In the course of the past six years I have been occupied with the care of the recent admissions to a large public asylum, with a direct admission rate averaging over 160 per annum, including a small proportion of private patients. Among the admissions, patients have from time to time been sent in who presented conditions of delirium such as are often associated with acute physical illness, cases which might not have been out of place in the wards of a general hospital. Such cases have always had for me a particular interest, and not unnaturally so, for are they not those amongst which are to be found some of our most regrettable fatalities, as well as of our most satisfactory and gratifying recoveries.
While it is generally admitted that in the light of our present knowledge no scientific classification of mental disorders is possible, yet it is necessary for statistical purposes to tabulate our cases in some way. Prior to 1907, the tables of the Commissioners in Lunacy presented only the one heading of"acute delirious mania" under which such cases as I have hinted at could reasonably be placed. In that year, however, the term "confusional insanity" appear-ed in addition. This led me to inquire what form of mental disorder was implied by this term, and I came to the conclusion that very decided differences of opinion existed among alienists as to the nature of the conditions that should he placed in this category.If any excuse were needed for inquiring into this question, it might he found in the words of Lugaro, who says in reference to this topic: "here is another morbid picture that requires further elucidation."
I am not, perhaps, in a position to add much to our knowledge of these interesting and not uncommon forms of mental affection, but it has appeared to me desirable, and possibly not without value, to collect my notes--often, I am afraid, incomplete--on cases that presented delirium or confused states as an integral part of the clinical picture. It is the purpose of this Thesis, therefore, to examine the material which has come under my own observation, and to see how far my own experience bears out the views of modern authorities on the vexed question of confusional insanity, as well as to discuss the problems that a consideration of this material suggests.
The cases which will be utilised in this thesis belong solely to the female sex, comprising, with a few exceptions, direct admissions since January 1907.
The plan which is here adopted is briefly as follows:- in the first chapter the opinions of accepted authorities are outlined and commented upon, and the absence of unanimity in their views is emphasised.In the second chapter personally observed cases are described in considerable detail, and incidental reference is made to others which present points of interest for my subject: in the third chapter a synthetic study of my cases is given, and in chapter four certain problems presented by a consideration of my material will be discussed. Finally, certain conclusions to which I have been led will be set forth.