In ancient times, phrenitis was considered a persistent febrile delirium, which the medicine of the time understood as a form of mental illness. Today, the condition is described as inflammation of the diaphragm, which is treated via the administration of antibiotics. In most cases, bacterial causes underlie the disease.
What is phrenitis?
The clinical picture of phrenitis dates back to ancient times and has survived into the Middle Ages. At that time, the disease was described as persistent delirium with fever. The Corpus Hippocraticum wrote down phrenitis. This made the clinical picture a recognized disease during antiquity, and numerous typesetters tried their hand at describing it. In modern medicine, phrenitis no longer exists in its original form of fever delirium. Today, physicians are more likely to diagnose diaphragmatitis, whereas in ancient times, phrenitis would have been diagnosed. The febrile delirium formerly described may or may not be one of the symptoms of diaphragmatitis. As a symptom, febrile delirium is rather nonspecific and thus may occur in the setting of various diseases.
Causes
Inflammation of the diaphragm was considered as a cause of phrenitis during ancient times. According to ancient thought, the diaphragm was the seat of the soul and mind. Because the symptoms of the disease seemed more indicative of mental illness, authors such as Galenos sometimes also cited the brain and its membranes as damaged areas of the body. In this area, too, an inflammatory cause was assumed at that time. Via Byzantine and Arabic texts, this view of phrenitis was handed down into the Middle Ages. Medieval medicine distinguished the clinical picture from mania and melancholia. Michael Ettmüller described the disease in distinction to the other two terms as a febrile inflammation of the brain. When psychiatry developed in the 19th century, the classification of phrenitis in mental illnesses was discarded because the symptom of fever did not fit into this area. Physicians of the 19th century therefore tended to understand phrenitis as a form of meningitis, which is known to be accompanied by fever, impaired consciousness, and convulsions. The current view is that phrenitis is an infectious or psychologically caused inflammation of the diaphragm.
Symptoms, complaints, and signs
Ancient writings describe chills, delirium, and anxiety as leading symptoms of phrenitis. The confusional states of the disease are thought to be due to high fever, which can likewise cause seizures, hallucinations, eye rolling, tremors, and temporary loss of consciousness. According to current research, inflammatory molecules, so-called cytokines, can disrupt the release of neurotransmitters. Such impaired release of neuronal messengers triggers hallucinatory and delirium-like states, as described in ancient writings in the context of phrenitis. Febrile delirium may occur primarily in systemic inflammation. Such systemic inflammation usually appears in the form of large infections, as may be present in the diaphragm. Today, however, the accompanying symptoms of diaphragmatic inflammation are completely different from those of ancient times. In particular, hiccups, breathing problems or respiratory pain, and pressure on the costal arch are now considered leading symptoms.
Diagnosis and course of the disease
During ancient times, the diagnosis of phrenitis was made by visual diagnosis and corroborated by examination methods such as palpation. Today, physicians make the diagnosis of phrenitis by taking a medical history in combination with a blood test and possibly a chest x-ray. The blood test may reveal the extent of the inflammation. Concomitant hiccups may be an indication to the physician of trichinella infestation as a trigger for the inflammation. In the present, phrenitis is still painful, but delusional symptoms are rare. Today, the disease is generally not fatal. In contrast, in ancient times, most patients died from the inflammation.
Complications
Phrenitis leads to various complaints in patients. First and foremost, those affected thereby suffer from a high fever and furthermore also from chills. Likewise, there is an inner restlessness and feelings of anxiety or panic attacks. The disease can also cause the patient to become delirious.The affected person continues to suffer from hallucinations or seizures. The hands tremble and there may also be a complete loss of consciousness, during which the patient may also injure himself. Furthermore, phrenitis can also lead to various inflammations and other infections, as the immune system itself is significantly weakened by the disease. Likewise, those affected suffer from breathing difficulties and constant hiccups. In most cases, phrenitis can be treated relatively well and easily with the help of antibiotics. This does not lead to further complications. In some cases, however, sufferers are also dependent on psychological treatment. As a rule, life expectancy is not negatively affected. Likewise, bed rest has a very positive effect on this disease.
When should one go to the doctor?
If symptoms such as fever, chills, or anxiety and panic attacks occur, there may be an underlying infection. A doctor should be consulted if symptoms do not resolve on their own after a few days. Phrenitis is a disease that does not exist nowadays, which is why a specific medical clarification is not necessary. Nevertheless, typical fever symptoms must be investigated, since a similar condition may be underlying. For example, persistent delirium with fever may occur, which may be due to various causes. If the symptoms described occur, it is best to consult the family physician. People suffering from a chronic infectious disease or immune deficiency are particularly at risk. Pregnant women, children and the elderly also belong to the risk groups and should consult a doctor if typical signs of fever as well as changes in consciousness are noticed. In addition to the general practitioner, one can consult the internist. Treatment is medicinal and can usually take place on an outpatient basis. In case of severe fever attacks, inpatient therapy in a specialized clinic is necessary.
