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the experience of Bevan Lewis-' only 32.3 per cent, of cases of puerperal insanity were in primi- para;. Hoppc-^ found the proportion as high as 45 per cent. The usual percentage given by au- thors is between 30 and 35. Nor do those cases of pregnancy consequent on illicit relations, where the shame, the dread of publicity and of social ostracism, hold the woman under a great mental stress, figure as a predisposing cause of puerperal insanity. Out of the 112 cases collected at the Norristown Asylum of Pennsylvania, not one of the women confined betnovate scalp lotion was unmarried."' MoreP* states that puerperal insanity seizes the virtuous moth- ers of families even more frequently than the women who, betnovate c especially in Paris, find so easily the means of concealing their shame and the fruit of their illegal love. While Clouston^' found about 25 per cent, of his cases to occur in illegi- timate pregnancies, in Edinburgh the average rate of illegitimacy was only about 10 per cent. To make septiccrmia responsible for the insanitj^ seems also to be groundless. In true septicaemia, ushered in with the usual signs of puerperal fever, insanity is a rare occurrence."" Puerperal insan- ity, furthermore, is equally met with in nervous women as betnovate n cream in perfectly rational patients that are free from any hereditary stigmata. betnovate online Is it not, therefore, obvious that, besides the enumerated predisposing causes, some special cause betnovate n must be looked for to betnovate scalp solution buy betnovate cream online explain the occurrence of puerperal insanity, particularly in those cases where the former can be safely excluded, and where the outbreak of the disease is least ex- pected? In consequence of the greater activity of the circulation, the arterial tension is generally in- creased during pregnancy."' The veins, too, are fuller ,^^ which is manifested by the frequency of Aaricose enlargements. The propulsion of the betnovate buy online blood being, therefore, effected by the aid of an increased strain of the heart, we find cardiac hyper- trophy as a constant phenomenon betnovate skin cream of pregnancy.-" betnovate face r.oth ventricles vmdergo slight eccentric hyper- trophy, betnovate ointment 0.1 the left more than the right. The in- crease in weight of the betnovate scalp application heart (8.8 per cent, of the -^Insanity at the Puerperal Period. Wood's Medical and Sttrgical Monographs, Vol. vi, p. 300. "Archiv fur betnovate for acne Psychiatric, 1893. "J. H. Lloyd, Insanity and Dis. of the Nerv. System in the Child hearing Woman. .American System of Obstetrics, 1889, Vol. ii, p. 558. -^Traiti th^oriquc ct pratique dcs maladies nientalcs, Paris, 185J, p. 106. -^Clinical Lectures on Mental Diseases, 1884. ^Bevan Lewis, /. c, p. 500. ^E. H. Douty, .American betnovate c ointment Gynacological and Obstetrical Journal, Fchniary, 1897. ^Th. Parvin, The Science and Art of Obstetrics, 1895. "James T. Whittaker, Diseases of the Heart, in T;ventieth Cen- tury Practice, Vol. IV., p. 90. normal weight) continues with the duration of pregnancy up to the day of labor, and is followed by a reduction, which is rapid at first and more slow afterwards.'" The cause of the hypertrophy is to be sought in the increased work thrown on the heart in supplying the placental circulation, the uterus, and the mammae with blood. More- over, pregnancy increases the quantity of betnovate gm the blood, as has been demonstrated in pregnant dogs and sheep. (Spiegelberg, Gescheidler, Heiss- ler.) As in the uterus, the involution of this cardiac hypertrophy ma}-, in exceptional betnovate c cream cases, be imper- fect and become permanent under the strain of rapidly following pregnancies. Hypertrophy of the left betnovate cream 0.1 heart tending to increase the diameter of both the mitral and aortic valves, the condition of valvular insufficiency is thus easily explained. In a small number of cases valvular disease betnovate gm skin cream is, in- deed, traceable to pregnancy and to the puerperal state.^"- Latent cardiac disease of rheumatic origin ante- dating pregnancy frequently reveals itself first dur- ing gravidity. "A crippled heart may cause no serious disturbance in the non-pregnant condi- tion, but when pregnancy occurs, it is unequal to the increased work thrown upon it, and cardio- pathic accidents may set in."'" The time when gravidocardiac accidents begin or become in- tense is from the third to the sixth month, gen- erally buy betnovate cream in the fifth. In labor the danger from car- diac disease is greatest. The physical signs of simple non-malignant en- docarditis are notoriously not always character- istic." The great majority of the cases are latent,

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