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.
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.