Puerperal insanity in the 19th and 20th centuries.

Abstract

All patients with puerperal psychosis admitted to the Royal Edinburgh Hospital within 90 days of childbirth during the periods 1880-90 and 1971-80 were compared. The majority of cases in both groups had an affective illness with an acute presentation and a fixed interval of onset. The 19th-century cases had a more florid presentation and a greater length of admission (mean, 151 days) to the hospital than the 20th-century ones (mean, 39 days). The incidence of the disorder rose from 0.34 per 1000 childbirths per year in the 19th-century group to 1.04 in the 20th-century one, but this could be explained by nosocomial factors. Most 19th-century cases occurred in multigravid women, which questions the association of puerperal psychosis with primiparae.