sensibility in the diaphragm, and by the popular belief that the human passions are centred in the præcordia, whereas they merely react upon it, as stimulants when the passions are exhilarating, or as depressants when they are of a contrary nature. Nevertheless, the ganglionic nervous system, in a pathological point of view, is looked upon as a terra incognita; and its diseases are neglected or very incompletely considered in systematic works on pathology, and are scarcely better treated in books on nervous diseases-a neglect partly due to the wild theories that have been broached respecting the ganglionic nervous system by fanciful writers. Thus, notwithstanding Lobstein's classic work, Georget, writing in 1836, affirmed, that nothing is known about the diseases of the solar plexus, or the ganglionic system of nerves, and a little later, Sir H. Holland stated "that the ganglionic system, and the various nerves of organic life, are still only partially known to us in their proper actions, and yet more obscurely in their intricate connections with the nervous powers of animal life;" and that, "a less definite influence of the system of organic life, as one of the causes of exhaustion, is the only morbid liability of this all-pervading nervous system." It is not surprising, however, that the pathology of the ganglionic system should have been hitherto imperfectly considered, since its physiology is full of desiderata; but the experiments performed by Claude Bernard, and the inference drawn from them by Brown-Séquard, that the blood vessels were paralyzed by the section of their ganglionic or vaso-motor nerves, have given a physiological basis to the study of the diseases of the ganglionic nervous system. These experiments establish the fact that the partial paralysis of the ganglionic nerves leads to the congestion or to the inflammation of the tissues within the area of their distribution, and the controlling influence of the semilunar ganglia over the bloodvessels of the abdominal viscera is shown by the experiments of Samuel, who found their extirpation in dogs, cats, and rabbits to give rise to an extraordinary amount of hyperæmia of the intestinal mucous membrane. Besides controlling circulation, it would seem as if the ganglionic system furnished to the human frame a nervous influence that plays the part of steam in the steam-engine, the unconscious nerve force giving to the cerebro-spinal system a power, of which the human mind has the full consciousness. At all events, any one who will take a comprehensive view of the various stages of the reproductive process in women, will be struck with the fact that frequent prostration of strength is a predominant symptom even when women are healthy. At every recurring menstrual period, at the cessation of menstruation, after connection, parturition, and during lactation, there is felt, more or less, a loss of energy;-so it seems as if woman could not pass through any of the stages of that function which serves to communicate life, without the momentary loss of some portion of her own vital energy, reminding one of those animals who die when once they have transmitted life to others. Et quasi cursores vitæ lampada tradunt. A glance at the preceding table will show that debility of variable intensity is the constant characteristic of all the complaints which I attribute to the diseased action of the ganglionic system, and Dr. Handfield Jones,* who has seriously taken in hand the study of ganglionic affections, has well pointed out that, however painful may be cerebro-spinal neuralgia, it does not induce syncope or leipothymia, which are apt to accompany the irritation of any of the sympathetic plexuses. Debility is, of course, often met without our being able to trace its origin to any particular part of the body; but debility is so intense when disease of the central ganglia is evident, and so constant an attendant upon every form of gangliopathy, that we may consider debility as its main symptom. The same remark applies to chlorosis, and still more forcibly to leipothymia and syncope. Gangliopathy.-I give this name to a condition in which. more or less debility is associated with paralysis, hyperæsthesia or dysæsthesia of the solar plexus and the central ganglia of the sympathetic system. Gangliopathy has often *Functional Nervous Diseases." been described as cardialgia, gastralgia, and gastrodynia, but these names should be restricted to neuralgic states of the stomach. Gangliopathy has been written of, as neurosis of the vagus, as leipothymia, as sinking dyspepsia, as hysterical asthma, and one of my cases had been called by other practitioners a nervous affection of the diaphragm. Women frequently complain of chest pains, or of spasms, inward spasms, or inward hysterics. The effects of a moderate blow to the pit of the stomach will explain what I mean by gangliopathy being attended by paralysis. For instances of perverted ganglionic action, I refer practitioners to the most prominent symptoms of overlactation; but, as I am drawing attention to a disease that has been to a great extent overlooked, I shall begin by giving cases that illustrate the various forms of gangliopathy, and I prefer to use a term that localizes the disease without specifying its nature, because I think the present state of science seldom warrants a more definite expression. CASE 15.-Ganglionic hyperæsthesia.