Treatment and therapy
In ancient times, patients with phrenitis were usually confined to bed so that they would not harm themselves or others during febrile delirium. In most cases, bloodletting was initiated to treat the manifestations, which at that time was understood to be the most important means of curing most diseases. However, even this method of treatment involved high risks of infection, since medicine at that time did not work in a sterile manner. In addition, dietary prescriptions and rubs with oil for ancient patients of phrenitis were supposed to initiate healing processes. As a rule, these treatments could not cure the usually infectious inflammation of the diaphragm. Therefore, normally only patients with an exceedingly strong immune system survived. In most cases, the untreated inflammation continued to spread, which in many cases caused the delusional manifestations in the first place. Nowadays, mainly bacterial inflammations of the diaphragm are treated via the administration of antibiotics. In case of antibiotic resistance, the doctor usually gives enzymes as an alternative. In addition, painkillers are often prescribed for the pain. Cough drops relieve any cough symptoms. If, instead of an infectious cause, a psychosomatic cause is in the picture, the physician will advise his patient to undergo concomitant psychotherapy.
Outlook and prognosis
As a rule, phrenitis can be cured relatively well if it is recognized early and treated immediately. It is very rare for complications to occur, and especially only if the phrenitis is not treated at all. For this reason, the affected person should ideally see a doctor very early and also initiate treatment to prevent the occurrence of further symptoms. It is also not possible for the disease to heal on its own, so that in the case of phrenitis it is always necessary to take medication in order to cure the disease completely. By taking antibiotics, the symptoms usually disappear within a few weeks and the disease heals completely. Further aftercare is usually not necessary. However, if the disease is not treated, the infection can spread and, in the worst case, lead to the death of the affected person. Since the disease can also occur in some cases due to a psychological illness, the treatment proves to be relatively difficult.Sufferers may also become ill again after a complete cure, since immunity to phrenitis cannot be built up.
Prevention
Phrenitis caused by bacteria cannot be completely prevented. On the other hand, phrenitis with psychosomatic causes can be prevented by psychotherapeutic treatment. During this treatment, the patient usually learns stress management strategies that prevent the onset of psychosomatic illness.
Aftercare
Phrenitis is a medical diagnosis that is no longer in use today. In the Middle Ages, the aftercare of phrenitis mainly involved discussions with clergy or physicians. Because a mental illness was suspected behind the symptoms, sufferers were often relegated to closed institutions or socially ostracized. In particular, the typical manias and pronounced melancholy were seen in the Middle Ages as signs of a severe mental illness or even an obsession and were not treated adequately or at all. Nowadays, phrenitis is often equated with meningitis. Meningitis follow-up includes regular visits to the doctor as well as other measures that depend on the intensity of the disease and other factors. In general, patients should take it easy and keep a close eye on symptoms. The doctor should be visited every one to two weeks so that the course of the disease can be closely monitored. In the event of unusual symptoms such as fever or pain in the limbs, the doctor must be informed immediately. In the event of circulatory problems, the emergency medical services should be contacted. Affected persons may need initial care, as the symptoms of the disease can lead to a circulatory collapse or sometimes even a heart attack. Meningitis or phrenitis follow-up is done by the general practitioner or an internist.
Here’s what you can do yourself
Phrenitis is a disease of antiquity. Therefore, it is very unlikely to appear nowadays. Sufferers who show symptoms of phrenitis should strictly observe immediate bed rest. Interaction with the physician is vital for survival and should be intensively maintained. Rest, sleep and recuperation are necessary. Disturbing factors, ambient noise or other influences are to be reduced to a minimum. Everyday professional as well as private obligations are to be reorganized immediately. People from the social environment or caregivers should take care of all errands during the time of illness. The body should be provided with a sufficient amount of fluids. In addition, a healthy and balanced diet is important. The immune system must be supported and stabilized. Vitamins, nutrients and trace elements are needed for this. For optimal rest, sleep hygiene must be checked. The mattress as well as the bedding should be neither too warm nor too cold. An adequate supply of fresh air is necessary to ensure that the ill person receives enough oxygen. Lowering the fever can be assisted with fresh wraps or bandages. Since the affected person tends to behave aggressively, he must be adequately protected from himself and others. Measures to reduce a risk of injury should therefore be taken.
