Ever since cessation the breasts have been very painful, and the nipples frequently exude a milky-looking or glutinous fluid. Treatment similar to that employed in the preceding case relieved the patient. She was forty when I last saw her, and the menstrual flow had not returned. If the sudden stoppage produced delirium in this case without any appreciable cause, the nervous system was tainted with epilepsy; the patient's sister was also epileptic.

II. MANIA. Drs. Dusourd and Tyler Smith have noticed mania at the change of life. Before giving a curious instance, I shall mention that B. de Boismont has seen a case of mild dementia transformed by this epoch into furious mania, which lasted long. On the contrary, when cessation occurs in maniacs, it generally causes the disease to subside into dementia, and a sudden calm follows a state of furious agitation. Ferrus, Dubuisson, B. de Boismont, and others have noticed this singular effect, which reminds me of a mode of curing mania, ascribed to the priests of Cybele. "Qui ante castrationem maniaci erant, sanam aliquanto mentem ab illo recuperant."

CASE 32.-Mania.-Alice B., a bilious-looking woman, with gipsy features, dark hair, gray eyes, tall and slender, was forty-four. The menstrual flow appeared at thirteen; was abundant every two or three weeks, with a good deal of headache, sick headache, and pseudo-narcotism. Married at nineteen, had several children; the last at thirty-six, and was regular until she had a violent flooding at forty-two, since which time there has been no menstrual flow. After this sudden cessation, the abdomen swelled, was very painful, and without serious disease she dwindled down to a skeleton. She was improving, when, about two months after the flooding, as she was sitting by the fire, she felt a sudden flush in the head, face, and arms; she could not speak, and became unconscious. She was very violent, scarcely slept, eat enormously, and wanted what she could not afford. After this had gone on for three months, one night she said in a collected manner to her husband, "I will go to bed." She did so; slept soundly; was much more rational when she awoke, and gradually improved, without any other medicine than an occasional purgative. She never had a return of mania, but it has left her nervous, light

headed, and she forgets where she puts things. She came to the Dispensary for an inguinal abscess, with flushes, and drenching perspirations, and returned for advice whenever the nervous symptoms became too troublesome, and they were always subdued by scruple doses of Dover's powder, alkalies, purgatives, and tepid baths. The particulars of this case were confirmed by the patient's husband. Both state that the attack of mania came without any known cause; I therefore consider it a result of the organic changes evidently determined, in a nervous woman, by the sudden cessation of a flow accustomed to be abundant every two or three weeks.

III. HYPOCHONDRIASIS AND MELANCHOLIA.-These two degrees of the same mental condition are often met with at the change of life, particularly hypochondriasis, which seems to be an exaggeration of some of the symptoms of pseudo-narcotism. I have already drawn attention to the haziness of intellect, and to the state of temporary self-absorption into which women so often fall; to their love of solitude, their distrust of friends, their exaggerated estimation of trifles; and what is this but a temporary state of hypochondriasis, susceptible of becoming permanent at the change of life? This is why Gardanne and Dubois d'Amiens say they have often observed hypochondriasis at cessation; and they correctly remark that it is accompanied by epigastric suffocation, sensations of strangulation, and neuralgia. Chambon has likewise noticed the frequency of hypochondriasis at this period, and thinks the bilious are most liable to it. Sir H. Halford has drawn from nature the following picture: "She sits in an indolent posture, looks gloomy, hardly speaks at all, and we learn from her attendants that she lives under the impression that some fancied evil is about to befall her. She is suspicious, undecided in all her movements, and manifests symptoms which differ in degree only from melancholy mania."

Dr. Maudsley also observes that "when positive insanity breaks out, it usually has the form of profound melancholia, with vague delusions of an extreme character, as that the world is in flames, that it is turned upside down, that everything is changed, or that some very dreadful but undefined calamity has happened or is about to happen The counte

