Insanity during the puerperium

Abstract

I. That any variety o.f mental disease may have its starting point in the Puerperium.

II. That the common varieties directly due to puerperal causes have a common symptom viz. confusion.

III. That this confusion nay be combined with excitement in the form of 1. Acute Mania with confusion and 2. Conditions of Acute delirium which latter are severe forms of the confusional excitement, and that these two constitute by far the most cases occurring in the first fortnight.

IV. That symptoms of Katatonia may occur in any of the varieties, and together with confusion may give rise to conditions of stupor.

V. That confusion with Melancholia is the mental state in most of those cases that begin late in the Puerperium.

VI. That the acute confusional excitements may be due to sepsis or collapse and that the prolonged cases of delirium usually known as Acute Delirious Mania are on the mental side no more acute than some of the rapidly recovering cases,and that the gravity of the condition is due to physical conditions.

VII. That many of the prolonged delirious conditions are streptococcal in origin and that the infection is probably in many cases a tubal one.

VIII. That the neurotic diathesis is present in nearly every case and is probably in inverse ratio to the amount of the sum of the other predisposing ;&nd exciting causes.

IX.That mild sepsis may bring about Insanity in combination with a severe neurotic tendency.

X. That apart from extraneous complications viz. Consumption: death from suicidal wounds etc: those cases that die in spite of treatment are almost all septicaemic in origin.

XI. That the causes of the milder confusional states and melancholic states are probably exhaustion, mental or physical, and that intestinal and metabolic toxaemias may play a contributory part in their causation.

XII. That examination of the blood points to a toxic element in excited cases apart from sepsis and that the cases due to collapse and exhaustion are probably,as the result of diminished power of immunity in the blood and diminished nervous resistance, in part the result of autointoxication.

XIII. That the mental symptoms even in melancholic cases are suggestive of a toxaemia.

XIV. That the prognosis in Puerperal Insanity is good. That complete mental recovery takes place in the majority of cases,and even the patient who is most unstable mentally may recover most quickly if treatment is begun at once. That the prognosis is unfavourable in proportion to the duration of action of the predisposing causes and to the severity of the physical exciting causes.

XV. That in the treatment of the cases of excitement and delirium antistreptococcic serum may be of value. That it must be given immediately and in sufficient doses in those cases where the temperature does net fall under othez1 treatmentand that even after the temperature has been elevated for some time, very large doses should be tried, guided by the leucocytcsis.