habitual pursuits, and to something that will keep a patient in sleepless agony for two or three days. Headache is a very frequent symptom at the change of life, as at puberty. It occurred in 208 of my cases. Some like E. P., aged fiftyfive, never had a headache until cessation, but have ever since suffered from it more or less. In another patient headache was the prominent symptom at menstruation, parturition, and at cessation; a dull heavy kind of pain, with pseudo-narcotism which lasted more or less for six months. With regard to its seat, it may be met with in the following order of frequencyviz., in the temple and forehead, at the top of the head, and at the occiput. The last-named places have been noticed by Friend, Etmuller, and others, as most habitual. I have rarely met with it in the occiput, though if Gall's localization were correct, that should be its most frequent seat. With regard to the nature of this pain it is described as "shooting," "throbbing," " gnawing," "burning," or as "if the head were in a vice." It varies in intensity, from that slight amount which merely inconveniences, to that agonizing pain sufficient to prostrate a hard-working woman and make her lie by, for some days. In ninety-two cases, the patients suffered from sick headache without any signs of gastric disease, and mucus was alone brought up; and need one be surprised at sickness sometimes accompanying cessation, when it often accompanies puberty, and sometimes attends each menstrual flow? Headache may, doubtless, be caused by plethora, but generally it is a nervous symptom and behaves as such. I have had frequent opportunities of observing the alternation of violent hemicrania and gangliopathy, the one arising as the other abated; I have also witnessed a marked antagonism between the cerebral and pelvic extremities of the spinal cord, the violent headache subsiding as pain became intense in the sacrum; and as a general rule those who suffer much from cerebral, are less troubled by pelvic pains.

CASE 22.-Periodical headache at cessation.-Sarah T., a tall, stout woman, with the capillary vessels of the cheeks very apparent, looks nervous and as if going to cry, was fiftysix in September, 1855, when she came to the Farringdon Dispensary. The menstrual flow appeared at sixteen, and

left gradually at fifty-one, after dodging her for a year. She then suffered for a twelvemonth from flushes and perspirations, particularly at meals; otherwise she was pretty well all day, but at two o'clock in the morning a severe headache generally awoke her from a sound sleep. This occurred "off and on, for two years after cessation," says the patient, and her account is confirmed by her daughter. The sudden loss of her husband induced great debility, and caused the flushes and drenching perspirations to return, four years after their subsidence.

Dr. Teissier, of Paris, has published-Gaz. Méd. de Paris, 1851-a case of periodical hemiplegia. A lady, sixty years of age, becomes unconscious every month since the cessation of menstruation and at the period she had been accustomed to menstruate. On recovering her senses one-half of her body is paralyzed, and her speech is affected. This continues for several days, and gradually disappears to return at the next monthly period. Being naturally of a calm and tranquil disposition, those about her know when the attacks are coming on, by her agitation and restlessness.

CASE 23. Cerebral Neuralgia.—I have related in my handbook of "Uterine Therapeutics," how, after having enjoyed tolerable health till the fortieth year of her age, a lady began to suffer from chronic inflammation of the womb, which increased nervous excitement and occasionally caused hysterical fits and vomiting that resisted all approved remedies, and only yielded to the application of an issue at the pit of the stomach.

On menstruation ceasing in her forty-eighth year, the patient still suffered occasionally from vaginitis and exulceration of the cervix with a yellow discharge, but she became less nervous and had no more hysterical attacks, which were replaced by maddening attacks of pain in the head, coming on every second or third week, and obliging her to remain for twentyfour hours in a dark room. During three years a host of remedies were tried in vain; among those given internally were the salts of zinc, Indian hemp, and bromide of potassium, while chloroform, the deutosulphide, and the tetrachloride of carbon were tried as outward applications to the nape of the

neck, and to the temples; an occasional application of leeches to the temples doing more good than any other remedy, while the neuralgic nature of the complaint was shown by the fact that no severe attack occurred during a six weeks' stay at Birkenhead; the attacks returning when she came back to her own healthy and comfortable home. After this state of things had lasted about two years, Dr. Russell Reynolds met me, and we agreed to consider the case as one of those unsatisfactory ones, in which pain seemed to depend on perverted cerebral nutrition, the result of chronic disease and its unhealthy necessities, and he suggested alteratives and tonics, and whatever exercise could be taken. The sudden loss of a husband, leaving her less well provided for, than she had a right to expect, and subsequent pecuniary losses, will account for the cerebral attacks becoming severer and more frequent. They often lasted forty-eight hours, with little abatement of pain, with a considerable amount of salivation, and incessant desire to pass a very large amount of scarcely colored urine; and as there were often two attacks a week, they told very unfavorably on the memory of the patient, and on her power of attention and she had also lost flesh, although digestion had improved. Such was the state of the case when Dr. Livingston, of New Brunswick, wrote to suggest the trial of tincture of aconite in a solution of hydrochlorate of ammonia, and I first tried scruple doses of this salt, three times a day, for a fortnight without any good effect, and on the 30th of last October I tried the tincture of aconite, beginning with five drops, but pushing on rapidly to twenty drops three times a day. After she began to feel fulness in the throat, and tingling in the tongue, the attacks ceased for a month, when came a desperate one. The aconite was continued, and again there was no attack for another month, when two occurred. I increased the aconite to seventy-five drops in the twenty-four hours, and there were no attacks for three weeks, and then two in succession. I diminished the dose of tincture of aconite to twenty drops three times a day, as the larger dose was disagreeable to her. Although the aconite has thus checked the frequent recurrence of the terrific hard attacks, never a day passes without headache, and about three or four o'clock A.M.

