mixt. before, and the carb. of soda after meals. This was continued from the 12th of December to January 26th, and the number of fits of speechlessness diminished from four to one a day, and were of shorter duration. In addition to other measures, I then ordered 8 grs. of ox. of zinc, and 2 grs. of ext. of hyoscyamus to be taken every night. This was continued until March 15th, when the patient was discharged, still complaining of being once a day utterly unable to give utterance to her thoughts, but the speechlessness is of short duration. She was in good circumstances, had a kind husband, seemed in fair health, and the change of life could alone account for her fits, which resemble the little fits of epilepsy.

CASE 29.-Epilepsy and Impetigo.-Mary F., a woman of the average size, with gray eyes, brown hair, and a florid complexion, came to the Paddington Dispensary, February 16th, 1849. She was then forty-eight. The menstrual flow came at ten, and continued regular, sometimes too abundant, but without other disturbance. She married at seventeen, had three children, the last at thirty-four; since then she has been left a widow, and the flow remained regular until the last two years, when it began to dodge her. With the exception of giddiness during the previous year, she had enjoyed uninterrupted good health up to this period, but now flooding at irregular periods, with great abdominal pain, lays her up for three months at a time; there is no uterine disease, but she is troubled with obstinate constipation, faintness, flushes, and sweats. She suffers from pain at the top of the head, which is worse when she lies down; without sick headaches or hysterical symptoms, she always feels giddy, stupid, sleepless, heavy, and "never as she ought to feel." Moreover, two years ago, when the menstrual flow began to be irregular, she had, for the first time in her life, a cutaneous disease, attacking both arms and face. The arms soon got well, but the face was sometimes better and sometimes worse. Now the cheeks are hot, livid, hard, and covered with flaky scales, a quiescent state which has lasted for three months, but the skin often blisters and distils a watery or a gummy discharge every month or six weeks. Since this affection of the face has appeared, the patient has been subject to fits, which come on suddenly from fright, exertion, or with

out cause.

Talking to me has often brought one on. They come three or four times a day at uncertain periods. Her teeth chatter, she becomes unconscious, and this, at first, lasted only for a few minutes, but now often for an hour, when she becomes violent, and tears everything she can lay hold of, which obliges her to have some one to take care of her. The fits are worse and more frequent when the eruption fades, and the brain always feels relieved when the eruption is worse. February 16th. I ordered 2 comp. col. and calomel pills to be taken every second night, and 1 oz. of castor oil the following morning; a scruple of sulphur and borax twice a day; one drachm of carbonate of soda after each meal. The comp. camp. mixt., hot foot-baths every night, 10 grs. of Dover's powder every night, were afterwards given, and March 8th, five leeches were placed behind each ear, for the patient would not be persuaded to be bled. March 17th.-The leeches did no good, the patient being no better than when she first came. In addition to the usual treatment, as the face is worse, it is to be fomented with warm milk and water. April 5th.-A bdominal pains were much complained of, and required enemata, with 30 drops of Battley's solution twice a day; without pain, however, or any red discharge, she would frequently pass "large clean clots of blood." A blister once benefited her, so I ordered another, which was useless. June 14th.-She has just recovered from a flooding, which had not occurred for the previous eight months. This has relieved the abdominal pains, but the head is as bad as ever, the nervous fits as frequent, and the face discharges much gum-like matter every second day. I ordered a blister to be kept open on each arm, but being myself laid up about this time, I lost sight of her. The life of no woman ever presented a more marked contrast. Perfect health up to the change of life, after which constant illness. The organic changes set on foot by the change of life caused all the patient's sufferings. Bleeding, daily tepid baths, prolonged for three or four hours, would have been very serviceable, but could not be taken. I would not have attempted to cure the cutaneous eruption before an abundant drain had been permanently obtained from blisters or issues.

6thly. INSANITY.-Some authors assert that insanity is more

common to women than to men; and explain this supposed frequency by the shock felt in the nervous system at puberty and at cessation. The first assertion is doubtful, and the second an exaggeration: for, on consulting the Registrar-General's Reports, it will be found that deaths from insanity are most frequent in women from twenty to forty, or while the reproductive organs are endowed with greatest activity; results in accordance with the statistics of Haslam, Pinel, Esquirol, and Fodéré. From forty to sixty, when men are most actively engaged, and hope fails as well as physical strength, many more men than women die insane. From sixty to eighty, when the sexes most resemble each other, insanity affects them equally. A still better way of ascertaining the liability to insanity at the change of life, is to take the admissions of a large lunatic asylum. The following table, for which I am indebted to the late Sir Charles Hood, shows the ages of women admitted at Bethlem Hospital, from January, 1845, to December, 1853.

