Maniacal chorea differs from the mania of the puerperium from other causes: in maniacal chorea the woman is not so sullen, and is more garrulous than the patient with puerperal mania. The prognosis is better in maniacal chorea as to recovery of reason. Sometimes, however, the mania of puerperal chorea persists for months, or it may become even permanent.
If the fetus is viable and the choreic woman, with a clear toxic chorea, shows signs of exhaustion from the spasms and insomnia, or if her mania is becoming fixed and her delusions are dangerous (such women are likely to kill the infant), or if she has endocarditis, the uterus should be emptied, as a rule. If, however, the symptoms show a recession on treatment, the uterus should not be emptied. Albrecht[137] reported a case of chorea cured by an injection of serum from a normal pregnant woman. Each case must be judged by its own characteristics. The last sacraments should be given as soon as the symptoms grow grave.
[137] _Zeitschr. f. Geburtshülfe u. Gynäk._, lxxvi, 3, p. 677. Stuttgart.
Hysteria in a woman, even when mild, may grow serious in pregnancy when it takes the form of melancholia; but it is dangerous when it passes into maniacal excitement. In mania there may be exhaustion from a refusal to take food, and in labor maniacal hysteria may wreak grave injury on both mother and child. Hysterical women should be treated before pregnancy; indeed, the process of avoiding hysteria should have begun in the patient's grandparents.
The term hysteria has been handed down from the days when physicians thought there was a connection between uterine disorders and the set of nervous symptoms grouped about the title hysteria. It is now etymologically meaningless--men also grow hysterical. Briquet found 11 male to 204 female hysterics, and later statistics increase the number of males.
The disease is not readily definable. The patient is usually a young emotional woman, oftenest between fifteen and twenty years of age. She commonly has anesthetic spots on her body, concentric limitations of the fields of vision and reversals in the color fields, hysterogenetic zones, or tender points, which when pressed appear to inhibit the hysterical fit. The symptoms enumerated here are not, however, found in every case of hysteria, and it is difficult at times to diagnose the case. There is a popular notion that hysteria is a disease of malingerers, but it is as real as typhoid fever or a broken leg, and a much greater affliction than either of these conditions. Malingering is only a symptom of the disease.