lead. February, 1856.-To relieve the abdominal pains, she took pills, each containing 2 grs. of blue pill, and a quarter of a gr. of ext. of opium. March 27th. The patient was in every way better, but the motions were again bloody; the same treatment was continued, and on April 16th she stated that she was less subject to gloomy fits and to suicidal tendencies, though pseudo-narcotism was intense, the abdomen much distended by wind, and the tongue furred. An increased amount of flushes and perspirations coincided with the improvement, and she had grown suddenly stouter, although eating very little. I continued the same treatment, for I could not obtain her consent to have 3 oz. of blood taken from the arm. May 17th.— After fourteen months' absence of the menstrual flow, she passed, after great vaginal pruritus, many large black clots of blood, with skin-like substances, after which she had a watery discharge, and voided about a teacupful of blood by the bowels, with sickness, flatulence, and the old symptoms. More blood was passed on the 28th, after a scene with her drunken husband. I ordered her to take three times a day a tablespoonful of a mixture containing 2 drachms of the solution of hydrochlorate of morphia and of chloric ether, in 6 oz. of distilled water, and when this had cured the internal pains she took effervescing draughts three times a day. August 13th.-She had again become bilious, had passed a little blood in motions, looked seven months pregnant, but her health and appearance have surprisingly improved, notwithstanding the worry of sick children, and a home ruined by the bankruptcy of an unkind husband.

CASE 35.-Melancholia.-Mrs. L., a thin, nervous-looking lady, with dark hair, and gray eyes, was fifty-nine when she consulted me in December, 1855. The menstrual flow appeared at fifteen, and came regularly with but little disturbance. She married at twenty, had six children, and was regular until the menstrual flow ceased gradually at fifty-four. Soon after this, without worry or any apparent cause, she became subject to headaches, drowsiness, and for a time both her sight and hearing failed her. She would sit by the fire all day absorbed in transacting strange things with strange people of former times, and often frightened by ghastly faces. At other times, she

felt an incontrollable impulse to move about, and to dash her head against the wall, getting up and moving about without a motive, and then sinking down again, to remain immovable for hours. She slept with a light in the room, lest on awaking in darkness, she should throw herself out of the window. At times she had a strong impulse to kill her two grandchildren, and took care never to be left alone with them; but finding the temptation becoming too strong for her to resist, she left an affectionate daughter's comfortable home. She was much troubled, off and on, with dry flushes, and with the sensation of weight and gnawing at the pit of the stomach. I ordered 10 ounces of blood to be taken from the patient's arm, and, after a brisk purgative, I prescribed a quarter of a grain of acetate of morphia, every night for the first ten days, every other night for the next ten days, and every third night for the ten days following. I prevailed on her to stop two hours a day in a tepid bath, hot water being added when the water got cool. The baths were thus taken for a month, after which time, the patient looked and felt another person. All the symptoms had abated. I then gave 10 grains of Dover's powder every night, my comp. camp. mixture, and ordered a belladonna and an opium plaster to be applied, on alternate weeks, to the pit of the stomach, and a scruple of a powder composed of equal parts of flour of sulphur and of biborate of soda, to be taken twice a day. When this had been taken for a fortnight, the flushes, instead of being dry and burning, were mitigated by gentle perspirations. The treatment was continued for several months with slight interruptions, and a tour to the German spas completed the cure.

IV. UNCONTROLLABLE IMPULSES AND PERVERSION OF MORAL INSTINCTS. As pseudo-narcotism has been seen gradually merging into hypochondriasis, so the symptoms of insanity are often those of hysteria, made intense and permanent. Girls, well-behaved until puberty, then become snappish, fretful, uncontrollably peevish, full of deceit and mischief: is not this a state of miniature insanity? Law has decreed, that to establish a defence on the grounds of insanity, it must be proved that, at the time of committing the offence, the accused did not know that he was doing wrong; whereas medicine

