I. That any variety o.f mental disease may have
its starting point in the Puerperium.
II. That the common varieties directly due to
puerperal causes have a common symptom viz.
confusion.
III. That this confusion nay be combined with
excitement in the form of
1. Acute Mania with confusion and
2. Conditions of Acute delirium which latter
are severe forms of the confusional excitement,
and that these two constitute by far the most
cases occurring in the first fortnight.
IV. That symptoms of Katatonia may occur in any of
the varieties, and together with confusion
may give rise to conditions of stupor.
V. That confusion with Melancholia is the mental
state in most of those cases that begin late in
the Puerperium.
VI. That the acute confusional excitements may be
due to sepsis or collapse and that the prolonged
cases of delirium usually known as Acute Delirious
Mania are on the mental side no more acute than
some of the rapidly recovering cases,and that
the gravity of the condition is due to physical
conditions.
VII. That many of the prolonged delirious conditions
are streptococcal in origin and that the infection
is probably in many cases a tubal one.
VIII. That the neurotic diathesis is present in nearly
every case and is probably in inverse ratio to
the amount of the sum of the other predisposing ;&nd
exciting causes.
IX.That mild sepsis may bring about Insanity in
combination with a severe neurotic tendency.
X. That apart from extraneous complications viz.
Consumption: death from suicidal wounds etc:
those cases that die in spite of treatment are
almost all septicaemic in origin.
XI. That the causes of the milder confusional states
and melancholic states are probably exhaustion,
mental or physical, and that intestinal and metabolic
toxaemias may play a contributory part in their
causation.
XII. That examination of the blood points to a toxic
element in excited cases apart from sepsis and
that the cases due to collapse and exhaustion
are probably,as the result of diminished power
of immunity in the blood and diminished nervous
resistance, in part the result of autointoxication.
XIII. That the mental symptoms even in melancholic
cases are suggestive of a toxaemia.
XIV. That the prognosis in Puerperal Insanity is good.
That complete mental recovery takes place in the
majority of cases,and even the patient who is
most unstable mentally may recover most quickly
if treatment is begun at once. That the
prognosis is unfavourable in proportion to the
duration of action of the predisposing causes and
to the severity of the physical exciting causes.
XV. That in the treatment of the cases of excitement
and delirium antistreptococcic serum may be of
value. That it must be given immediately and in
sufficient doses in those cases where the
temperature does net fall under othez1 treatmentand
that even after the temperature has been
elevated for some time, very large doses should
be tried, guided by the leucocytcsis
