=Puerperal Mania.= A word about extreme mental unbalance during the puerperium is worth while at this point because the nurse will frequently hear of this distressing condition, and will almost inevitably come in contact with it at some time. It was formerly believed that there were certain mental disorders which were peculiar to pregnancy and the puerperium, but this belief has given way before the present knowledge of psychiatry. The puerperal patient is sometimes delirious and violent for longer or shorter periods of time, but apparently these conditions are due to toxemia or fever, or a mental unbalance has resulted from her reaction to the idea of motherhood, just as it would have resulted from an equal strain of some other character. In other words, the young mother may suffer mental derangement from the same causes that would produce this state in any other person, but not from causes or conditions which are peculiar to the puerperium. If the excitement or delirium are due to a toxemia, they are relieved by treating the cause, while from the nurse’s standpoint the care would be the same as for any delirious patient. The patient should not be left alone and she should be protected against doing herself any injury. A mental disturbance which is due to the patient’s inability to adjust herself to the state of motherhood, and all that that implies to her, is a different matter, and is discussed in the chapter on mental hygiene. “Sympathy with, interest in the poor so as to help them, can only be got by long and close intercourse in their own houses—not patronizing—not ‘talking down’ to them—not ‘prying about’—sympathy which will grow in insight and love with every visit.”—FLORENCE NIGHTINGALE. PART VI THE MATERNITY PATIENT IN THE COMMUNITY CHAPTER XIX. ORGANIZED PRENATAL WORK. Mortality in Childbearing. Aims of Prenatal Care. Difficulties: Educational, Economic, Social, Professional. Prenatal Work in Other Countries. Progress of Prenatal Work in this Country. The Women’s Municipal League of Boston. Maternity Centre Association of New York. Routine and Methods. Results. The Situation in the Country as a Whole. Prenatal Care in Rural Communities. Forms and Routines used by Maternity Centre Association, New York City. CHAPTER XX. HOME DELIVERIES AND CARE OF THE YOUNG MOTHER BY VISITING NURSES. Forms and Routines of the Philadelphia Visiting Nurse Society. CHAPTER XIX ORGANIZED PRENATAL WORK The foregoing discussions of prenatal care and the principal complications of pregnancy, and the dangers to which expectant mothers, young mothers and their babies are exposed, bring us sharply face to face with the questions, “What can be done about it?” “What is being done about it?” and, “Is anything more possible?”