PUERPERAL INSANITY. A term applied to mental derangement occurring during the first six weeks of the puerperal state. During the great changes comprised in the onset of labor and the beginning of uterine involution, with the nerve drain, the rapid metabolism of tissue and the necessity for sudden adjustment to a new order of life, the risks of every woman are great: and the mother who is predisposed to mental de rangement is in especial danger. The onset of an attack of puerperal insanity is frequently sudden, but more frequently preceded by nerve fag, insomnia, restlessness and garrulity, fickle fancy, unreasonable likes, or dislikes, and per verted affection. Suspicion and obstinacy, vio lent hatred of husband or infant follow. Delu sions^ and hallucinations of a terrifying kind occur, and there is constant excitement, per petual talking in an incoherent way, impulsive action, often obscenity in speech and conduct, and often homicidal or suicidal impulse.
Puerperal insanity takes the form of mania in about one-half of the cases, of melancholia in about one-half. Moral shock has often a strong influence in the production of this insanity, for over 25 per cent. of the cases occur in mothers of illegitimate children. It is frequent in primipar:e. About one-half are violent or homicidal, about one-quarter of the cases are suicidal. Eighty per cent. of the cases re cover.
The treatment must be directed toward the genital apparatus, the digestive tract, the capacity for sleep, and the necessity for hydro therapy. Custodial care is, in the vast majority of the cases, necessary: for removal from fa miliar home surroundings is valuable. Consult Bevan Lewis, Text-book of Mental Diseases (Lon don, 18S9).