On puerperal mania / by Thomas More Madden.

  • Madden, Thomas More, 1838-1902.
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: On puerperal mania / by Thomas More Madden. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    manifested the symptoms of the malady within the first week after delivery; and this fact is to some extent a confirmation of the old idea that the complaint in question is connected witli the irritation caused by the secretion of milk, especially if this be disturbed or put back, in which case a metastasis to the cerebral system was held to take place. Dr. Horatio Storer, of Boston, has, in bis recently published work on 'Keflex Insanity in Women/ with great ability advocated the view that the frequency of insanity in females is owing to reflex irritation caused by ovarian or uterine derangements. The same theory has been applied to explain the cause of puerperal mania. Th ere can be no doubt, however, that toxaemia, or puerperal blood poisoning, plays at least fully as important a part in the causation of puerperal mania as reflex irritation does. In the great majority of these cases suppression, or diminution of the lochia, which generally became foetid as well as scanty before disappearing, was observed. The retention of the matter which should be thus eluninated, and its circulation through the cerebral vascular system alfords, I think, a not improbable explanation of many of the phenomena of puerperal mania. I must say, however, that I have seen weU marked cases of puerperal mania in which there was no diminution of either the mam- mary secretion or the lochia. To understand why it is that puerperal women are so liable to a peculiar and generally speaking transient form of mental disturbance, we must bear in mind that for healthy thought, or mental action, a healthy condition of the blood in circulation through the brain, as well as a normal state of the circulation itself—that is to say, a per- fect freedom from any derangement of the general circulation, or local misdirection of blood which might seriously disturb the balance of the circulation, is essential. I have seen more than one case of puerperal mania which commenced apparently during the patient's' sleep J and this reminds me of an observation I made in an essay of mine published some years ago, ' On Dreaming considered especially in relation to Insanity,' viz. that fearful dreams, if frequently re- peated, may eventually influence the permanent state of the mind; and, considering the close resemblance between the phenomena of dreaming and insanity, which is but a waking and active dream, we may expect that the former condition, if prolonged, might pass into the latter state. Insanity occasionally does commence in a dream that continues after the cessation of sleep, and cases are re- corded in which persons recovering from mental alieniition were nightly disturbed in their dreams by the same hallucinations which had previously haunted them in the waking state. Some women, for instance, says Dr. Storer, in his recent work on ' Eeflex Insa- nity in Women,' are much troubled with frightful dreams whenever they are pregnant. Dr. Lowder used to relate the case of a lady who was obliged to have a nurse sitting at her bedside all night to