cases, there was no organic uterine disease to account for the paraplegia; but in one of Dr. R. Leroy d'Etiolles, there was considerable uterine swelling, and abundant leucorrhoea, and the patient could not walk without several attendants. Iodide of potassium cured the uterine hypertrophy, and the paraplegia disappeared. The following case is related by Ollivier d'Angers, who does not seize the import of the ganglionic symptoms which play so prominent a part in the case.

CASE 39.-Frequent attacks of paraplegia, with gangliopathy. -A lady, aged forty-nine, in whom the menstrual flow had been very irregular for a year, every now and then, without ascertainable cause, had the following train of symptoms, whether in bed or up, reposing or walking, eating or fasting. There was pain and constriction in the epigastric region, with or without sensations of suffocation, which sometimes awoke the patient suddenly. Then came flushing of the face and head, and afterwards burning sensations in the upper part of the spinal column, with pain and numbness in the arms, which became partially paralyzed. This lasted for about an hour, when cold perspirations appeared; she then felt as if cold water were poured down her back, and her lower limbs became paralyzed. This temporary paralysis has often occurred so suddenly, that the patient, taken unawares, has fallen down. In about three-quarters of an hour, these symptoms disappear, without leaving any trace; but they have recurred, from three to five times in one day, on several successive days, previous to the menstrual flow, and about ten days after, during which time constipation was great, urine more frequently passed, and with tenesmus. Leeches repeatedly applied opposite to the painful part of the spinal column, tepid baths and purgatives, greatly diminished the frequency and intensity of the attack, and the menstrual flow became more regular.

A blow to the pit of the stomach determines paralysis; and here, the womb, after its fashion, gave a shock to the nervous ganglia at the pit of the stomach, which reacted on the spinal cord, and caused paralysis of the limbs. In remarking on this case, Ollivier d'Angers insists on the necessity of applying the leeches to the spinal column, asserting that the same effect would not have been produced by applying them to the pu

denda; but this position is disproved by the following case, which occurred in the practice of a medical friend:

CASE 40.-Paraplegia.-A lady's maid, aged forty-five, complained of violent pain in the loins, for which a mustard poultice was ordered; and, as the pain persisted, a blister was subsequently recommended to the lumbar region. This application was soon followed by paraplegia, and a neighboring practitioner gave, as his opinion, that the application of the blister had determined the paralysis of the lower limbs. Although this assertion was contradicted by another medical man, who was called in on account of the persistence of the paraplegia, my friend received several letters from the solicitor of the family, menacing him with an action; but he set them at defiance, and he afterwards learnt that the patient went home to her friends, and that a country practitioner, more clear-sighted in this instance than the eminent men of town, putting together the circumstances of the patient's age and the previous irregularity of menstruation, applied leeches to the womb. The result was a gradual diminution of the paraplegia, and she was soon able to walk with perfect ease.

TREATMENT. In how many cases, where partial paralysis was supposed to be caused by inflammation of the spinal cord, have the backs of delicate patients been uselessly tormented by blisters and moxas; whereas, the treatment should be directed to whichever organ, womb or kidney, may cause the paraplegia. I have seen admirable effects from the use of the hot mineral waters of Aix in Savoy, and great good is sometimes done there by parboiling the powerless limbs, the patient being placed in a bath, in and out of which hot water is continually flowing. Shower baths and douches of hot spring water will be found useful; and shower baths of water, alternately hot and cold. Such appliances, irrespective of sex, are valuable, not only in paraplegia, but in all chronic, local paralytic affections, which seem to depend on some obstructed circulation of the nervous fluid. When the patient cannot leave home, benefit may be derived from stimulating baths, which can be made by adding to the water 6 oz. of liquid ammonia, 1 of camphorated alcohol, and from 2 to 4 lbs. of common salt. On leaving this bath, the limbs should be rubbed for twenty minutes with some

camphorated and stimulant liniment. Remak thinks highly of electricity in these cases of hysterical paraplegia, one pole being applied to the pit of the stomach, and the other to the lumbar region of the spinal column, but this must be carefully done.

SCIATICA. From four cases, I have selected one which forcibly shows the utility of sudorifics in diseases of the change of life.