teaches, that some are led by an irresistible impulse to deeds which they know perfectly well are criminal; deeds committed without motive, because liberty is warped by an instinctive impulse, which the patient cannot control. Freewill alone is punishable, says medicine; where freewill is not, punishment is barbarity, and the more barbarous, if inflicted by the hand of justice. It is, however, so difficult to distinguish the strong temptation, which might have been successfully resisted, from this irresistible impulse, that judges are averse to the doctrine of irresistible impulses; they look upon it with suspicion, because it is the plea frequently brought forward to save undoubted criminals from the scaffold. Abstract views of punishment also render judges averse to this doctrine. Baron Bramwell, in summing up on Dove's case, is reported to have said: "Why should punishment be administered at all? It is not inflicted on a man because he has inflicted evil on others, but to hold out an example to deter others from evil. That is the true reason, in my opinion, and the only object of punishment." Assuredly the punishment of criminals has also for its object the appeasing of divine justice, and the atoning to society for mischief done; and although the inconsiderate admittal of the plea of irresistible impulse, would certainly increase crime by withdrawing that constant check on evil inclinations, -the fear of punishment-still, rather than one innocent should suffer, it is better that a hundred criminals should escape. However much the plea of irresistible impulse may have been abused, I firmly believe it leads some to the commission of crimes they abhor. I have been consulted by at least ten women of high or low degree who, at the change of life, bitterly lamented their frequent temptation to commit suicide or murder. Judges, as enlightened as merciful, have admitted the doctrine of uncontrollable impulses in cases of puerperal insanity. If they admit that parturition determines uncontrollable impulses, they must also allow the possible occurrence of the same impulse at all the critical periods of woman's life; during puberty, pregnancy, lactation, the menstrual periods, and cessation. It is notorious, that the female mind is susceptible of being totally unhinged by the first impressions of the reproductive apparatus on the nervous system;

by the irregular performance of the menstrual function; by connection, parturition, and lactation; by some diseases of the ovaries and womb; and lastly, by the shock felt on the withdrawal of that ovarian stimulus to which the system had been accustomed for thirty-two years. Such being the case, what is to be the fate of women, who, at the change of life, unfortunately yield to some ungovernable impulse? Judges should be consistent, and as they shrink from inflicting punishment on mothers who murder their children during a fit of puerperal mania, and as on two occasions* they have advised juries to return a verdict of "not guilty" for the murder of infants by young women who had habitually suffered from disordered menstruation, they would, I trust, deal in a similar spirit with crime committed by women at the change of life, if it could be proved by medical testimony that this period has been an evident source of mental trouble, to a woman convicted of stealing, murdering, or committing other crimes. I lay some stress on this subject, because, when, a few years ago, a lady was brought up for stealing some pocket-handkerchiefs, and the mental infirmities determined by the change of life were pleaded in extenuation of the offence, the jury were divided. The difficulty of dealing with such cases is, that a patient cannot accept the benefits of a humane interpretation of the law, without abiding by the means wisely devised for the prevention of crime by the insane,-seclusion amongst criminal lunatics. Now seclusion may be useful in some cases, but is objectionable, until it has been proved that judicious treatment cannot remove a form of temporary insanity, as yet shallowly rooted in the system. Dr. Reid'st reflections on mental derangement apply forcibly to that occurring at the change of life. "Lord Chesterfield speaks in one of his humorous essays, of a lady whose reputation was not lost but only mislaid. In like manner, instead of saying a man has lost his

* Regina v. Brixey, Central Criminal Court, June, 1845. The murder of an infant by this woman was proved; but she was acquitted on the plea of her being subject to disordered menstruation.

Amelia G. Snos well was tried at Maidstone, March 20, 1855, for the same crime, and was acquitted on the same plea.

Reid's "Essays on Insanity," p. 204.

senses, we should, in many instances, more correctly say, that they were mislaid. Derangement is not to be confounded with destruction; we must not mistake a cloud for night, or fancy, because the sun of reason is obscured, that it will never again enliven or illuminate with its beams. There is ground to apprehend that fugitive folly is too often converted into a fixed and settled frenzy, a transient guest into an irremovable tenant of the mind, an occasional aberration of intellect into a confirmed habit of dereliction, by a premature adoption of measures, sometimes necessary, but only so in extreme cases." I shall briefly notice the most frequent of the ungovernable impulses occurring at the change of life, after mentioning that I have known women, previously economically inclined, become reckless in their expenditure, and given to extravagance at the change of life; while others, from generous, became penurious, or avaricious, in the midst of plenty, and their talk was about the workhouse, and dying without bread. A lady, who suffered much from melancholy at this period, twice had both her ponies shot, because one of them was taken ill; and a Dispensary patient labored under a delusion that she was covered with lice, which I could never detect; and, notwithstanding copious ablutions and sulphurous baths, she constantly returned with the same pitiful story.

TEMPER OR UNCONTROLLABLE PEEVISHNESS.-As at puberty, so at the change of life, temper is perhaps the most frequent of its instinctive impulses. The patient often says, "From mild and kindly disposed, I have become irascible and mischievous;" or, "I have suddenly become so mischievous, that I am quite afraid of myself." The character of a charming lady, whom I have been so fortunate as to cure, was thus for a time completely altered. The menstrual flow came at thirteen, and left at forty-seven. During the dodging time, uterine prolapsus was troublesome, and required a pessary; at cessation, there was uterine irritation, incontinence of urine, distressing flushes, and perspirations. She was low-spirited, melancholy, snappish, quarrelsome; so uneven-tempered that her servants would not stop long with her; and so suspicious, that a commonplace observation made by her husband, servants, or friends, was interpreted as a conspiracy against her.