blood at the change of life. Mild purgatives, either the saline, or vegetable extracts, with calomel or blue pill, are often as advantageous in cerebral affections, at cessation, as at other periods, even when they are not positively indicated by the furred tongue and morbid intestinal secretions. The use of antacids, cooling salts, and diuretics, as already explained, are useful adjuncts. Warm baths relieve the hyperæsthesia of the nervous system, severe pseudo-narcotism, and all those conditions which verge on insanity. The good effect of prolonged baths has been long shown by Pomme; and Recamier revived the practice, which is now generally followed in French lunatic asylums.

Hydropathic treatment will be found very useful in various forms of functional nervous derangement, particularly when the patients are stout and present no signs of organic disease. Witness a childless lady, the wife of a rich man, who, two years after cessation, persuaded herself that she was pregnant, on account of a slight increase of abdominal swelling. She would not allow an examination, for fear her anticipation should prove untrue; she engaged a monthly nurse, and made all other arrangements. After a time an examination was made, and the womb was found unimpregnated. For many months she was very hysterical, having choking fits, and long fits of crying and depression. Many remedies and doctors were tried without benefit, whereas six weeks of hydropathy restored her to good health, which has been maintained for the last three years.

Sedative medications are, however, the chief remedies; and what has been already said on this subject in the chapter on Therapeutics should be read as a preface to the suggestions about to be made. I will merely add that I have invariably given sedatives for pseudo-narcotism, just as Hoffman cured the sopor of intermittent fever with large doses of opium. Faithful to the plan of applying the sedative to the suffering surface, I seek to relieve the distressing headaches of the change of life, and many of its more distressing affections, by applications to the head. In all mild cases of headache, pseudo-narcotism, and hystericism, I recommend the patient to sponge the head all over, once or twice a day, with cold

vinegar and water or eau de Cologne and water, and after half drying the hair, to rub in, for five minutes, sweet oil, or any pomatum. If these refrigerant measures do not relieve, hot flannels to the temporal regions can be tried. The head should be sponged with water, holding in solution 2 to 4 oz. of camphorated spirits of wine to the pint, with the addition of a little eau de Cologne or lavender water. Camphorated vinegar and water, or water in which camphor has stood, or the comp. camphorated liniment well diluted, are excellent remedies. This last has been sold as "Ward's essence for the headache;" but a still better preparation is Raspail's sedative lotion, which is made by adding 2 oz. of liquid ammonia and of common salt, and 3 drs. of camphorated spirits of wine to 32 oz. of water. This lotion may be used with a small sponge, or a pad of soft linen may be soaked in it, applied to the painful part of the head, and renewed as often as may be required. It reddens the scalp, causing burning sensations, but its action can be lessened by diluting it with water, and in severe cerebral affections, a handkerchief should be tied round the forehead to prevent the liquid running into the eyes, while copious spongings are made to the head of the reclining patient. Cold cream should afterwards be rubbed into the scalp, or cold cream with 1 dr. to the oz. of camphor, and 10 drops of the essential oil of bitter almonds. In pseudo-narcotism amounting to stupor, I have, in addition to other means, rubbed into the scalp, eau de Cologne with as much camphor as it would dissolve. After rubbing it in for a few minutes the patient has come to herself. In a case in which these attacks of stupor frequently followed the epigastric pain, this was my only treatment during the attack. On recovering her senses, the patient felt as if her brain were "benumbed," and then succeeded a sensation of internal pricking, like "pins and needles." When this was complained of, I wrapped the head in flannel, and left the patient to repose. The effects of the measures are sometimes surprising when they are faithfully carried out; but as nothing is so irksome as system, most patients prefer talking about the inefficacy of medicine to carrying out systematically any plan of treatment. In very exceptional cases the head should be shaven, and sedatives rubbed into the scalp. The ext. of bel

