Prognosis.—The prognosis of puer peral insanity is favorable: 75 to 80 per cent. recover, but a large proportion of the remainder die of exhaustion.
In no class of cases of insanity is the prognosis so favorable as in those of puerperal origin.
The number of previous pregnancies seems to have little influence, but the age seems of more importance; the younger the patient, the better, appar ently, is the prognosis. J. E. McCuaig (Med. News, Nov. 10, '95).
Treatment.—The principles of treat ment indicated under acute confusional insanity are in place here. Bed-rest, good food, and hypnotics when necessary are the indicated remedies.
Bearing in mind that puerperal in sanity is an infection psychosis, the local sources of infection should be sought out and removed if possible. In some cases there is simply saprannia due to absorption of septic materials from the birth-canal. Here the use of douches of hot water, medicated with antiseptics or not, are in order. In cases of purulent endometritis curetting of the interior of the uterus with repeated irrigation or gauze packing will be required. In cases where tubal, Para- or peri- metric inflam matory disturbances have occurred, the proper procedure has always seemed to the writer to be the operative removal of the foci of infection. Even in cases of long standing (two to five years) the oper ative removal of local sources of irrita tion and infection has resulted in entire cure of the mental disturbance.
Lactational Insanity.
Definition.—Mental disturbance oc curring during the period of lactation, usually coming on from six weeks to ten months after labor. Prevailing types: confusional insanity and melancholia. Symptoms and Course.—In the de pressed cases all the phenomena of mel ancholia are usually present. Frequently there is simple depression without hallu cinations or delusions. Suicidal tenden cies are frequent.
The cases usually described as mani acal belong, in the majority of instances, to the acute confusional type. There are varying hallucinations and delusions, in coherence, refusal of food, generally fever, want of control of the sphincters, and a tendency to exhaustion.
Etiology.—Prolonged or excessive lac tation is given as the chief cause of in sanity occurring during the nursing period. Careful inquiry will, however, show that certain conditions favoring toxemic infection are often present. Thus, a mammitis or mammary abscess not rarely precedes the mental disturb ance. Defective uterine involution is regarded by Bevan Lewis as a factor. The writer has found lacerated cervix and endometritis present in some cases.
Lactation, as such, plays no role at all in the production of insanity. It is due to other circumstances that during the first few months after delivery women are, on the average, more predisposed to nervous and mental diseases than under ordinary conditions. W. Hirsch (Med. Record, Jan. 6, 1900).
Diagnosis.—The occurrence of con fusional insanity during the nursing period is the only diagnostic feature.
There is nothing distinctive in the tomatology. Between 3 and 4 per cent.
of all cases of insanity in women occur during the nursing period.
Progn osis.— Moderately favorable.
From 40 to 50 per cent. recover. Clou ston claims as high a proportion as 77 per cent.
Treatment.—Removal of local sources of infection or irritation. Good food and hmmatic tonics are usually indicated. Arrest the drain upon vital power by stopping the nursing.
Saturnine Insanity. Definition.—Insanity following , the absorption of lead.
Symptoms and Cause.—Two forms of insanity from lead are described. In the one the patient is incoherent, but not very much disturbed. In the other there is violent, noisy behavior with inco herence, followed by deep sleep or coma. Tremor and subsultus tendinum are usually present. At times there are epi leptiform convulsions.
Diagnosis.—The usual objective signs of lead poisoning are present.
Prognosis and Treatment—The dis ease is extremely grave. About one fourth of the cases die in the attack. Dementia may follow in cases escaping death. The majority of cases recover with or without mental defect. The treatment is that of lead poisoning.