Cases illustrative of the insanity of pregnancy, puerperal mania, and insanity of lactation / by John B. Tuke, Esq.

  • Tuke, J. Batty, Sir (John Batty), 1835-1913.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: Cases illustrative of the insanity of pregnancy, puerperal mania, and insanity of lactation / by John B. Tuke, Esq. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    much more serious cliaracter. Dr Burrows noticed them chiefly in connexion with the first secretion of milk, on the fourth or fifth day. Some of these are examples of phrenitis, and not properly of mania. Frequency of pulse is a symptom of primary importance. An inflammatory state of the pulse is indeed a most serious symptom; and why? Because it indicates, not phrenitis, which is excessively rare, but inflammation of some internal organ, of which the usual symptoms are masked by the mental affection. The latency of the symptoms of acute and chronic diseases amongst the insane is one of the great difficulties asylum physicians have to contend against. Phthisis may exist for years undetected, were it not for the stethoscope, without cough, sweats, emaciation, or hectic, till the disease is very far advanced. Tuberculosis of other organs may run its course without any indication of its presence. Caries and necrosis kill without pain, most extensive abscesses collect without causing inconvenience. I have known dements die of typhoid fever without any symptom but diaiThoea. This peculiarity extends to inflammation of all the internal organs. Keflex action is impaired amongst the insane;—this is exemplified in a small way by the idiot as he sits with a drop hanging from his nose without any irritation of that organ; in a greater, by the dement or chronic maniac dying of consumption, bronchitis, or pleurisy, without cough or pain, however extensive the internal disturbance may be. This remark applies equally to the subject of puerperal insanity, in whom inflammation of vital organs may exist without a symptom further than a slightly inflammatory pulse / and I have known even this symptom absent. But where it is present the prognosis must be most unfavourable. I am sorry to admit that, in my experience, which extends to four cases complicated with internal inflammation,—two of bronchitis, one each of peritonitis and pelvic cellulitis,—the result was invariably fatal. There may have been circumstances in these cases which tended to such an issue, such as aggravation of the disease produced by the moving of the patient fi-ora her home, and consequent cold and exposure; nevertheless it justifies the conclusion that any such combination must be looked upon as serious in the extreme.^ On the other hand, puerperal mania of itself does not kill, and, where you have to combat it alone, not only death need not be dreaded, but, in the very large proportion of cases, a return to sanity may be prognosticated. It is, perhaps, the most curable form of insanity. This statement is made advisedly, but does not extend to those cases which are placed midcr asylum treat- ment as a dernier ressort. ' Puerperal paraphrenitis is by no means denied. Two probable cases are alluded to in the previous paper. But it is of rare occurrence, and may be mistaken for puerperal insanity associated with internal inflammation. Marked head symptoms always, however, indicate the diagnosis.
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