her as her husband for twenty-five years. The shock brought on delirium which lasted a fortnight, and a muco-sanguinolent discharge from the womb, which has continued ever since, and has now lasted three years, without impairment of health. There was neither ulceration, polypus, nor cancer to explain this discharge, which came from the internal surface of the womb, only inconvenienced the patient, and was not much diminished by astringent injections. Another patient has a pale pink discharge whenever she strains, or remains standing long, and whenever she puts her hands into warm water.

Vaginitis. The occurrence of vaginitis at the change of life or afterwards was only noted four times in 500 patients, but I have seen many cases of this complaint during the last twelve years, and sometimes the patients were mothers of large families, and had never suffered till cessation, when vaginitis became troublesome. Vaginitis is often attended by great internal heat, bearing-down pains, vesical disturbance, with or without scalding sensations on passing urine. The discharge is sometimes purulent, offensive to the nose, and acrid enough to chafe the pudenda. At other times it is milky or watery, and the gentlest digital examination is most painful. Before ordering vaginal injections, in very acute cases, it is better to reduce the inflammation by a saline purgative, and copious dilution with imperial drink, or linseed tea; by large, thin, warm, linseed-meal poultices applied to the lower half of the abdomen; by lotions, with linseed tea, adding to each pint one or two drachms of acetate of lead; by the rectal sedative injections; and by a tepid bath, prolonged for an hour. In a few days the lotion may be used as a vaginal injection, and it may be requisite to apply to the vagina, every fifth or sixth day, a solution of nitrate of silver, forty grains to the ounce of distilled water.

It is not unusual for those who have suffered much from uterine disease to have occasional attacks of vaginitis after the change of life, and four patients have, for several years, been obliged to come to me on this account, once or twice a year. In them there is no trace of uterine disease, but sometimes vaginitis coincides with an enlarged and displaced womb, or with a fibroid. I have just seen a lady who, six years after

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FOLLICULAR INFLAMMATION.

the ménopause, was given up as suffering from cancer, and in whom I can only find extensive vaginitis, with a large anteverted womb. Sometimes vaginitis seemed to be the result of a tendency to mal-nutrition of most of the mucous membranes, sometimes I traced it to too frequent connection in advanced life. I have also seen acute vaginitis in married women in whom there had never been intromission, and I have met with women who had previously had children, and nevertheless inflammation and spasm had so contracted the vagina that I could, with difficulty, introduce the forefinger. Occasionally vaginitis is the only organic lesion that accompanies distressing cases of neuralgia of the sexual organs, to be hereafter considered, but regarding which I may already state that the neuralgia persists after the cure of the vaginitis.

FOLLICULAR INFLAMMATION OF THE PUDENDA.—This form of disease is most frequent during previous years, but I have occasionally known it to begin at the change of life, and to be subject to occasional relapses for the following three or four years, while I have met with three instances in which the disease had begun about thirty, and continued many years after the ménopause. The annoyance suffered is extreme, and the irritation such as to render the application of the hands imperative, and causes the discharge, at other times mucous, to become bloody. In one lady the irritation came on periodically, and then several hard lumps, about the size of a filbert, would appear in the margin of the labia. These swellings seldom suppurated, but occasionally vesicles appear on the skin. I have observed that in severe cases of this description, there is no exaltation of sexual desires, connection being, on the contrary, abhorrent to the feelings, though it may be otherwise when the affection is slight.

The labia should be fomented every two or three hours, with a lotion containing half an ounce of acetate of lead, and two drachms of laudanum to four ounces of distilled water, and fine linen should be steeped in the lotion, and gently applied to the irritated surface, using afterwards a powder made of powdered starch, 3v; powdered acetate of lead, 3ss; and essential oil of bitter almonds, my x. If that does not do good, I recommend a lotion made with two drachms of sulphate of

zinc, two drachms of diluted hydrocyanic acid, and two ounces of glycerine to sufficient distilled water to make an eight-ounce lotion.

A tepid bath, or hip bath, should be taken daily, or every other day, warm water being added, so that the patient may remain in it for an hour, or more, if possible. After the full effect of a saline purgative, a sedative rectal injection should be given once or twice in the day; and at night a scruple of Dover's powder, or of Battley's solution, may be beneficial. Should this plan of treatment fail, it would be necessary, instead of the acetate of lead, to have recourse to the application of a solution of nitrate of silver. The patient cannot effectually apply this remedy, which must be done by the medical adviser, who will have to steep cotton-wool in a solution of nitrate of silver-40 grains to the ounce of distilled water— and to rub it well into the recesses of the mucous membrane, before its morbid excitement will abate. Trousseau recommends, as a never-failing lotion for this affection, a pint of water, in which is dissolved a large pinch of a powder made with equal portions of deutochloride of mercury and muriate of ammonia. He also recommends first two vaginal injections a day, then one of a solution of deutochloride of mercury, 3j to the pint of cold water. I agree with Huguier, that the vulvovaginal glands are not liable to inflammation after forty-five.