the patient begins to bathe her head with Raspail's lotion, which she has found to be the most effectual of all milder measures, and in the afternoon she feels better and brighter. The respite given to the patient, by the aconite, has permitted her to follow out more fully the advice repeatedly given to her, to get out every day, and to mix more with society.

A fortnight after a previous attack came one which lasted four days. The skin was hot, the lips parched, the pulse at eighty, the eye deep sunk. There was a sensation as of blood rushing to the brain, and this was but slightly relieved by six leeches to the temples, although the loss of blood was considerable. At the next attack she took a whiff of nitrite of amyl, which frightened her by the prostration it produced. Chloral in doses of twenty to forty grains gave a certain amount of unsound sleep, and a different kind of headache, with painful congestion of the sclerotics. Dr. Russell Reynolds advised placing the patient under the influence of atropia during the attacks, but the effects were so disagreeable that the patient would not long take it. He likewise advised the arseniate of iron, which was taken for two months; it did no good, assuredly caused a spasmodic cough, which only desisted on lying down. Now this patient is taking a combination of sumbul and bromide of potassium, at Dr. John Ogle's suggestion, but with questionable utility. The right remedies are not always attainable, and doubtless a pleasant companion to enliven solitary meals, and plenty of travelling, would do more good than medicines.

and

3dly. PSEUDO-NARCOTISM. The following cases will show the meaning I wish to convey by this term.

CASE 24.-Pseudo-narcotism.-Mary H., very stout, middling stature, sanguine temperament, flushed face, heavy eyes, uncertain walk and attitude, with all the appearance of being intoxicated, was sixty, when she came to the Paddington Dispensary, September 24th, 1849. The menstrual flow appeared at eleven with giddiness and sleepiness; it continued regular and abundant, though always accompanied by "a drowsy giddiness," for which she was often bled and cupped. She married at twenty-one, and had a child at twenty-six. The dodging time began at forty, and lasted until fifty-eight, when ces

sation occurred. During these eighteen years the menstrual flow was irregular, being sometimes very scanty; at others, a flooding. She was also troubled with leucorrhoea, bad back pains, faintings, flushes, sweats, headaches, and was so giddy that she frequently tumbled down, and people thought her tipsy. When walking out, she was always obliged to get near the railings, so as to have something to hold by. She said she never drank anything but coid water, and her landlady confirmed her statement. At about fifty-eight, when the flow stopped, she was at St. George's Hospital for ascites and boils. Diuretics considerably reduced the ascites, and for the last six months she has suffered more from cerebral symptoms. Intense headache, with pain, and singing in the ears, pains in the eyes, chills, and flushes, are now most distressing; and the perspiration trickles down her face. Every twenty-eight days these symptoms are very troublesome, and remain so for a few days. She has been unable to do any regular work for five years. I had eight ounces of blood taken from the patient, ordered a brisk purgative, to be repeated every week, several glasses of cream of tartar lemonade to be taken daily, and warm pediluvia every night. By following this treatment for a few weeks, the case was greatly improved; but she would not allow the bleeding to be repeated, whereas if ever there was a case in which bleeding would have been beneficial it was this; for she was of full habit, bore bleeding well, and the menstrual flow had always been abundant; three to four ounces of blood should have been taken from the arm every month, for the first two months, then every third or fourth month, with baths, purgatives, alkalies, and mild sedatives. This is one of the most marked instances of pseudo-narcotism I have met with. It appeared with first menstruation, returned at every menstrual period, and completely incapacitated the patient from earning her livelihood for five years.

What name then is to be given to this nervous affection? If it be called congestion of the brain, there were no signs of this condition in the following case, in which the nervous symptoms were similar:

CASE 25.-Pseudo-narcotism.-Mary G., thin, tall, with dark hair, delicate complexion, drowsy look, and, when roused,