The authors restrict the denomination of post-operative psychoses to delusional disorders which occur in the sphere of ideation alone; so that neurasthenia, for example, following upon an operation, is excluded. They also exclude delusional states directly due to toxæmia, which are transitory and differ in their symptoms and treatment—just as puerperal insanity differs from the transitory puerperal delirium arising from septicaemia. They admit, however, that the line of demarcation between these two groups of cases may be hard to draw. Moreover, as has been pointed out by Magnan, we may have a febrile or toxæmic delirium superposed upon a true psychosis. Hereditary predisposition is a marked feature in post-operative insanity, so much so that one may deny the possibility of an operation alone causing a psychosis in a healthy subject; at the same time this is no argument for rejecting this class of cases. Gynæcological operations are not more likely to cause post operative insanity than other operations; the confusion with simple neurasthenia has led to this opinion. The symptoms of post-operative insanity are most variable, and have furnished some justification for denying its existence as a separate form; moreover, in cases where general paralysis and other well-defined psychoses have supervened (or appeared to) upon an operation, we must attribute the occurrence to a mere coincidence. The variation in symptoms, or in the character of the psychosis, arises from the variability in the mental conformation of the patient and the varying predisposition—the all-important factor. The nature of the operation itself is another factor to be considered. The prognosis varies considerably as well as the treatment.
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