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.
920/982 (page 890)
![Probabl}’’ tlie fatal cases are often not removed to asylums. Of four cases, occurring in 23,591 deliveries in the Guy’s Hospital Lying-in Charity, all proved fatal; but this is an unusual result. One died from septicaemia, of which the mania was a complication ; one from pneumonia; two apparently from exhaustion. In one of these two cases there was albuminuria. If the patient does not die, cure follows in the great majority of cases. It may still be hoped for, even after the disease has per- sisted for twelve months. Sometimes, however, the patient lapses into permanent melancholia or dementia. Of the above 78 cases recorded by Savage, 13 patients were nncnred at the end of from 12 to 18 months. The most frequent duration is from three to six months. In recurrent attacks the prognosis is less favourable, and the cure generally requires longer time. In melancholia, the average duration is somewhat longer. The greatest number of recovei'ies takes place from the fourth to the seventh month. The insanity of lactation.—’fhis form of insanity is com- moner among the j)Oor than among the rich, and commences in general ])hysical weakness and anmmia, It is most frequent in nHiltipnne who have been weakened by numerous or quickly- repeated pregnancies. It may commence at any time, from two months up to eighteen months or more after delivery. In a few cases, the outbreak has followed almost immediately upon weaning. 'I’he majority of patients suffer from the outset from melancholia, and, even of those who are excited at the commencement, almost all become melancholic afterwards. 'I’he proportion of recoveries and the duration of the disease are similar to those in the insanity of the piierporal period. Prophylaxis,—Mari-iagc should be discouraged iti women who have a strong hereditaiy disposition to insanity, and also, in most cases, in those who have already had an attack of insanity. Such advice, however, will generally not be followed. If pregnancy occurs in such women, the utmost care should be taken to main- tain the health by nutritious food and hygienic management. If a patient has previously suffered from the insanity of pregnancy, and has premonitory signs of mental disturbance in a subsequent preg- nancy, the question of inducing abortion with the hope of averting insanity may arise. In general, this proceeding is as likely to precipitate the insanity as to avei’t it, and the hope of benefit is therefore hardly enough to justifiy the sacrifice of the child. Treatment.—As the disease so generally terminates in recovery, it is desirable to avoid sending the patient to an asylum, in order to avoid the consequent stigma, provided that she is in a position to secure the services of skilled attendants. Since she must be constantly watched, day and night, two attendants at least are necessary. In cases of violent mania, four may be required. With patients who are not wealthy, therefore, removal generally](https://iiif.wellcomecollection.org/image/b21932645_0920.jp2/full/800%2C/0/default.jpg)
