Lee, of Manchester, England, in his exhaustive treatise, “Puerperal Infection,” refers very casually to the maniacal symptoms of the infection. (P. 290.)
Williams, in his “Obstetrics,” however, speaks assuredly of puerperal insanity and gives definite etiological factors, two of which are the result of childbearing. (Pp. 915, 916.)
Hirst, in his “Practice of Obstetrics,” feels that it is an entity and more distinctly a disease of this period because of the etiological features he mentions and which will be referred to later. (P. 248.)
Webster, in his “Text Book of Obstetrics,” discussed it as an entity under a separate heading, but not by any etiological factor does he separate it from other psychoses. It is in the frequency of its occurrence that he quotes from Clouston, of Edinburgh, viz., one in 400 labors, in which Hirst concurs that we may infer it is a distinct disease. (P. 613.)
Berry Hart, of Edinburgh, in his “Guide to Midwifery,” says “Insanity may come on in women” while childbearing, and refers to predisposing causes, but gives no well defined picture of the condition. (P. 574.)
Wright, of Toronto, in his “Text Book of Obstetrics,” refers to insanity of pregnancy: symptomatically ordinary insanity, but etiologically speaking, the statement that constipation is frequently marked in the barest allusion. (P. 430.)
De Lee, of Chicago, “During the puerperium and lactation, insanity is a not infrequent disease,” and from his discussion of it he very apparently holds it as an entity. (P. 373.)
Tweedy & Wrench discuss insanity at more length than any of the other authors and must be convinced that it is a definite disease. (P. 401.)
Edgar refers to the “essential puerperal psychoses” and discussed their etiology and time of occurrence very definitely. (P. 800.)
The most comprehensive work on this subject, however, is that in the Journal of Obstetrics and Gynecology of the British Empire, of Robert Jones, Superintendent of London County Asylum, Claybury, England, and to quote him is most convincing. “Of the specially puerperal cases—and it is in this period that I recognize a special form of insanity—more suffered from mania than melancholia.”