Is it an entity? In Peterson’s “Obstetrics,” Lewis, of Chicago, tells us
that the opinion is gaining ground that it is a coincidence and without
etiological relation to maternity and that to childbearing can we
probably assign only an exciting etiologic relation in the production of
an outbreak of insanity. The study of so-called puerperal insanity then
resolves itself into the study of the different types of mental disorder
as they may occur and reveal themselves in a pregnant, parturient or
puerperal woman. (Pp. 825–830.)
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.”
Having covered a fair field of literature in this subject of definition
we must now seriously consider the question—Have we or have we not a
definite disease? Shall we go on to discuss this subject at greater
length or shall we put it in the category of a broken wrist or an attack
of diphtheria, either of which might occur after the time that any woman
had had a baby? If I should say the latter, I should have to conclude
this paper and take my seat. So let us go a little farther along and
discuss its frequency before the question is answered.