Hence it appears that, although the time at which the change of life generally appears is not most prone to insanity, still 437 out of 1320 became insane from forty to fifty-five, whilst after that age the number suddenly diminished. Dr. Davey, of Northwoods, informs me that about one in every six insane women have had a first attack between thirty-six and forty, and that the chances of insanity diminish from forty to fifty-five. The effects of the puerperal state and lactation in producing insanity explain why it is most frequent in women

before the fortieth year; but the table heading this chapter shows that, out of 500 women, there were sixteen in whom the mental and moral faculties were severely compromised by the change of life. B. de Boismont received into his asylum in one year eight patients, in whom insanity could only be accounted for by this cause. Dr. Forbes Winslow assures me that he has frequently seen insanity brought on by this epoch; and Dr. Wood confirms this assertion. If headache, pseudonarcotism, hysteria, and epilepsy be caused by the change of life, it would indeed be strange if it should not likewise produce insanity. If Esquirol be right in establishing that derangements of menstruation form one-sixth of the physical causes of insanity, and B. de Boismont in professing the same opinion, and in saying that the menstrual epochs are always "un temps orageux" even for insane women who regularly menstruate, it would indeed be singular if the change of life did not sometimes produce insanity. If it be caused by puberty—a fact already recorded by Hippocrates—it would be astonishing if it were not sometimes the result of the change of life. A favorable prognosis of climacteric insanity may be generally given as to ultimate recovery, but it is best to explain to the relatives that the disordered state of mind may last for two or three years, although I have known women recover in six months. In two cases there had been insanity at an earlier period of life, but no relapse at the change of life.

FORMS OF CLIMACTERIC INSANITY. I shall pass in review— I. Delirium; II. Mania; III. Hypochondriasis, or Melancholia; and IV. Irrepressible impulses, and the perversion of moral instincts.

I. DELIRIUM.-B. de Boismont, who has seen four cases of delirium at puberty, has likewise met with transitory attacks of it at the change of life. Sometimes the delirium is general, or it may run exclusively on one subject; and it is a matter of reflection for the psychologist, that while, in virtuous women, ideas thus combined, without the guidance of volition, may take a lascivious turn, in depraved characters, if Parent Duchatelet is to be believed, delirium runs on ordinary matters,

and never on erotic subjects. I have met with three cases of delirium at the change of life.

CASE 30.-Delirium.-Mary S., of the average size, but thin, with a sallow complexion, dark hair, and hazel eyes, was forty-seven. The menstrual flow appeared at thirteen, and it had always been particularly free from morbid symptoms. Though twice married, she never conceived. About fifteen. months ago the menstrual flow became irregular, and she was much troubled with headache and abdominal pains. One night she went to bed as usual, and awoke delirious. She ran down the street in her nightgown, required three men to hold her, was taken to the Bristol Infirmary, and in three days, the menstrual flow having come on, her senses returned. Several abscesses appeared in both arm-pits, some broke, others were lanced, and, when better, she came to London, and applied at the Dispensary for relief from headache, nervousness, and lightness of head. There had been no menstrual flow for the last ten months. I gave her a scruple of Dover's powder every night, and the comp. camph. mixture, which cured the patient. The singularity of this case is, that no nervous symptoms presented themselves until the attack of delirium. The patient was in tolerable circumstances, had a kind husband, and nothing to trouble her, so I cannot attribute the delirium to anything but the change of life.

CASE 31.-Delirium.-Mary L., a tall, stout woman, with brown hair, light gray eyes, and a sanguine temperament, was thirty-six when she came to the Paddington Dispensary, October 31st, 1850. The menstrual flow appeared at twelve, and continued regular, abundant, and without much disturbance. She had none of the usual head-symptoms of menstruation, but, from her twentieth year, was subject to epileptic fits. She married at twenty-two, had three children, pregnancy always warding off the fits. The menstrual flow was regular until her thirty-second year, when, a few days after its last appearance, without any known cause, she became delirious, and was taken to the Marylebone Infirmary. In a few weeks she was well enough to leave, and, though her health was not restored, she never had a similar attack. She is very nervous, giddy, and bewildered; but for the last year has had no fits.