-Miss C. was fortyeight, tall, stout, with dark hair and a flushed face. The menstrual flow came regularly from thirteen to forty-seven, but afterwards irregularly, being often a mere show. This patient was never nervous or hysterical; she complains of pain at the pit of the stomach, which first appeared when the menstrual flow became irregular, and says that now she is never without uneasy sensations at the epigastric region, which do not generally interfere with the current occupations of the day, though often paroxysms of acute pain occur, especially at night, when they suddenly awaken her from a sound sleep. The pain then experienced is described as a "tearing pain," and after it has lasted from ten to twenty minutes, a ropy mucus comes from the mouth, by expuition, without eructations. When the intensity of the pain has abated, the patient lies prostrate for hours, conscious, but incapable of exertion. Sometimes she faints away, and after a bad attack was forced to keep her bed a day or two. During the last six months, flushes and perspirations have been abundant. The tongue was clean, digestion good, and no trace of tumor at the pit of the stomach. I recommended 6 oz. of blood to be taken from the arm, 2 tablespoonfuls of a comp. camph. mixture before, and 10 grs. of carb. of soda after meals; 2 comp. col. pills and 10 grs. of Dover's powder on alternate nights, and a mustard or a linseed poultice to be applied to the pit of the stomach every night. The camphorated mixture that I often give in similar cases is composed of 3 drachms of tincture of castor, 6 drachms of tincture of hyoscyamus, and 5 oz. of camphor julep. After continuing this for a month, the paroxysms came only once a week, instead of almost every night; I then ordered a warm bath to be taken for two hours every other night, just before going to bed; alternate belladonna and opium plasters, changing them every week, and a scruple of sulphur once a day. This was persisted in for six weeks, and then left off, because there had been no paroxysms for ten days. When the patient left town, I advised her to take the mixture now and then, as well as the pills and the comp. sulphur powder, and to have 2 or 3 oz. of blood withdrawn from the arm at intervals of three and six months. This case seems to me best accounted for, by admitting a neuralgic affection of the ganglionic nervous centre, for the stomach performed all its functions healthily, and there was no sign of cerebral disorder, neither did this affection obscure the comprehension of its true nature by awakening other nervous disorders. It caused no hysteria, no pseudo-narcotism, not even headache. This neuralgia of the ganglionic centre was well characterized by the paroxysmal character of the pain, and by the state of exhaustion and faintness it determined. CASE 16.-Ganglionic hyperesthesia.-Mrs. K., aged fortytwo, consulted me, July 5th, 1855. This lady is stout, of an average height, with dark hair and eyes, a swarthy complexion, and has all her life been subject to bilious complaints. The menstrual flow first appeared, with frequent fits of fainting, at twelve. It continued regular, and was often accompanied by brow-ague. She married at twenty-seven, but never conceived. In 1848, after having been a year at Ceylon, she was first taken with excruciating pains in the dorsal region of the spine, and in the abdomen, which pains always came on at night. She improved under a mercurial treatment, had the Bombay fever the following year, but came home recruited by the long sea voyage. Four years after her return, the menstrual flow became irregular, and now she never passes more than " a little green water" for one day. Since the menstrual flow became irregular, she has been always ailing; was once under Mr. Keate for an hysterical affection of the shoulder-joint and paralysis of the arm, and has often had attacks similar to those she had at Ceylon. She stated, that every night she was awoke by an acute, "gnawing, hot pain" about the fifth dorsal vertebra. This pain encircled the right side, reached the pit of the stomach, where it centred and kept tearing and gnawing her for about two hours. The patient very graphically described the sudden coming of the attack-" as if the thing called pain played a thumping overture upon her.” She has learned to relieve these attacks by laudanum; in their absence, she is very often troubled with a burning pain at the pit of the stomach; and of late, when this was intense, she has often fainted several times a day. This lady, though stout and healthy-looking, is endowed with great nervous irritability, increased by anxiety for a very nervous husband. She feels every change in the weather, and suffers acutely when there is thunder in the air. She is often heavy, stupid, drowsy, and forgetful: very low-spirited, thinks she is going out of her mind, and is often tempted to commit suicide. For the last two years she has been much troubled with flushes, but without perspirations; and circulation is inactive, for her fingers are cold and blue, even on a warm summer's day. The pulse is small, the tongue slightly furred. July 5th.-I prescribed the comp. camph. mixture before meals, carbonate of soda after; 6 grs. of blue pill, and 2 of ext. of hyoscyamus every other night, 10 grs. of Dover's powder every night, a scruple of the sulphur and borax powder once a day, and warm baths twice a week. July 18th. Decided improvement followed the sound sleep which came when the treatment had been followed for a few days; the paroxysms of neuralgia were no longer periodical, and she had only had two since the 10th. I continued the same treatment, but also ordered two belladonna plasters, one to the epigastrium, the other to the painful part of the spine, which were to be renewed every week. Aug. 15th. The patient being very bilious, I ordered 3 grs. of |