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This form of mania has been treated of, in one of the papers of Medical Transactions, by Dr. Robert Gooch. He says, “ It is well known that some women who are perfectly sane at all other times become deranged after delivery, and that this form of the disease is called Puerperal Insanity.” The most common time for it to begin is a few days or a few weeks after delivery; sometimes it happens after several months, during nursing, and soon after weaning. It is said sometimes to arise at the commencement of labour.
“ The approach of the disease is announced by symptoms which excite little apprehension, because they so often occur, without any such termination;—the pulse is quick, without any manifest cause; the nights are restless, and the temper is sharp. Soon, however, there is an indiscribable hurry and peculiarity of manner, which a watchful and experienced observer, and those accustomed to the patient will notice; her conduct and language become wild and incoherent, and at length she becomes decidedly maniacal. It is fortunate if she does not attempt her life before the nature of the malady is discovered.
“ When the disease appears under the form of melancholia, it commonly begins some months after delivery, and comes on gradually: the pati
ent has suffered in her health from nursing, experiences a failure of memory, confusion of mind, and an irresistible and inexplicable depression of spirits; she finds it difficult to think on any subject long; her domestic accounts bewilder her, she is dissatisfied about herself, and full of anxiety. This state continues in a greater or less degree for several weeks. At length it becomes more marked; her countenance is mournful and downcast, she is silent and thoughtful, fancies that she has some serious disease, accuses herself of some moral depravity, and supposes herself an object of punishment and scorn.
“It is needless here to give a minute and detailed discription of mania and melancholia in child-bed or suckling women; it is generally like mania and melancholia under other circumstances; but I may here remark, (what those who have carefully observed the affections of the nervous system will readily acknowledge), that when once its functions are greatly disordered, there is no end to the diversity which the symptoms are capable of assuming."
“ When once it has begun, its duration is very different in different cases; sometimes it subsides in a few days, or even hours;—but this is rare;--it commonly lasts several weeks, or even months; but of ninety-two cases of puerperal insanity admitted into the hospital de la Salpitriere at Paris, two lasted two years; and thirty
six (that is, more than one-third,) went uncured. It is a common opinion that puerperal insanity is: harmless to life; most cases, it is true, terminate: favourably. Those who consider puerperal mania: as a disease ultimately harmless to life and understanding, will be surprised at the proportion of incurables and deaths in this hospital; the only way to explain it is by supposing that none but those cases which resist the ordinary treatment at home, that is, the picked bad cases, find their way to this institution.
“Some women are so liable to insanity in the puerperal state, that they have been deranged in many successive confinements; this, however, is far from being always the case. I have known several who having been affected with mania after lying-in in the country, have, in their next confinements, come to town to be attended; they were long and carefully guarded from noise and agitation, dieted cautiously, purged frequently, and although apprehensions were long entertained about them, completely escaped their former attack
“ As to the causes of this disease, the chief seems to be that peculiar state of the sexual system which occurs after delivery; in many instances the only remarkable circumstance about the patient, is,--that she has been delivered, or is nursing; yet there is another cause which greatly contributes to the excitement of this disease,considerable inter
ruption of that mental tranquillity so requisite during the susceptibility of the puerperal state; the frequent admission of boisterous persons into the lying-in room; an officious, eager, irritable nurse, or relative, who, with the best possible intentions, is continually doing the worst possible things; sudden and violent agitation, domestic anxieties, and misfortunes, have preceded and apparently contributed to the appearance of the disease. Still patients often lie-in, are disturbed, irritated, frightened, depressed, and shocked, without becoming insane; hence we must take into the account at least a predisposing cause susceptibility of the brain.”
“ Whenever it is possible, the patient should be confided to a nurse accustomed to the task, she is not equally safe under the care of any other, how- . ever intelligent and discreet; these nurses learn by experience all the arts which such patients employ for the attainment of their object, and regularly and methodically secure the knife, garter, door, and window, &c. There is no contrivance to which the patient can resort, which they have not learnt by practice to anticipate; it is a striking example of the superiority of an ordinary mind, disciplined, over a fertile but undisciplined cunning.” · In another part of the paper, Doctor Gooch says, “above all things, never attempt the removal of her delusions by argument; and when
the violence of the disease has subsided, facilitate the recovery of her natural feelings and faculties by presenting their natural objects.”
It would be difficult to add any thing to this excellent paper which might be useful to the general reader. The whole progress of the disease is so clearly and so correctly marked, that those who have ever watched a case of puerperal mania will at once acknowledge its truth; and those who have never been led to such observation may almost trace the growth of the malady in the statements so familiarly put forth by Doctor Gooch.
One remark of importance may be made to guard the reader from misunderstanding the means of 66
facilitating the recovery of natural feelings and faculties by presenting their natural objects.”
When the violence of the disease has subsided—the husband should see the patient but seldom, and then only in the presence of other persons. Powerful reasons render this precaution absolutely necessary, even during convalescence; and several months should elapse after the patient appears to have perfectly recovered before any closer intercourse ought to be allowed. On a rigid observance of this may the happiness of future Issue depend.-Many a wretch has suffered death under the laws of his country, by reason of a mental incapacity to receive moral impressions. This is a con