10. The puerperal state not only does not protect women against the causes of paralysis other than those which we have mentioned, as rheu matism, chloro-anEemia and hysteria, but seems to predispose the patients to palsy from these causes, by producing abnormal hwmic conditions.
11. Puerperal paralyses are generally slight and transient, but this is particularly true of reflex paralyses, for hemiplegias, paraplegias and pa ralyses of the special senses may be of indefinite duration.
12. Organic paralyses borrow their character, as regards gravity, from the nature of the causative conditions, being either temporary, perma nent or even fatal, as the case may be.
13. The lesions most frequently reported are: cerebral hemorrhage, cerebral or spinal meningitis, whether alone or accompanied, as they fre quently are, by renal degenerative changes.
14. The frequent coexistence of these renal lesions, and of cerebral or medullary lesions, shows how important albuminuria is in the pathogeny of puerperal palsies.
15. It is possible, within certain limits, to establish a precise diagnosis of the cause of these puerperal paralyses, and this cause once being known, to, establish a prognosis which will be surer in proportion as the cause of the paralysis is better known.
16. The treatment must depend on the causes, some of which are per manent, the others being transitory and temporary.
Intellectual Disturbance& These are, aa Mame says, of two kinds. One consists in simple moral tendencies, which do not deprive the patient of free-will, but impart a peculiar character to her manner and her physiognomy. The other is a state of mental alienation, variable in type but well-marked. In the first instance, the disorders are very different, as caprices, whimsicalities, changes of disposition, variable moods, new tastes, unreasonable antipa thies—disorders, in short, affecting either the whole of the mental facul ties or only one of them, (understanding, sensibility, will. Boudrie.) Thus, one sees women who, having been remarkable for the sweetness and amenity of their character, become sad, morose, sour, violent even, and unable to endure the presence of persons hitherto dear to them. Others, inclined to be naturally sad, melancholy, grave or serious, de velop an activity and a gayety surprising to their friends. Still others, particularly primiparfe, await their confinement with terror, and are per suaded that they will not survive the trial which is before them. Hence they grow melancholy, and conceive fears regarding the proper develop ment of their children. Mara quotes, from Vandermonde, the history of a woman who had a horror of water during the first four months of each of her eleven pregnancies. In certain cases, the nervous distur
bance eventuates in true mental alienation, or puerperal mania. On this subject, however, authors do not agree. Insanity may, indeed, manifest itself, not only in pregnant women, but during labor in the puerperium, and even in lactation. So, while some authors describe the mental alienation occurring at these different periods under the generic term, puerperal mania, others reserve this name exclusively for those cases of insanity developed during the puerperium. Others add the insanity of lactation, making the mania of pregnant women a variety by itself, riz., sympathetic insanity. Aside from the emotional character peculiar to pregnant women, there is an undeniable sympathy between uterine dis turbances and intellectual disorders.
These conditions have been found by Lisfranc, Azam and others when pregnancy did not exist. Much more should they obtain when there ex ists a long-continued irritation, such as is produced by the presence of the fcetus in utero. But this sympathy, existing in pregnancy, is not un derstood in the same way by all authors, and is even rejected by some. Thus, while Falret, Georget and Scanzoni deny it, Le Grand du Saulle, Tarnier, Dagonet and Becher positively admit it. Others, like Marc6, Brierre de Boismont, Baillarger and Morel admit it with certain reserva tions, and although they admit the sympathy, consider it to be imperfect. Marct expresses himself thus: " If we consider it proper to exclude from the class of sympathetic manias, (taking this term in its strictest accept ation), those which are developed after labor, during lactation or after weaning, we reserve the term for those causes of transient insanity occur ring during labor, and disappearing so soon as confinement is terminated; for those mental affections which, beginning at conception or dining the early days of pregnancy, cease after the termination of the puerperal state; and, finally, for those rare cases in which a delirium of a few hours' duration accompanies the milk fever and disappears with it." This sympathy cannot be absolutely denied, and the material proof of ita existence has been furnished by Voisin, who discovered, by the aid of the microscope, a large number of embryoplastic nuclei, particularly in the semilunar ganglion, and at a more advanced period, fusiform bodies and distortion of the nerve-cells, which, filled with fatty and pigmentary granules, are mingled with healthy cells or with other atrophied cells.