CASE 26. Successive fits of coma at menstrual periods.— Malle., aged eighteen, sanguine and nervous, was suddenly affected with a lethargic drowsiness, when the menstrual flow should have come on, which symptom was alleviated by bleeding. At the following monthly period the drowsiness came again, but with greater intensity, and bleeding was again resorted to, but it failed to relieve her, so was not tried at the third and following menstrual periods, when the same lethargic state occurred, instead of the menstrual discharge. The drowsiness was followed by hysterical delirium; she became violent, and refused all food for seventeen days. Pomme put her, by force, into a tepid bath, and after remaining in it twelve hours, she quieted down, and took food. For two months she stopped daily eight hours in the bath, cold applications being made to the head; the delirium then disappeared, and the menstrual flow came.

The fact of morbid sleep being so frequent a symptom of the disturbed performance of the reproductive functions, tempts me to say one word on sleep as a physiological phenomenon. As sleep is often produced by the morbid action of the ganglionic nervous system on the brain, it is fair to ask, whether this nervous system has nothing to do with the production of our daily sleep? I think that a good theory of sleep should take into consideration the influence of the ganglionic nervous system in its production; and without attaching too much importance to a singular case, it may be mentioned that, in 1824, at the great hospital at Vienna, Joseph Frank saw a man who, for many years, passed all his time in sleeping. When his body was opened, the only unusual appearance was a considerable hypertrophy of the semilunar ganglia of the cœliac plexus, and of the other divisions of the great sympathetic.

I said that the singular cerebral condition described by me has no name, but is confounded with hysteria, with which it has nothing in common, or with coma, a disease of rare occurrence, which may be the result of some other affections. I have, therefore, given it a name, because new words are justifiable, when they serve to specify the nature of things. Sir H. Holland has observed that, the difficulty of getting a correct nomenclature for morbid sensations, applies particularly to the

cerebral. "Nervous stupor," or "spontaneous narcotism," would be good terms, but as the symptoms are similar to the gentle or powerful effects of narcotic poisons on the brain, I have applied to this group of cerebral symptoms the term Pseudo-narcotism, thus graphically expressing the fact, without prejudging the question.

4thly. HYSTERIA.-Medical writers should be careful to explain their meaning when using the term hysteria. When Dubois d'Amiens, Vigaroux, Béclard, Gardanne, and B. de Boismont say, women are not subject to hysteria at the change of life, and F. Hoffman, Pujol, and Meissner, say that they are, what do they mean? Do they mean that they are not subject to globus hystericus, and the minor symptoms of hysteria, or that they are not subject to hysterical fits? A glance at the table that heads this chapter will enable the reader to decide the question relating to the frequency of hysteria at cessation; for out of my 500 cases, 146 who had suffered more or less from globus hystericus and the minor symptoms of hysteria still continued to suffer from them at the change of life; and, for the first time after cessation, seventeen had globus hystericus, and four had repeated laughing and crying fits, whereas only three had hysterical fits. In several of these cases, globus hystericus was so severe as to make the patient jump up in bed, for fear of being suffocated. Landouzy gives a table showing that, out of 351 cases of hysterical fits, twenty-five only occurred after the fortieth year, and that they are very rare before puberty. Out of 821 cases of hysteria observed by Georget, Briquet, Landouzy, and Beau, only twenty-one originated from the fortieth to the fiftieth year, while 259 began from fifteen to twenty, and 574 from ten to twenty-five years of age. With regard to the effects of the social position, hysterical symptoms are much less common among the poor, and they occur most frequently when the nervous system of woman is wrought up to an artificial state by luxurious living, by overworking the mental faculties, and still more by the over-development of emotion. With regard to the influence of temperament in producing hysterical phenomena, I have met with them most frequently in patients of a sanguine temperament, in whom the least disturbance of the periodical function has,

through life, often brought on this disorder; whereas in women of a nervous temperament, hysteria often diminishes in proportion as the activity of the reproductive organs diminishes, ceasing entirely with the subsidence of their action. Landouzy has shown that, in the vast majority of cases, hysterical convulsions were ushered in by pain or strange sensations in the hypogastric and ovarian regions, pains which induce the sensation of suffocation felt at the pit of the stomach, and then the globus hystericus. Dr. Copland has known the convulsive attack to be preceded by leipothymia, and I have often been struck by the alternations of gangliopathy with globus hystericus or other minor hysterical symptoms; globus hystericus subsiding, for instance, when a paroxysm of cardialgia appeared.

