Is the beneficial effect often produced in a case of recent and acute insanity by local inflammation (cellulitis) mainly due to the local disturbance or to a general, systemic disturbance? This question appears to me to have more than a mere theoretical interest, for the following reason:—If the effect noted be due mainly to the local inflammation we may go on applying blisters and equivalent chemical irritants on a sufficiently large scale to the skins of patients; but if the result is to be ascribed solely or largely to the accompanying general disturbance, it will be advisable to consider whether such cannot be evoked with greater certainty and thoroughness than is possible with the means now employed. I much doubt whether local inflammation, the result of chemical irritation, can be compared, from the point of view of influence upon existing mental disorder, with cellulitis∗ of unknown origin, such as occurs in the insane. Upon this point it would be instructive to hear the opinions of experienced observers. No one probably will deny that a more profound general disturbance is associated with idiopathic cellulitis than with inflammation due to chemical irritation. If, then, cellulitis is capable of producing the more striking mental alteration, it seems legitimate to ascribe this to the more profound systemic disturbance referred to. The qualitative difference in the nature of the irritants in the two cases possibly entails some difference in the modes of local reaction; even if this be so one would still, I think, be justified in adhering to the conclusion reached, i.e., that the greater mental effect produced by cellulitis is due to the greater systemic disturbance.
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