husband and gone to her mother, declaring that she would no longer live with him, though she exhibited no other definite indications of insanity.

This and much more of a similar character, indicating how greatly the emotional system is often affected from the influence of a gravid uterus, may occur with females during their first and sometimes in succeeding pregnancies, and yet the mind not become so much affected that the subject is regarded as wholly irresponsible. Indeed, we must bear in mind the fact that no such experiences ought to result from the conditions of pregnancy; that the prime physiological purpose of the uterus is that of child-bearing; and that if women had never lived in the conditions of civilization, or disregarded the laws of their physical nature, there would occur no greater irritation from the pregnant state than is the case with the females of other animals.

These disturbances of the emotional system during the period of pregnancy, however, are of special importance in two respects. In the first place, when existing in an exaggerated degree, they may be regarded as harbingers, or rather as danger signals, which may warn the physician of the coming of more serious ones, either during the later period of pregnancy or during the periods which are subsequent to confinement. They may almost insensibly merge into the morbid mental states incidental to the puerperal or lactational periods, especially the latter. In the second place, they present states of mind which are on the border line, if any such exists, between sanity and insanity. They indicate, as almost no others do, how imperceptibly the one state merges into the other, and also how quickly the one state may change for the other. The morbid mental state of to-day may be changed for one of comparative composure and "sweet reasonableness" to

morrow. The depression or emotional excitement of the morning may give place to hopeful expectation in the evening.

In those cases of pregnancy, therefore, in which the nerve centres become so profoundly affected that insanity results, it becomes necessary to introduce another element of ætiology, i. e., that of heredity, or a predisposition. When the nervous system is so burdened, or is very sensitively or delicately poised, the irritation arising from such physiological processes may then prove sufficient to cause serious derangement of the mind. When such is the case the disorder generally assumes the form of melancholia. The table on opposite page, which includes the cases of the insanity of pregnancy that have been admitted to the Retreat since 1845, indicates how influential is the factor of predisposition both in the history and termination.

Insanity is said to occur more often during the first pregnancy than in subsequent ones, and in females who either have not been married at all, or have married late in life. Its importance then is increased, as its effects relate to two lives instead of one, and are likely to arise in subsequent pregnancies or parturitions. Such cases are of special importance to general practitioners, as friends hesitate to place them in institutions; and, indeed, very few institutions have the requisite accommodations for their proper care. There can exist no doubt that many cases of insanity during pregnancy are cared for at home for this reason and because of the large measure of sympathy and anxiety which could not be aroused in other forms of the disorder.

CASES OF INSANITY OF PREGNANCY IN CONNECTICUT HOSPITAL FOR INSANE.*

Symptoms. These are nearly always of a depressive character. They appear to develop from the primary states of emotional excitement, suspicion, and irritability, to which allusion has already been made. Persons not only become restless and irritable, but unable to control these states. They are sleepless, suspicious, and imagine

* Furnished by Dr. James Olmsted, Superintendent.

that their husbands are visiting other women; have suspicions that their food is poisoned and refuse to take it; are careless of dress and personal appearance, and become apathetic.

Dr. J. Batty Tuke says that "in no form of insanity is the suicidal tendency so well marked. Thirteen patients out of twenty-eight have either attempted or meditated suicide. In some the attempts were most determined—a loathing of life and the most intense desire to get rid of it being the actuating motives." At times the excitement and irritability become so great as to render them dangerous to those having the care of them; this generally arises from some form of delusion or hallucination.

In other cases there appears a depravity of the moral nature as exaggerated as that already described as arising in the physical appetites. Women who have always borne reputations of the highest character are overcome with a desire to appropriate articles belonging to others, of almost any kind, which they may chance to see. These may be of very little value and such as the person never before had any interest in possessing, but the desire to appropriate them now becomes quite irresistible, and little effort is made to conceal it from others. In short, they are veritable kleptomaniacs, and at times it may become a very delicate duty of the physician to give his opinion in such cases, and to explain how such methods of conduct may depend upon the mental derangement of pregnancy.

PUERPERAL INSANITY.

The term puerperal insanity will be used as descriptive of cases which may develop immediately after delivery and also of those which may arise during the first succeeding