CASE 27.-Hysteria.-Lucy P., tall, thin, with brown hair, gray eyes, and a chlorotic complexion, was forty-nine when she came to the Farringdon Dispensary, in October, 1854. She had always enjoyed good health, and married at eighteen, the menstrual flow first appearing the day after her wedding. She had several children, the last at thirty-three, and from that time until she was forty-four, the flow continual regular. It then dodged her for three years. For six months it came regularly every fortnight, then every two, three, or five months. Several times, when she had been long without the menstrual flow, "a gush of blood would come from the mouth or ears, and she was obliged to go to bed." She was much troubled with faintness, flushes, sweats, abdominal pains, piles, which bled occasionally, pseudo-narcotism, and for the first time in her life, hysteria. She once had a convulsive fit, and very frequently crying fits, and the sensation of a lump in the throat. After suffering in this way for three years, the menstrual flow completely ceased two years ago, and her health grew worse. She has become weak, and her complexion turned from ruddy to sallow; she is laid up for weeks with bilious attacks; she brings up bile, and her bowels are either relaxed or confined. She is much troubled with headache, with pseudo-narcotism, with nervousness, and with the hysterical symptoms already detailed. This patient had always enjoyed good health until the dodging time began; she had never been well for the fol

lowing five years, but she was restored to health in about six months. She first took 4 grs. of blue pill, and 2 of ext. of hyoscyamus, every other night; the comp. camph. mixture before meals, and a drachm of carbonate of soda in a mouthful of water after meals. After three weeks these medicines were discontinued, and 5 grs. of citrate of iron were given in an effervescing draught, after meals, twice a day, and 10 grs. of Dover's powder every other night. The bowels were kept open by an occasional dose of sulphur.

E. W., aged fifty, the sister of a very nervous man, and herself very nervous, has not menstruated for the last sixteen months, but has been troubled by bleeding piles. She awakes every morning with pain in the lower part of the abdomen. This is relieved by pressure, and by lying on the stomach; but only vanishes on her throwing up a large quantity of wind, which often gives her the appearance of being five months pregnant. There are no signs of dyspepsia about this patient. Under the influence of mental annoyance, I have often seen a copious extrication of flatus occur in healthy persons of both sexes, the flatus finding vent in repeated eructations.

5thly. EPILEPSY.-When it appears in connection with first menstruation, it will often wear itself out after a certain number of years, but it occasionally returns at the change of life. I have seen four such instances, and in another, the patient first suffered from epileptic fits during lactation; she had seven children, but the fits only came on during four lactations, and lately at the change of life. She could assign no cause for their coming on at some lactations and not at others; but she had kept the temperance pledge four years previous to the epileptic fits at cessation. Drs. Tyler Smith and B. de Boismont have seen several cases wherein hysterical and epileptoid attacks only came on at first menstruation, at the decline of life, and at each menstrual period, the nervous symptoms completely disappearing on the cessation of the menstrual flow. Dr. Radcliffe informs me, that one of his patients had repeated epileptic fits at puberty, which induced medical men to advise her remaining single. She, however, married, had children, and did not suffer again from the epileptic fits until the change. of life. In one of my patients, epileptic fits became more fre

quent and severe after the ménopause, and in two other cases, epilepsy occurred without any other cause than the change of life; and Moreau notes this epoch, as the only cause of epilepsy, in nine out of 529 cases occurring in women. Besides the wellknown anomalous sensations arising from various parts of the body, I have met with one patient in whom the attacks were brought on by a fixed and intense ovarian pain, the result of subacute ovaritis. Pressure on the ovarian region often brought on attacks, and I myself thus caused a severe one. Dr. Copland has often seen epileptic fits preceded by leipothymia, the pulse retaining its usual strength; and this confirms my belief that the ganglionic nervous system may have something to do with epilepsy, although it be a disease of the cerebro-spinal system.

CASE 28.-Aphasia.-Mary H., a tall, healthy-looking woman, with brown hair, and hazel eyes, a harnessmaker's wife, was fifty when she consulted me. The menstrual flow appeared at ten, and came regularly with little disturbance until she married at twenty-one. She had four children, the last at thirtynine, and was regular until forty-seven, when cessation took place, after menstruation had been irregular for four months. Some days after the last menstrual flow, and without any known cause, while she was hanging out clothes in the garden, she felt giddy and fell down, remaining insensible for ten minutes. The fit was repeated once a week, then every fortnight, afterwards with an interval of six weeks, when she became free from them for six months, but felt more nervous than usual; and some time after, while in apparent good health, and talking to her husband, she was all at once deprived of speech. She was perfectly conscious, knew what she wished to say, but could not utter the words. She had no pain, no choking sensations, she did not stammer nor stutter, she had no headache, but felt giddy even when lying down. For two years this fit came every day, and if it missed the day, it would come at night, on waking after her first sleep. She consulted me because the fits have, of late, come two or three times a day. She is now very nervous, frightened at the dark, and at everything, and she complains of headache. After well opening the bowels, with the comp. col. and calomel pills, I gave my comp. camph.