Anæmic Insanity.—This is the variety of insanity produced by exhausting discharges, loss of blood, or starvation, and takes its name from the condition of anæmia that precedes and accompanies it. Dr. Aitkin says that “any acute disease which occurs in an anæmic individual assumes a peculiar character.” Now this is precisely what occurs when such an individual becomes insane. There are two very distinct kinds of anæmic insanity, which may be called the chronic and the acute. The chronic results from anæmia produced gradually by exhausting discharges or such slow processes. Its symptoms are precisely those that Dr. Skae described as occurring in the insanity of lactation without the sexual characteristics of the latter, so that I need not occupy your time in describing them. The most important characteristics are the premonitory giddiness, flashes of light, singing in the ears, headache. The acute variety follows great and sudden losses of blood or starvation. It is most typically seen in the latter condition. At first there is a state of mental prostration, with pale and cadaverous countenance, wild and glistening eyes, severe pain in the epigastrium, and an intense thirst; then the mind becomes quite imbecile, so that the patient will make no effort for his own benefit, and after this a state of maniacal delirium, with hallucinations of the senses, comes on. The patient sees ravishingly cool and limpid streams and green fields, which if he is at sea he will at once jump overboard to reach, he tries to sing, and converses with imaginary friends. This is soon succeeded by coma or convulsions and death. But if food is given before this, the patient often remains for a long time delirious or imbecile in mind, cannot get rid of his hallucinations, and cannot exert his mind in any way.
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