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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![excitement, a condition not found in ordinary acute mania. Sir J. Simpson, indeed, stated that the albumen disappeared from the urine within a short time after the access of the malady; but, in such case, the insanity can hardly be regarded as uraemic. Insanity has occasionally been a sequel of eclampsia, but only in rare cases. Puerperal insanity may occur after aii abortion as well as after labour, although not so frequently. Sometimes it recurs in successive pregnancies. In other cases, after a first attack of puerperal mania, some uterine disorder, or an ovarian tumour, may cause a recurrence. 1 have known very acute mania, resembling puerperal mania, and followed by rapid recoveiy, to be the sequel of the operation for the incision of the cervix uteri. Clinical course.—In the majority of cases the form taken is that of mania (in 57 out of 73 cases, according to Tuke). This is csj)ccially the case when the outbreak takes place within a fortnight after delivery, 'fhere may be premonitory signs of mental dis- turbance. (Icnerally there is sleeplessness ; the patient may take an unreasonable dislike to the nurse, or alter in her manner to her husband. 'I’he maniacal outlu’cak may be sudden. Generally it is marked by extreme restlessness of motion and incoherent voluble speech. Tliroughout the incoherence may be sometimes traced a ])romincnt delusion, or some idea which had previously occupied the patient’s mind. Hallucinations of vision are frequent. The ])atient may violently resist being kept in bed, may tear off her clothes, or try to throw herself out of the window. She is often violent towards relations, takes a dislike to her husband, and is a])t to try to destroy the child, ’fhe suicidal tendency is also often marked. In a few cases the mania comes on very suddenly— within a few days after delivery—and passes ofl’ as suddenly. Patients in this state may destroy their children or injure them- selves or others, and the explosion may suddenly restore the balance of reason. The condition is therefore one of medico-legal importance. In other cases the onset is not so violent. The patient at first may merely be incoherent, may refuse food, or may show signs of delusion ; but, in all cases which occur within the first fortnight after delivery, an outbreak of violence is to be apprehended. The 2)ulse is rapid when excitement is present, but the tempera- ture is not generally elevated, unless the insanity is dependent upon, or associated with, some other cause of pyrexia, such as seiffic disturbance. The tongue is usually coated, and the bowels often constipated. Evacuations may be passed involuntaril}', or without regard for decency. There may be filthy habits, such as eating excrement. Food is often refused. The urine is scanty, and con- tains excess of urea, urates aud phosphates, in consequence of the increased waste of tissues. The lochia and secretion of milk are](https://iiif.wellcomecollection.org/image/b21932645_0918.jp2/full/800%2C/0/default.jpg)
