There was an acute parenchymatous nephritis with focal plasma cell infiltrations suggesting acute interstitial nephritis. This case appears to have shown one of the most nearly normal brains in the whole Danvers series. Patient was variously designated, as "dementia" and as "acute confusional insanity." Father also insane.
In its slightest degree this phenomenon of excitation is characterized by a feeling of well-being, of euphoria, which even at the point of death may give the patient the illusion of a return to health, or there may be a more pronounced excitation with impulsive sexual and alcoholic tendencies. Autointoxication may lead to the usual train of confusional symptoms.
During the short interval when she was conscious she did not appear to be other than normal, but that, I fear, is not conclusive evidence. One would have to study her. If, as Dr. Sartorius suggests, she may be suffering from confusional attacks, she would part of the time be so completely sane that one would suspect nothing wrong. Subjects of that kind often live a sort of double life.
Then she replied carefully: "Well, you know soon after she came here she began to behave just a little oddly at times. At first the doctor did not think it serious, but towards the end he was afraid that she was a little a little " "A little what?" "Well unbalanced. Have you ever heard of anyone having 'confusional attacks'?" "I don't know. Yes, perhaps. What about it?"
Either it was the result of those "confusional attacks" the doctor had hinted at, or she was, as both doctors now implied, a victim of morphia-mania.... Unthinkable! Esther! What was this noise outside the door? Confused voices reached him speaking in French, together with the heavy tread of several men, who apparently were tramping up the stairs.
He thinks stupor usually follows depression or mania and says that “the ‘Confusional Insanity’ of German and American authors is just a lesser degree of stupor.” Omitting his stupors in general paralysis and epilepsy he makes three clinical divisions: melancholic or conscious stupor, which is not a product of delusions, although delusions of death or great wickedness may be present, impulsiveness and fits may be observed; anergic or unconscious stupor, which corresponds roughly to our deep, benign stupor; and secondary stupor after acute mental disease, which resembles our partial stupor.