It is difficult to distinguish this form of mania from that known as puerperal mania, the two conditions being essentially similar. This, too, is to be regarded as a complicated toxemia, in which products of defective metabolism, of insufficient elimination, and of phagocytic activity mingle in a blood whose corpuscular elements are already much disturbed by injury or hemorrhage. Regarding these cases from a surgeon’s standpoint, and carefully avoiding any attempt at minute explanation of the phenomena, such cases are met with in the practice of operating surgeons, as in the experience of obstetricians, presenting themselves either as mild forms of harmless mental aberration, or assuming almost any of the types of insanity as made out and classified by experts in that subject. From the mildest mental alienation up to intense and even homicidal or suicidal mania, one may meet with all degrees of departure from the normal standard. Bowel washing, hot-air baths, hepatic stimulants, and carefully regulated nutrition will usually restore to the brain its natural food supply, and hence its normal function. I have repeatedly seen much good result from the exhibition of small doses (0.30 to 0.50) of potassium iodide.
TOXIC ANTISEPTICS.
As stated above, it is generally recognized that in people of peculiar idiosyncrasies the administration of certain drugs ordinarily considered harmless is followed by more or less toxic symptoms. Obviously if this were universally the case, or true in the majority of instances, the use of these drugs would speedily be abandoned. As it is, it is well to have in mind the consequences which are occasionally known to ensue, and perhaps to weigh in every case the chances as to whether it is worth while to use a given substance of known occasional toxic power as against another which is not known to possess it.
Of the less active antiseptic agents, boric acid is considered absolutely innocuous, yet is known sometimes to cause intestinal disturbance, while in one instance serious toxic effects followed its use. Naphthalin will sometimes produce vertigo or vasomotor symptoms, especially when administered internally. Many of the antiseptic materials used are more or less irritating to the skin, and such local expressions as eczema, etc., provoke little comment.
Iodine is a drug whose activity should be borne in mind. Applied upon the surface, it tans the skin and does no good. Injected in solutions of varying strength into serous cavities (for example, hydroceles, etc.) it gives rise to symptoms which may be alarming. Fatal poisoning following its injection into an ovarian cyst has been reported, and alarming symptoms have been produced by injection of the ordinary solution into a hydrocele sac. Much of the virtue ascribed to iodoform is credited to the liberation of free iodine by its decomposition. Whether or not this be true, iodoform is one of the most frequently toxic of the antiseptic agents in ordinary use. In mild cases it produces headache, restlessness, wakefulness, and often a distinct taste of iodoform in the mouth. In more pronounced degrees of poisoning there is fever, often with mental derangement which may amount to delirium or even to acute mania, and may cause well-founded suspicion of meningitis. Death after its use has repeatedly occurred from syncope or in coma.
Carbolic acid produces unpleasant effects, both upon patient and operator, or with whoever it may come in contact. Aside from its local effect upon the skin, which is most unpleasant, but which usually passes away within a few hours, it seems to affect especially the kidneys, causing often temporary albuminuria with discolored urine, deranged secretion, and sometimes more acute forms of disturbance, similar to those met with after its internal use. Carbolic poisoning was observed most frequently during the era when Lister’s original directions were scrupulously followed, and at a time before it was learned that it is much better to remove dirt than to try to antagonize its action. Eminent surgeons were compelled to discontinue its use because of its unpleasant effect upon themselves as well as upon their patients.
Among the powerful antiseptic agents in common use are the soluble preparations of mercury, ordinarily corrosive sublimate, in solutions of varying strength, which are used for irrigation, douching, etc., and for preparation of dressings. An intense eczema may follow its local use, and symptoms of mercurial poisoning may appear in individuals of peculiar susceptibility to this drug. Salivation, intestinal irritation, and other phenomena of mercurial poisoning have been produced, with the result that the solutions and preparations of corrosive sublimate are much weaker than those which were used at first. The drug eczema produced by corrosive sublimate interferes with one of the essentials of ideal wound healing—i. e., physiological rest. The area involved should be protected with a sterilized powder or by anointing it with sterilized ointment.