ladonna, hyoscyamus, and opium, are what I formerly used, 1 drachm of each to 1 ounce of cold cream; and they may very advantageously be combined with mercurial ointment, as in the instances already given. The other treatment required to cure nervousness, pseudo-narcotism, hysteria, &c., is given in my chapter on Therapeutics and in the cases I have related. The case 23, at page 168, shows the many remedies that may be tried for cerebral neuralgia, and I may add that Graves found nitrate of silver to be useful in this complaint, and that it may be given for a fortnight without danger of darkening the skin. I will again remark on the urgency of procuring sleep, for long-continued sleeplessness is likely to produce insanity by habitually subjecting the mind to that increased intensity of feeling which takes place in the darkness, the silence, and the solitude of night. It is astonishing, in how much more lively a manner we are apt, in these circumstances, to be impressed by ideas that present themselves, than when the attention of the mind is dissipated, and its sensibility in a considerable degree absorbed by the action of light, sound, and that variety of objects which, during the day, operate upon our external

senses.

In the first place, sleep should be courted by abstaining from exciting pursuits or amusements, between the last meal until bedtime. This will be often sufficient, and will allow required remedies to act well and speedily. It should be also remembered, that if cold sometimes causes insomnia, this is more frequently the result of the bad habit of so tightly shutting up bedrooms that the air becomes foul and hot; indeed, Dr. H. Bennet tells me that insomnia is to be always cured by sleeping with the window open. Some cannot sleep while the process of digestion is going on, while others sleep better for a light supper, and very bad sleepers should have a cup of milk or a slice of bread and butter, on their night table, for taking one or the other will often give sleep to those who have been tossing about for hours. Failing these hygienic modes of procuring sleep, I have recourse to henbane alone, or with Indian hemp, Dover's powders, in 5 or 10 grain doses, are the remedies I have most frequently prescribed; but chloral promises to eclipse all other agents when the only object is to produce

sleep, for its action is trustworthy and unattended by the drawbacks of all narcotics. It must not be supposed, however, that opium and morphia are to be dispensed with. They have other modes of action beside that of promoting sleep, and are often useful at the change of life. With regard to sleep, young practitioners must be aware that the assertions of aged patients cannot be implicitly relied on unless they be corroborated by other testimony; for the aged often fancy they do not sleep at all, and firmly deny having done so, after a very fair proportion of that blessing.

When incipient insanity is accompanied by signs of ovariouterine disease, a very important part of the treatment is the exhibition of sedatives by the rectum. Amongst others benefited by this mode of treatment, I may mention a patient sent to me by Mr. F. Brown, of Chatham. She was about fifty at the change of life, lived in complete seclusion, and was a prey to all sorts of strange delusions. As there was leucorrhoea, frequent uterine pains, and great suffering on digital examination, there was a chance that sedative enemata might afford her relief; so I ordered them, with other measures, though without giving much hope to her husband. I heard, however, that the treatment had been very successful. Dr. Ferrus attributed great utility to menstrual medications, when insanity has coincided with, or has seemed to be determined by the suspension of the menstrual flow; and he agreed with Dr. Conolly that, in such cases, the prognosis is most favorable. Many patients are sleepless, restless, nervous in the extreme, alway's in motion, always attempting, but with little strength to perform; the distinction, then, between the radical and acting forces should be remembered, the object being to moderate the acting, and to increase the radical forces; accordingly, steel may sometimes be advantageously associated with sedatives; the citrate of iron in 5 or 10 gr. doses, in an effervescing draught after meals, is the best way of taking it. With regard to the prevention of nervous affections and insanity at this period, my only recommendation is, to read over again the chapter on the general principles of hygiene at the change of life.

CHAPTER VIII.

NEURALGIC AFFECTIONS AT THE CHANGE OF LIFE IN 500 WOMEN.

TABLE XXVII.

Liability to Neuralgic Affections at the Change of Life.

Thus, during the change of life, 497 neuralgic affections were divided amongst 500 women, some taking more than their share. In after-life, these affections become much less frequent, with the exception of lumbo-dorsal neuralgia, which often persists, in a slight degree, until advanced age, and few women escape those neuralgic affections of the nervous expansions of the skin, which are often called rheumatism, while, of course, the senses become more and more obtuse. When the organs of