e draw s the follow ing conclusions from his study :1. Though it is true that the same form of delinquency is common tothe different varieties of insanity, it is none the less a fact that the graveoffences are more generally committed by two special categories oflunaticsepilept ics and paranoiacs.2. As the race exercises a conspicuous influence in determ ining thenature of the delinquency and the crim inal proclivity, the crim es committed by the insane are found to resemble in character those of thesane population to w hich the insane crim inals belong : crim inal tendencies are m ost m arked in the insane in districts w here sane crim e is m ostfrequent.3. A large number of the individuals examined presented somatics ti gma ta o f dgnrescence,he m inim um being am ong the paranoiacs,the m axim um am ong the epileptics and the im beciles.4. Am ong the patients, delirious ideas, either paranoiac or m erelythe exaggeration of superstition, w ere very frequent, and, alone or w ithother influ en ces, w ere o ne o f th e ch ief m otiv es o f crim e.W . C . SU LL IV AN .The crim inality of the insane \D ella crim inalit nei p azzi}. (Il M anicom io, anno xix, N o. 3, 1903.) A ngiolella.T he author discusses the relation betw een insanity and crim e, basing

his views on the study of a series of crim inal lunatics in the Noceraasylum. The number of such cases admitted in ten years was 115,which, compared with the total male receptions in the same period,gave a proportion of 3^99 per cent. The number actually under treatm ent is 81, being 9*96 per cent, of the daily average of m ale patients.T hese proportions, the author points out, though high, w hen it is bornein mind how the presence of such cases must interfere with the orderand discipline of a general asylum , are extrem ely low considering thecurrent ideas of the crim inal tendencies of the insane.Of the 115 cases 68 were lunatics w ho had com mitted crim es, and 47w ere crim inals w ho had becom e insane in prison.O f the form er category 33, or nearly half, were epileptics in the w idesense of the Italian school ; 15 others were paranoiacs ; 13 m oral idiots ;w hile recurrent m ania and chronic m ania accounted for two each, andhebephrenia, lypem ania and hallucinatory delirium for one each. T husc rim in al te nd en cie s w ere c hie fly a ss oc ia te d w ith th e in sa nitie s a risin g o na b as is o f dgn re sc en ce ,nd were hardly found at all in the purepsychoneuroses.Moreover, except in cases of paranoia, there is very rarely any