Lewis has found that there are seldom any prodromal, usually of sight and sound, and great motor and mental excitement, appear; later motor agitation, subsultus, expressions of fear and uneasiness. Toxic cases are similar, but not so severe. Progress toward recovery is gradual—hallucinations disappear and lucid intervals occur. Lactational cases come on slowly, hallucinations at first few and later more constant; not a type of melancholia, but a mild, exalted mania, with frequently suicidal tendencies. Hirst’s cases have been of mania, melancholia or profound lethargy, stupidity and mental confusion, and Webster’s experience has been about the same. Edgar feels that while most of the cases have been classed as mania, they are in reality hallucinatory insanity. De Lee has found melancholia with suicidal intent most common, but has also observed mania with infanticidal tendencies, while Vinay holds that the maniacal forms are the most frequent. Tweedy & Wrench have found that insanity of the puerperium is always associated with either severe anæmia from hemorrhage or with sepsis. The patient is first irritable and uneasy about unknown dangers. She had a headache, is constipated, she may refuse food or to see her child or husband, and sleeps badly, and finally becomes definitely maniacal and may have suicidal tendencies. During lactation the patient becomes gloomy, sleeps badly, and is constipated. Definite melancholia develops with delusions and suicidal tendencies. PROGNOSIS. All authorities disagree markedly on this most important aspect. Williams tells that the progress is three to six months and if longer the prospect is very poor, 20–40 per cent fail to regain mental equilibrium and 5–10 per cent die, this high mortality due, he feels, to the underlying infection and not the mental derangement itself, and with these figures Hirst is in practical accord. Lewis tells us 25 per cent of the infection cases die, but the progress of toxic cases is not so bad. Death occurs usually from sepsis or the exhaustion on account of the motor excitement. Lactational cases recover in 50 per cent, and they take eight to nine months. Webster quotes from Clouston of Edinburgh that 75 per cent of his cases have recovered; one-half of those in three months and 90 per cent in six months, and occasionally recovery takes place after years of impaired mentality and, surprisingly, he states that there is probably a larger number of recoveries in acute and severe cases than in mild ones. Dr. Lee states that the prognosis is fair—recovery in the majority of cases in from six weeks to six months. Edgar tells us that exhaustion is the usual cause of death but recovery is the rule even from the insanity; if not, it goes on to a terminal dementia or paranoia. A high pulse-rate is a bad sign.