Berry Hart says the prognosis is good under proper treatment and the return of menstruation is such a good sign that emmenagogues should be employed.
Tweedy & Wrench say some 60 per cent of all cases recover, but if, as the patient gets fatter and stronger the mind does not improve, the prognosis is bad.
In the subject of treatment our authorities again differ, but not in the usual way. Webster briefly dismisses it with advising an asylum, as does Hirst, except in cases of refusal of families or friends to commit the patient, when general symptomatic treatment is necessary. Edgar and De Lee both are no more explicit. Berry Hart with his regard for the return of menstruation, says when the patient gains weight to use hot sitz baths, aloes and iron pills and binoxide of manganese two grains in pills thrice daily should be administered. In lactational insanity immediate weaning of the baby is indicated. Williams feels that it is a good deal of an obstetric problem because of its presumably infective causes and we must search for the underlying etiologic factor for the cause. The symptomatic treatment he refers to only generally and suggests, if immediate improvement is not seen, to refer to a psychiatrist.
Tweedy & Wrench logically prescribe rest, food, excretion, and exercise as the key notes of prevention and cure. When the attack is established, use forty grains of bromide and ten of chloral every two hours. With acute mania, hyoscine is the best stand-by.
Lewis of Chicago gives many practical suggestions.
The deduction and conclusions that we may draw from this summary of the literature and from our own experience are these:
First: We have a definite clinical entity.
Second: Its etiology is in a great number of cases toxic, either bacterial or chemical, except in the lactational type which is one of general impoverishment of the body from prolonged nursing.
Third: It occurs in about one in 2,000 labors at present and it causes about 6 per cent of all insanity in the female.
Fourth: Its types, which I am poorly equipped to discuss technically, I will group briefly as manias and melancholias. At first thought we would expect the former to be the strictly puerperal type, and the latter the lactational and in general this classification is correct.