Fifth: Symptoms of the former have a more or less sudden onset frequently preceded by a febrile disturbance and a pulse that either fails to fall as the temperature does or even climbs higher. There may or may not have been foul lochia previously. The onset is characterized by hallucinations, sexual and religious excitement, suicidal and infanticidal promptings, the latter more common in the lactational type.
Sixth: The prognosis is fairly good and as time goes on is improving, especially for the class of cases due to infections or intoxications.
Seventh: Treatment will tax all our ingenuity. General bodily health must be closely watched. The cause of infections must be met on surgical principles, as in any other infection, and the emunctories must be carefully looked after in this class, and, in those of chemical origin, its particular cause must be run down and met, whether in liver, intestine or kidney.
Rest must be obtained in the proper way. Restraint without resistance must be used, a constant attendant rather than a straight jacket. Pleasant surroundings make for mental rest as well.
Food must be nutritious and easily assimilated and its elimination must be watched and the kidneys stimulated with all the means at our command.
Exercise to the point of stimulation, but not fatigue, is as necessary as in any disease.
Medication must be studied very thoroughly. Of the hypnotics, hyoscine is the best. The suggestion of Berry Hart as to the emmenagogues is well worth a trial.
In the lactational type, we have profound exhaustion to deal with, and rest, more than exercise, will be indicated, but the most important indication is immediate weaning for the mother’s sake; while in the early puerperal type, weaning is indicated to remove from the mother all thoughts of the labor and also to avoid infanticide. If early improvement is not observed, a psychiatrist should be consulted and personally, I feel that a joint conduct of the case, particularly the early ones, of obstetrician and psychiatrist will give the most happy results to these unfortunates.—Long Island Medical Journal.