Treatment. —Authors have recommended venesectiou, nauseating doses of tartar emetic, prolonged warm baths, purgatives, narcotics, antispas modics, camphor and the milk diet. Med. advises prolonged baths, the expectant treatment, tonics and hydrotherapeutics.
II. Melancholia.
This is less grave than mania. The moral state of the woman, during pregnancy, seems to exert a special causative influence. It begins, like mania, either within a few days after delivery or near the sixth week. It is rapidly developed, or occasionally sad ideas may precede the invasion of the delirium, and of the melancholic depression. In certain cases, there is, for some days, a general excitement bordering on mania, and, later, the delirium becomes habitual. Ideas of persecution, fear of death, dread of punishment, and ideas of suicide form the basis of the delirious concep tions. There are hallucinations of sight and of hearing, and the patients may grow dangerous to themselves or to their children. Marce reports analgesia, hysterical attacks and catalepsy among the symptoms.
Prognosis.—This is, generally, not very grave, but the duration is long, from one month t,o six months.
Treatment. —It consists in prolonged warm baths, cold affusions, opium, chloral, hygienic measures and constant surveillance.
Together with these two chief forms must be mentioned the partial lesions of intelligence, the hallucinations of sight and of hearing, impul sive religious monomania and homicidal monomania. Marce mentions a
special variety of intellectual enfeeblement, which is prone to follow abun dant puerperal hemorrhages, may be general or partial, and particularly affects the memory. Dementia also occurs, and lastly, cyclical or duplex inaanity, characterized by two regular periods, one of excitement, of mania, and the other of depression, of melancholia, the association of which constitutes a paroyxsm. It sometimes follows mania, and may be intermittent. It is a secondary, chronic form of puerperal insanity.
III. Insanity of J.Vursing Women.
This form of insanity developes during the first six or seven weeks after labor, or later, after eight, ten or twelve months of lactation or even a few days after weaning. The disease begins in two ways, either suddenly, after exciting events, chills, etc., or gradually. The prevailing types are mania, melancholia, mononiania and duplex insanity% The prognosis is, generally, not bad. Marce saw twenty cures among twenty-six cases. The cure may, however, be slow, occurring only after several months or years. The first indication i3 to stop lactation. To accomplish this, dieting, purgatives, the iodide of potassium, and after suppression of the secretion, a tonic regimen may be useful.