Fritz, agreeing with Griesinger and Winckel, divides puerperal mania into three categories.
1. Symptomatic mania, which is only of interest on account of the febrile delirium, which increases and diminishes with the affections which c,ause it. 2. Puerperal mania, which developes slowly aud a long time before confinement, and gives rise to the furious delirium which labor or the puerperal state excites, by becoming the occasional cause; J. Puer peral mania, properly so called, which results from hemorrhages, eclamp. sia, violent physical and moral suffering, without hereditary predisposition. In this last class, Winckel distinguishes two kinds of mania. In one the affection is acuth, the course rapid, and there is an increase in the tem perature and acceleration of the pulse. The maniacal attack is preceded and accompanied for some time by head-ache, hotness of the head, photo phobia, great susceptibility to noise, tinnitus aurium and insomnia. In _ the other, the same general symptoms aro not observed; the pulse is nor mal, or slightly accelerated; the life of the patient is not in danger, but the mental disorder is more or lees chronic, and persists sometimes indefi nitely.
It is the first of these two forms which Simpson and Donkin Scott make dependent upon albuminuria. Fritz, on the contrary, declares that there is no relation of cause or effect between albuminuria and mania. Brafin says that the mania which succeeds eclampsia is afebrile, but he has almost always had in his cases a very marked acceleration of the pulse and elevation of the temperature. If, generally, mania follows eclampsia, it is not always so, and it may come on before, during and after the con vulsions, and he cites in support of his views four observations which were in part personal and in part reported by Leubuscher, Grenser, Don kin, Scanzoni, Spiess, Devilliers and Regnault, Esquirol, Trousseau, Seydel and Bonifas. Often the mania has ended in a few days, and again it has become chronic; but in these there were hereditary tendencies; two cases ended fatally, one by puerperal fever, one in profound coma coming on after an attack of mania. •
From these observations Fritz has drawn the following conclusions: 1. In whatever period eclampsia comes on, it may be accompanied or followed by mania; 2. Mental disturbances predispose the pregnant woman to mania and eclampsia, during and after confinement; 3. During labor, mania may appear either during the prodromic period of eclampsia, or during the interval of attacks, or else in the state following, or lastly even several days after the cessation of the attacks; 4. It is not rare to see an interval of health, more or less long, separate two of these periods. The mania is of short duration according as the attacks are feeble, and the interval between the attacks are longer; 5. The form of the mental disturbances which succeed almost always the eclampsic attacks is acute mania; 6. In all cases, a woman who has had eclampsia is predisposed more than all others to puerperal mania.
Becher does not believe with Fritz that eelampsia is, properly speaking, the cause of mania, and he is rather disposed to admit that the two dis eases depend upon the same lesion, which we do not yet know. Never theless, eclampsia constitutes a predisposition to puerperal mania, which may start up soon after the complete return of consciousness, and it is in the organic alterations, more or less serious,that we must seek the occasional cause. These having the same origin, sometimes they start up simulta -neously, sometimes succeed one another. To the cases already cited, be adds three of Plasse D' Einbeck, of which two were cured, and one died.
Cortyl, 1877, considers puerperal mania following eclampsia as depend ing on a tree perversion of nervous action, which, after producing disorders of motion, ends by provoking outbursts of mental disorders.
Finally, eclampsia may produce paralysis, either of the senses, blindness, or deafness; of the limbs, hemiplegia, paraplegia. We will refer again briefly to puerperal paralysis.