Page images
PDF
EPUB

the immediate effects of which do not pass off for a considerable time.

Both homicidal and suicidal tendencies may exist. In the first case the patient is generally under the dominance of the delusion that the nurse or some member of the family who may have the care of her is about to do her injury, and she suddenly attacks the person in selfdefense, using every means in her power to defend herself and destroy her imaginary enemy. Delusions are generally present in from 33 to 50 per cent. of all cases and in a still larger per cent. of maniacal cases. They seem to arise from hallucinations, and as these are, as already noted, nearly always of a terrorizing character the delusions are those of impending danger and injury. Food is refused because it is poisoned and every one is conspiring to take her life. In the second case she makes an effort to fly from some impending evil which seems to come to her through the presence of hallucinations, and the intense fear appears to drive all other thoughts, except those of safety, from her mind. She screams with terror and tries to dash herself against the walls of the room, to throw herself from the window, or strangle herself if left alone long enough to enable her to make the attempt. In the 175 cases at the Retreat suicidal impulse or efforts are noted in only 15 per cent. Of 36 cases at the Connecticut Hospital for the Insane 33 per cent. were either homicidal or suicidal or both; and 27 per cent. had made attempts to injure the offspring. These conditions of excitement usually continue ten days or two weeks and are succeeded by a more or less protracted period of dementia or melancholia, attended with delusions which often relate to the members of her family. Hallucinations are rarely present in the latter stages of the disorder.

In those cases in which the symptoms assume the type of melancholia or dementia from the first, the physical symptoms described as pertaining to puerperal insanity are not present. In the larger proportion of such cases the development of the disease is postponed until after the fifth week or later. Hallucinations are much less frequent and if present less frightful in character. Delusions, if present, are of the same general character as those which are present in melancholia from other causes. The character of thought is subjective; insomnia is often present and the patient is dominated with the belief that she is deserted by husband and friends, that she is unworthy, and is to be forever punished, etc. Of 114 cases in the Connecticut Hospital for the Insane 26 per cent. presented symptoms of melancholia.

Convalescence generally becomes established in the course of eight or ten weeks. The force of delusions gradually fades away, the mind becomes more active and interested in the details of daily life, and also in the presence of friends or relatives who may visit them, and from this period the patient passes on to a good recovery. In 20 cases there was a recovery in 75 per cent., and in nearly all within a period of five months. In 39 cases of recovery at the Connecticut Hospital five occurred in less than four weeks, 15 in less than eight weeks, six in less than 12 weeks and the remaining 13 in periods of from five to ten months. If the recovery is postponed beyond the period of five months the probability of its occurrence rapidly diminishes. The prognosis will therefore depend considerably on the length of time which has elapsed since the onset of the disorder. According to Dr. Bevan Lewis,* the element of

"Text-book of Mental Diseases," p. 372.

age is also an important factor in determining the prognosis, patients under 30 having a much more favorable prospect of recovery than those considerably past that age. This view does not appear to be corroborated by the record of the 39 cases embodied in the table on page 358.

It does not appear from this table that recoveries were very much hastened by early admissions. The average period during which the disorder had existed prior to admission, in the first three groups, is nearly the same, while the period during which they were under treatment is doubled in the last of the three, as compared with the first. The same point is even more fully demonstrated in the succeeding groups of cases. Nor does age appear to be a factor of much importance in relation to the duration of the disease, the average being the same in first and last groups. Other elements, such as physical condition, heredity, and forms of disease, must be considered as important in relation to early recoveries.

CASE 1.-A. V., age 24, had her second confinement about two weeks prior to her admission to the Retreat. A few days subsequently to confinement she became suspicious, turned against her husband and friends, and thought she saw devils on the walls flitting about her room. She threatened to kill both her babe and her husband, and was much excited. When admitted, however, she was quiet; the effort incident to the journey evidently had had a soothing effect. She had not slept during four days and nights. Her pulse was 90, full and soft, the skin moist, and she had taken but little food for several days.

TABLE SHOWING THE AVERAGES OF TIME UNDER TREATMENT, IN SPECIAL
RELATION TO THE LENGTH of Time DISEASE HAD EXISTED PRIOR
TO ADMISSION, AND AGES, IN THIRTY-NINE RECOVERIES.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][subsumed][merged small][subsumed][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

She was given milk and eggs, beef tea and beer, with chloral at bedtime, but did not sleep until the second night after admission. In the course of a few days she became utterly careless as to her dress and person, very filthy, and would take no food except as it was fed to her with a stomach tube. This state of mind continued for about ten days, when she began to take food more willingly and freely, and slept some during the day as well as at night. The breasts, which had been swollen, became less inflamed and more soft; the mind gradually became less excited but was much confused. The untidy habits, however, continued several weeks, after which the mind rather suddenly improved in the quality of its activities and in strength. She could answer questions correctly and asked to see her husband and child; looked over the illustrated papers which were given her and occasionally shed tears when alone. After eight weeks she appeared quite cheerful and wished to return home with her husband when he came to see her, and was discharged a week later, having gained several pounds in flesh.

CASE 2.-E. S. D., age twenty-one, single, domestic. Swede. In July, 1886, she was confined. On August 24th she was admitted to the Asylum. Three days before admission she had become much disturbed and talked continually in a very rambling and incoherent manner. She attempted to kill her nurse with a knife. Upon her admission she was very much excited and her friends reported that she had not slept any for three days. She slept very little the first night and was quite noisy. Two days after admission she began to sleep at night, but did not take much nourishment. August 29th she is reported as mischievous, attempts to throw things out of the window, and to disrobe herself. She imagines that she owns the institution and that she

« PreviousContinue »