CASE 41.-Sciatica.-Jane A., aged forty, had dark hair, gray eyes, small stature, nervous constitution, and was of slender make. After having suffered two years with violent headache and giddiness, she first menstruated between fifteen and sixteen, and continued regularly to do so very abundantly. She married at sixteen, became pregnant immediately; had seven children, was always regular until she quickened, and in three pregnancies she menstruated regularly up to the period of parturition. The previous summer she was treated for rheumatic fever, at the Royal Free Hospital. Menstruation proceeded regularly during the patient's stay at the hospital, appeared four times after her return home, and then stopped. She complained of an intolerable pain in the left lower limb; and, on examination, I found that pressure on the spine did not increase or cause the pain. To all appearances, the left limb was as sound as the right; and the pain was said to arise from behind the great trochanter, and to reach the back of the limb, following the course of the great sciatic nerve. The pulse was weak, the urine clear, and of the usual color. I ordered a blister to the spot which was the most painful, pills of compound extract of colocynth, and a sedative mixture. The blister did not relieve the excruciating pain. Turpentine embrocations were ordered, the other measures continued, and the blister repeated, without the least benefit. March 8th.The patient suggested that her pains might have been caused by the sudden cessation of menstruation five months previously. On learning that she had lately had flushes and nightly perspirations, never experienced before, I ordered her to take, as an emetic, 1 scruple of ipecacuanha with 1 gr. of tartar emetic, to continue the mixture and the pills, and to take a teaspoonful of flower of sulphur in milk on going to bed at night. 15th.

The heats and perspirations had increased; the pains had much abated. I prescribed another emetic, and continued the other measures. 29th. The pain is very trifling, and the heats, flushes, and perspirations, are more frequent, coming on, not only on exertion, but in bed, at night, and in the morning. April 6th. I ordered sulphur, 2 oz.; bicarbonate of soda, 4 drachms; and 2 scruples of ipecacuanha—a teaspoonful to be taken in a little milk every night. June 11th. She has had no return of pain; but when the flushes and perspirations abate, she suffers either from headache or from the sensation of "something working" to bring on the pain in the leg. Jane A. has not suffered in any other way from cessation; and as she was subject to a copious discharge every month, one can understand that she should feel the effects of its sudden cessation; and as she was very nervous, it is not surprising that the nervous system felt the sudden shock, particularly that portion which was predisposed to disease by the previous attack of rheumatism. I saw this patient again in 1855; there had been no sciatica nor return of the menstrual flow, and her health was good.

Gardanne mentions, that a woman of a strong constitution, at her forty-fifth year, suddenly ceased to menstruate; and was at the same time seized with violent pains in the left thigh, and at the end of four months, was not able to move the limb. As she had suffered from syphilis in her youth, mercurials were given, but without effect. Sabatier and Gardanne then ad. vised moxas to be applied to the leg, which produced slight fever and great perspiration, but restored the use of the patient's limb.

NERVOUS APHONIA. This is a rare affection, but I have had a good opportunity for studying the case of a lady, at the change of life, who, after losing her husband, came to town, and settled in Belgravia. Though she had not hitherto been subject to nervous affections, cold, over exertion, worry, or sometimes no apparent cause, would suddenly deprive her of her voice for a few days. The nervous nature of the ailment was shown by the sudden coming and leaving of the aphonia, and by the effect of change of air; for a drive in the Regent's Park or to Hampstead would often restore her voice to its

natural tone. She therefore left town to reside in the country, and has since enjoyed a comparative immunity from this complaint. Sometimes a potion, containing ether, speedily dispelled the aphonia. Dr. Deslieux has found chloroform useful, giving from 10 to 15 drops in a little water. In two cases, I found sudorifics useful, the permanent return of the voice coinciding with a marked determination to the skin. Cerise speaks in favor of emetics for nervous aphonia, and I have witnessed their sudden good effects, but the best treatment is undoubtedly the direct application of electro-magnetism either to the tongue or to the larynx by means of Dr. Morell Mackenzie's galvanizer. The shock makes the patient scream-the spell is broken, and the patient is immediately cured.

NEURALGIC AFFECTIONS OF THE EYES.-In two women, at the change of life, I have noticed the head symptoms to be accompanied by marked photophobia, and many patients complained of an unusual dimness of sight, which wore off on the abeyance of pseudo-narcotism, and other head symptoms. H. D., aged fifty, and chlorotic-looking, has been irregular for the last six months, and suffers much from intense debility, even after a full meal. She can scarcely keep herself awake during the day, but at night is kept awake by a dull, heavy pain in the eyes, lasting more than two hours, the probable cause of which being that she has lately worked too hard at embroidery. B. de Boismont gives the case of a woman who, at forty-five, was blind for three days; Boyer rightly judged that it depended on the change of life, and on recovering her sight, she remained subject to giddiness. Dusourd met with three women who were blind for two or three days, at the change of life, and he has several times observed them affected with hemeralopia; but Romberg erroneously considers women predisposed to amaurosis at the change of life.

DEAFNESS. When deafness occurs at the change of life it should not be considered senile, for it may depend upon inflammatory affections of the internal ear, or upon morbid lesions of the external canal; but deafness is, in general, purely nervous, attending on pseudo-narcotism; the patients being, as it were, stunned, do not hear until they are fully roused from their state of torpor. I have seen this deafness appear and