nance has the expression of a vague terror and apprehension. In some cases short and transient paroxysms of excitement break the melancholy gloom. These usually occur at the menstrual periods, and may continue to do so for some time after the function has ceased. It is not an unfavorable form of insanity as regards probability of recovery under suitable treatment." In a paper read before the members of the Provincial Medical Association, Dr. Conolly mentions having seen the melancholia of cessation last two years; but those must have been very exceptional cases, of which he could affirm that they were the beginning of the incurable decline of bodily, as well as of mental health. With regard to the causes of this state: it may be induced by plethora of the portal system, by ovarian misrule, and uterine irritation, but these physical causes would never produce melancholia without some cerebral predisposition and the concurrence of psychological causes. Peace and tranquillity of mind may be the lot of those who have passed the crisis; but it is easy to understand how the life of women, in this transition period, may be replete with anguish. Supposing health not undermined by the coming change, how can a sensitive mind and a loving nature remain undisturbed when all is changing around her, and, one by one, the cords snap which anchored her to life? At fifty, parents may have been gathered to the dust, children may have deserted the parental roof. The flame of vitality cannot die without forebodings of decay, and there springs up a doubt never before harbored— a doubt whether, with faded charms and failing energy, one can possibly retain possession of a husband's affection, and proofs of unkindness are looked out for where none were meant. Because the strength of youth is gone, a woman tries to convince herself she is useless, and may become first suspicious and then revengeful. If unmarried, is it wonderful that this peremptory notice served by nature, to put aside all long-entertained visions of fancied bliss, should wound to the quick a sensitive nature? The future then becomes a void, and despondency shows itself as boundless as the sands I have often watched at sunset, from my desert tent. In this desert of her thoughts no refreshing fountain is heard to pour forth the melodious song of hope; no palm-tree promises relief against

a scorching sun. She peoples the void with imaginary evils; hears strange voices where all is silent; feels awful forebodings, though nature smiles around her; and thus hopeless and full of fear she will sit alone for weeks and months in the darkened room of some gloomy dwelling, without any other enjoyment than solitude, or that of brooding over unbegotten evils, with mental faculties now paralyzed, or at times revived by conscience reproaching the poor sufferer with her inactivity, her sloth, and her want of faith in that God who deserts not His children.

CASE 33.-Apathy and sudden change of previous habits.This incapability of, or rather dislike to, exertion,-this aversion to the mental exercise of willing, is characteristic of the female mind when disturbed by cessation. I have been often consulted by a lady blessed with connections, personal appearance, and with a mind so highly cultivated that she might have taken the lead in society, had she not shrunk from its pleasures and duties, so soon as she first felt the influence of the change of life. Cessation took place five years ago, and ever since she has severed herself from connections, shut her door to numerous friends, and lived in seclusion. She rises at 4 P.M. and goes to bed between 4 and 5 A.M., so that, in winter, she sees as little of the sunshine as the Laplander. She says she cannot do otherwise, though she knows that her mode of life forces her sons to seek elsewhere for society they cannot find at home. To expostulation or joking, she replies, "You do not understand me;" the usual reply of those who cannot justify their conduct. This want of energy, which has been so unfortunate for others, is no less detrimental to her own happiness; for though annoyed at her distressingly nervous condition, she has not the courage to follow any plan of treatment. I said I had been often consulted, but my advice has been seldom followed, and few of the host of medical men this lady has consulted have been more fortunate. But what could medicine do in such a case without judicious management? Her present state depends upon her having had no strong guiding influence when it was most wanted. Evidently, therefore, to look for improvement while her actions have no other rule than caprice or apathy, is like placing an infant at the

helm of a three-decker, and expecting it to steer safely into port. In this lady's case, a widow, with children unable to direct her, the greatest chance of recovery would be to enter the family of some judicious medical man, under a promise to stop three months, and implicitly to obey all directions. Thus would the patient, in spite of her lamentations and prophecies, be gradually brought back to reasonable hours; thus could the medical man teach her the long-lost art of taking exercise, sometimes mingling it with distractions, at others carrying it to fatigue; and travelling might complete the cure.

CASE 34.—Melancholia, with suicidal tendencies.—Mary W., a tall athletic woman, with a pale face, iron-gray hair, a whimpering tone of voice, and apparently always ready to cry, was forty-five when she came to the Farringdon Dispensary in November, 1855. She was the wife of a publican, and in good circumstances. The menstrual flow appeared at thirteen, and came regularly, even during lactation, for she had borne several children, but it ceased suddenly eight months before I saw her. Two months after cessation, she passed a large quantity of blood by the bowels, and for the last five months, every month or fortnight she has had several loose motions containing blood. The abdomen was also very painful and enlarged, so much so that she was thought pregnant by a high obstetric authority. For the last few months she suffered much from dry flushes during the day, and from "her skin stinging and perspiring" during the night. "All this," says the patient, "I could easily bear, were it not for my nervous state." She complains of being all in a tremble, she is sleepless all night, and powerless all day, sometimes dozing, as if intoxicated, and waking up to thank God she is still in her senses; at others, she sits alone, doleful and disconsolate, ashamed of herself for being so lazy, and still unable to do anything, or forgetful of what she ought to do. She says, that "when she sits thinking, she feels numbness and a pricking sensation in her limbs," and is much afflicted with suicidal thoughts. I first prescribed my usual mixture before meals, carbonate of soda after, 3 grs. of blue pill, with 2 of ext. of hyos. every other night, 10 of Dover's powder every night, a large belladonna plaster at the pit of the stomach, and vaginal injections with a solution of acetate of