MANIA OF PREGNANT WOMEN.
Melancholia is the most frequent of all the forms of insanity in pregnant women. Mania is the next most frequent. The insanity may begin at any time, from the commencement of conception, which is rare, up to the end of the ninth month, i.e., up to some weeks before delivery. The number of cases increases after the eighth month, attains its maximum frequency at about the seventh or eighth month and then diminighes. Sometimes the disease bursts out suddenly, which is rare. As a rule, it appears slowly and increases gradually. The intellectual disturbances which attend pregnancy grow more and more marked, and disorders of volition and of observation are soon added. The disposition is altered, sleep first becomes agitated and then is replaced by insomnia, and the patients complain of head-ache and digestive troubles. Then true mental alienation, generally of the melancholic type, makes its appearance. In other cases, the maniacal form predominates, and then generally suddenly explodes, either without prodromata or after attacks of eclampsia. Some times there is simply weakness, languor and inertia, a sort of stupor with suicidal ideas, and, sometimes, there is excitement with ideas of murder and hallucinations. Again, there may be, in the maniacal form, excite ment, insomnia, irritability and paroxysms of furious mania. There is, eometimes, albuminuria, but this is sometimes absent. Garcia Rijo has reported inequality of the pupils.
the hinsanity disappears after labor, but it is not always so. Among the nineteen cases of Marc, the disease proved incurable in nine, or only disappeared long after labor; in seven cases, labor was the point of departure for the cure. In two of our own cases the insanity ceased abruptly, once with the expulsion of the child, even before the expulsion of the placenta. In the second case insanity ap peared at the sixth month, disappeared at the ninth, reappeared five weeks after labor, lasted six months, and then disappeared but not com pletely. In one e,ase, Mame saw the insanity aggravated by labor, and death rapidly supervene during the confinement.
Among Leidesdorff's six cases were four women who had presented psychical troubles before marriage. The insanity became serious during pregnancy, and melancholia followed labor. Of the two others, in whom
insanity began during pregnancy, one saw her mania augmented by labor, and one recovered immediately after delivery. Esquirol saw one case in which insanity reappeared in five consecutive pregnancies, disappearing each time after confinement.
Among the twenty cases of Leidesdorff, during pregnancy and the puerperal state, there were ten cures and one fatal case. In eight cases insanity remained. Esquirol saw only six deaths in ninety-two cases; Webster five in one hundred and eleven cases. After labor the insanity seems much more serious and the maniacal form has by far the worst prog nosis. Thus, there were, among fifty-seven patients seen by Burrows: Cures (28 in the first six months), 35; deaths, 10; incurables, 1; suicide, 1.
Among eight cases of insanity developed during labor or after delivery, seven of which bad hereditary antecedents, Burrows saw: Melancholia and homicidal monomania, 1 case, cure in 9 months; mania and melan cholia, 1 case, cure in 14 months; melancholia, 1 case, cure in 1 year; mel ancholia, 1 case, cure in 6 months; melancholia, 1 case ended in incurable dementia; abortion at four months, 1 case, suicide; abortion at three months with six attacks of mania before marriage, 1 case; incurable in sanity developed at four months. Among Leidesdorff's twelve cases dur ing the puerperal state, from twenty to twenty-nine years, there were: Melancholia, 8 c,ases; mania, 3 cases; dementia, 1 case. There were eight cures: five in four months; two in six months and one in a year.
It, therefore, appears that sometimes the cure follows closely upon labor, but that it sometimes occurs only after a certain number of months. In general, there is notable improvement after the first weeks following confinement. It is rare to see insanity develop and disappear during pregnancy. Sometimes the patient is improved considerably, and a happy termination is expected, when a sudden relapse destroys this hope, and only confinement can change the aspect of the disease. In the ma jority of cases, labor has no influence or a very doubtful one. Finally, acute mania may develop, and death result more or less speedily.