PRURIGO PUDENDI. This is a common form of prurigo, and after cessation it is often accompanied by prurigo of some other part of the skin, or prurigo senilis. This is a most distressing disease, and Lorry asserts that the mere local irritation is often succeeded by a fearful desire for sexual gratification. I have seldom met with severe cases, but B. de Boismont, Gilbert, and Mr. T. Hunt, note prurigo and eczema of the vulva and anus as not unfrequent at the change of life. The following case is derived from Mr. T. Hunt's practice.

CASE 42.-Herpetic affection of the labia.-A single lady of fifty, who had never menstruated, suffered from irritation, chiefly confined to the left side of the clitoris, which was in a state of hypertrophy from the constant friction. As the patient could not well retain her water, a careful examination was made, when it was found that the meatus was larger than usual,

and that there was no vagina or uterus. When young, she frequently had leeches applied to the labia to induce menstruation, but no examination had ever been made with a view of ascertaining the cause of the amenorrhoea, nor was she at all aware, up to the age of fifty, that she was the subject of malformation. She had all the other physical characters of a female, together with the modesty and delicacy of mind peculiar to her sex; there was sexual passion, and she would long previously have been married, had she not feared that matrimonial unhappiness might arise out of the total absence of the catamenia. She was never conscious of any local pain or fulness at the monthly periods; but she was frequently troubled with headache and giddiness at irregular intervals. In other respects her health was excellent; but the pruritus, which was often accompanied with an herpetic eruption on one of the nymphæ, was the great plague of her life, and strong religious principles had alone prevented her committing suicide. Arsenic and other remedies were tried in vain.

Mr. Hunt speaks most favorably of arsenic. In milder cases, saline purgatives have proved very useful; also, prolonged tepid baths, cold baths, cold hip baths, and cold water injections. The lotions recommended for vulvitis will be equally good in prurigo. Ointments with a preparation of zinc, lead, or mercury, may be tried, as well as powders containing calomel and camphor. I have given camphor in various ways, with good effect. Lotions made with the sedative camphorated lotion, or with camphorated vinegar diluted with water, camphor ointments, camphor powders, and camphor sprinkled between the bed and sheet. The utility of preparations containing carbolic acid confirms Hebra's assertion that prurigo is caused by pediculi, and suggests the careful cleansing of the patient's clothes so as to destroy the insects by which the complaint is often indefinitely prolonged.

NEURALGIC AFFECTIONS OF THE SEXUAL ORGANS.-In the first place, I must treat of Erotomania, or the inordinate desire for sexual gratification, which is a mental phenomenon, and should have been, therefore, placed on the list of irresistible impulses, in the chapter on cerebral affections. Pudendal neuralgia will then claim the reader's attention; and lastly, I will describe

as ovario-uterine, a little-understood form of abdominal neuralgia.

Erotomania.-The inordinate desire for sexual gratification, described by writers as furor uterinus, uteromania, and nymphomania, is a mental affection, suggested, promoted, and intensified in a very limited number of women by morbid ovarian influence, by uterine affections, and by the various kinds of pudendal disease that I have just described; and this sufficiently explains the importance of curing them.

The Greeks considered erotomania to be the result of Divine vengeance for neglecting the worship of Venus. In the Middle Ages, the complaint was considered to be a proof of Satanic influence; but we now rightly place in lunatic asylums those who suffer from it to an aggravated extent. I have stated at page 120, that the most distressing cases of erotomania are very rare at the change of life; but B. de Boismont had six cases in his asylum. Mathieu cites one case in a lady at fifty, and another in a woman at sixty years of age. Dusourd mentions three, and Louyer Villermay cites two cases, as having occurred after cessation. I do not agree with Mathieu and Roubaud that the disease is frequent at the change of life, for I have not met with a single instance of an aggravated nature. There is, however, so much of truth in the old French proverb about "Ce diable de quarante ans si habille à tourmenter les femmes," that towards the change of life, there is often a temporary rekindling of passion thought to be altogether extinguished, like the sudden reawakening of a smothered flame. This explains why, at the change of life, women sometimes take a husband when it is treatment they require, and why, occasionally, a married woman who had hitherto led so virtuous a life that it seemed impossible for her to go wrong, will actually sacrifice position, friends, children, and husband, to begin a new life with a worthless vagabond. With regard to treatment I will only say that it behooves the medical adviser to remove any kind of morbid irritation that may exist, not only in the pudenda, but in the womb and ovaries, and those who have to treat severe cases of erotomania in lunatic asylums must remember that a digital examination will not enable them to decide that there is no uterine disease; that point must be