Puerperal Mania, a form of mental derangement which attacks women during the lying-in period. It is to be distinguished from the melancholia which occurs at the same period, although some authors treat both affections under one head, either that of puerperal mania or puerperal insanity. It is also to be distinguished from the insanity of pregnancy and the insanity of lactation, affections which are liable to occur in the earlier stages of pregnancy, or during lactation after the puerperal period has passed; and it is also distinct from the delirium of labor. The insanity of pregnancy, which generally occurs between the third and seventh months, may be caused by derangement of some of the bodily functions, usually associated with an anaemic condition, and, according to Esquirol, dependent in more than one third of the number of cases upon hereditary predisposition. The insanity of lactation generally occurs after the sixth month of that period, and therefore its principal cause, weakness from the exhaustion of nursing, is apparent. The delirium of labor is caused by the over-excited or erethistic condition of the brain in consequence of the intensity of the pains of labor. It is of much rarer occurrence since the use of anaesthetics in labor than formerly.

Puerperal mania generally comes on during the first two weeks after confinement, while melancholia is rarely developed until the latter part of the month. Among other prominent premonitory symptoms are sleeplessness, loquaciousness, and aversion toward friends; and a short period before the attack there are often movements of the eyelids and facial muscles. At the moment of attack the facial expression is often peculiar, the features becoming drawn and pallid, with an expression of fright mingled more or less with that of rage. The patient then becomes boisterous, stares wildly and makes rapid gestures, clutches at things and persons near her, throws off her covering, and attempts to jump out of bed; and her language will often be so profane as to mortify her friends. The skin is cold, pallid, and clammy, and the pulse is small, quick, and irritable. There is great muscular weakness, which however sometimes alternates with great spasmodic strength. - Among the predisposing causes heredity is the most frequent, and it is said to be generally traceable to the female side of the family. The pathological condition Of the brain is therefore similar to that of insanity in general, but this cannot always be demonstrated by microscopical examination.

The principal exciting cause is mental emotion, and it has been observed that those who possess the most sensitive organizations and have been particularly the victims of treachery are much more likely than others to be attacked Formerly it was frequently held that the disease was of inflammatory origin, being a modification of phrenitis; but the opinion advanced by Gooch, that "it is not a disease of congestion or inflammation," has been sustained by modern experience. Dr. Ferriar believes that the loss of reason is often principally due to some interference with the establishment of lactation. Convulsions which occur after labor are frequently followed by mania. It seems to be well established that there is an essential connection between puerperal mania and albuminuria; but the indications of the presence of albumen are less persistent than in convulsions. - Bleeding, which was once a common practice, is now regarded as injurious in all but a very few exceptional cases, as the disease is nearly always associated with an anaemic condition of the blood and a state of nervous exhaustion. The best therapeutic agent for relieving the cerebral excitement is perhaps the hydrate of chloral, and it is said to have a much better effect than pure chloroform.

The most important remedial treatment, however, is the use of nutritious food to restore the exhausted nervous energy by reestablishing the organic functions. Ferruginous tonics may also be given with advantage.