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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