Licence: In copyright
Credit: A manual of midwifery / by Alfred Lewis Galabin. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![a length as to amount to moral perversion, as, for instance, when • they take the form of dipsomania or kleptomania. The anajmia and deterioration of blood which are common in pregnancy may often have to do V’ith the causation. In some instances albuminuria, or the blood changes resulting from jaundice, have been regarded as a cause. A mental cause frequently present is the fear or conviction, so commonly met with in pregnant women, especially those pregnant for the first time, that the result of delivery will be fatal. In many cases the development of melancholia out of this despondent frame of mind can be traced. It is a further proof of the relation between the two conditions that the insanity of pregnancy takes the form of melancholia in the great majority of cases. Out of 28 cases recorded by Tuke, there was melancholia in 20, typical mania in only 2; out of 10 recorded by Savage, there was melancholia in 7, and typical mania in only I. With the melancholia more or less of dementia is associated in a minority of the cases. Dispo.sition to suicide is strong. If the insanity persists after delivery, there may be a homicidal tendency towards the infant. 'I’hcre may be refusal of food, and the delusion that attem])ts are being made to poison is not uncommon. There is generally a])athy and indifference towards husband and friends. Erotic manifestations are comparatively uncommon. The tendency to moral ])crversious, such as dij)somania and kleptomania, some- times without other evidence of insanity, has been already men- tioned. Insanity may come on at any time during pi'egnancy, but generally after the second or third month. I'rof/iums.—'I'he great majority of patients recover, but usually not till after delivery. In a few instances, however, when insanity comes on in the early months, the patient recovers before delivery. There is, however, a liability to relapse after delivery. According to Spiegelbcrg, the ju'ognosis is more favourable when the insanity comes on in the early months. Of Savage’s cases, 90 per cent. I'ecovcred within twelve months. ’I’he average date of recovery was six months tafter delivery. When the insanity takes a form different from that usual during pregnancy—that is to say, when there is mania rather than melancholia—the prognosis is less favourable. The insanity of labour.—In some cases of labour a kind of transitory mania or delirium is produced by the intensity of the pain. The patient, in her frenzy, may injure herself, or, more frequently, injure the child, the excitement ]-eaching its height just at the final pains, when the head passes the vulva. As might be expected, this is more common in ])rimipara3, in whom greater pain is produced in the distension of the perineum, and inevitable laceration of the vaginal outlet. The mental agony resulting from seduction may add to the effect. There is a medico-legal interest in the question, since it has generally been held, when a woman](https://iiif.wellcomecollection.org/image/b21932645_0916.jp2/full/800%2C/0/default.jpg)
