In our published lectures, we have mentioned two cases of phlegmatia dolens, which had been under our care at St. Thomas’s Hospital, and where, in both, the disease had been thus produced during the ulcerative stage of cancer uteri: the interest of them was somewhat increased by their having been admitted at the same time, and by their happening to lie next to each other in the same ward: in one, the attack of crural phlebitis was severe, and the swelling of the limb very considerable; in the other, the affection was less severe: we did not take any notes of the cases, and must, therefore, refer to a similar one which has been recorded by Mr. Lawrence, and in which, the appearances after death were accurately detailed. The patient came under his care, on account of shooting pains in the loins and hypogastric region, which was tender upon pressure; she had incontinence of urine, and a sanious discharge from the vagina.
On examination, instead of the os tincæ and cervix uteri, a large irregular ulcerated excavation was found at the posterior end of the vagina. Shortly afterwards, increased uneasiness was experienced in the lower part of the abdomen, the right lower extremity swelled in its whole extent, with pain in the course of the femoral and iliac vessels, and all the other symptoms of phlegmatia dolens. The disease was treated by leeches and other antiphlogistic means, and the pain abated considerably; it, however, returned, and in about three weeks after, she died from a violent attack of uterine hæmorrhage. On dissection, the fundus uteri was found somewhat enlarged and firm, the cervix had been destroyed by that kind of phagedenic ulceration, which is commonly called cancer of the uterus. The hypogastric vein was closed in consequence of previous inflammation of its coats, and the same change had taken place in the internal iliac, the common iliac, the external iliac, the femoral and profunda veins, as well as in the internal saphena, all of which were completely impervious. The affection terminated above at the junction of the common iliac with that of the opposite side, the latter vessel being quite natural. The saphena vein was closed for a length of about four or five inches, beyond which it was natural. The right spermatic vein was closed in its lower half. The coats of the affected vessels, and the surrounding cellular substance were a little thickened, and their cavities were plugged by a closely adherent and tolerably firm substance of a light brown colour; at some parts, the vessels and their contents were of a dark livid hue. (Med. Chir. Trans.)[147]
CHAPTER XV.
PUERPERAL MANIA.
Inflammatory or phrenitic form.—Treatment.—Gastro-enteric form.—Treatment.—Adynamic form.—Causes and symptoms.—Treatment.
There are many points of similarity between puerperal convulsions, and the disease which we are now about to consider, so that an acquaintance with the nature of the one, will greatly assist the reader in his study of the other: the same causes which induce the one, will, with trifling modification, induce the other; the different species of puerperal mania, will, therefore, resemble more or less those of puerperal convulsions.
Disorder of the mind, which comes under the head of puerperal mania, is rarely met with before labour; for when it occurs during pregnancy it is usually referrible to causes unconnected with that state, as to hysteria; or is, a form of ordinary mania arising from hereditary predisposition, cerebral diseases, &c. It is true these are conditions which will render the patient exceedingly liable to an attack of derangement during labour, and especially during the puerperal state; but the identity of the affections cannot well be carried farther.
According to our own experience puerperal mania may occur under one of the three following conditions, viz.—