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Puerperal insanity in the 19th and 20th centuries
A U Rehman1, D St Clair, C Platz
1Government Mental Hospital, Peshawar, Pakistan.
Summary
Puerperal psychosis, a severe postpartum mental illness, presented more floridly and led to longer hospital stays in the 19th century compared to the 20th century. Incidence rates increased, but this may be due to hospital factors, not necessarily more cases.
Area of Science:
- Psychiatry
- Medical History
- Obstetrics
Background:
- Puerperal psychosis is a severe mental illness occurring after childbirth.
- Historical changes in presentation and incidence are not well-documented.
Purpose of the Study:
- To compare puerperal psychosis cases from the 19th and 20th centuries.
- To analyze changes in presentation, duration of illness, and incidence over time.
Main Methods:
- Retrospective comparison of patients admitted to the Royal Edinburgh Hospital within 90 days of childbirth.
- Analysis of case records from 1880-1890 and 1971-1980.
Main Results:
- Most cases in both periods involved affective illness with acute onset.
- 19th-century cases showed more florid symptoms and longer admissions (mean 151 days vs. 39 days).
- Incidence rose from 0.34 to 1.04 per 1000 births, potentially due to nosocomial factors; 19th-century cases often occurred in multigravid women.
Conclusions:
- Puerperal psychosis presentation and duration have changed significantly between the 19th and 20th centuries.
- The increased incidence in the 20th century may be influenced by hospital practices.
- The association with primiparity is questioned, as most historical cases were in multigravid women.