caused by a diseased condition of the ovaries. Esquirol relates the case of a lady in whom mania appeared on the nuptial night; the second attack came on at the time she conceived. Dr. Belhomme relates that a lady had a first attack of mania, lasting twelve days, during pregnancy in . 1825 She became again pregnant, and was again afflicted with mania in 1826 She was pregnant and had a more obstinate attack in 1830 Another slight attack during another pregnancy in 1835 Madness became permanent after suppression of men struation, in 1836 This time the lady was not in the family-way, but complained of pains in the pelvis. Lisfranc found hypertrophy of the fundus uteri and erosions on the neck of the womb, and the amelioration of the mental disease coincided with that of the womb, which was obtained by leeches, injections, and repose. Dr. Belhomme also cites the case related by Dr. Gaultier de Claubry, of a lady who had a first attack of mental derangement during pregnancy, but who soon recovered after her confinement. Ten years after she had another attack, and it was also thought that she was in the familyway; but Baron Boyer discovered a uterine polypus, which was extracted, and the mental derangement soon subsided. An old observer, Panarole, speaks of a patient who was remarkably modest and intelligent when pregnant, and who on being confined, was stupid and given to erotomania. Puerperal mania will not be forgotten. I merely couple the memento with the consoling fact that women almost always recover. An hysterical woman committed suicide, and Esquirol found nothing but an inflamed ovary. Négrier says, the ovaries cause two forms of madness. 1. Erotomania and subsequent idiocy; 2. Hypochondriasis with a suicidal tendency. Bedford has seen decidual dysmenorrhoea accompanied by the most fearful paroxysms of nervous irritation bordering on insanity; and Mr. Acton has traced many cases of imbecility, hypochondriasis, and syphilophobia in men, to lesions of the reproductive organs. Having passed in review the effects of the ovarian nisus. on the cerebro-spinal system at successive periods of life, and inquired how, in some women, it can be the main cause of madness, I conclude from the written experience of trustworthy observers, from the materials collected by myself, and from the vivid recollection of many facts: 1. That between the haziness of intellect, the slight forgetfulness of pseudo-narcotism and idiocy, there is no break; that every intervening degree is exhibited in some women, at one of the phases of healthy or of morbid ovarian nisus. 2. That between the first slight estrangement of a girl's temper and the maniac's delirium there is no break; every intervening link being supplied by some women, at some one or other of the successive phases of healthy or of morbid ovarian nisus. 3. That between those first indications of uncontrollable muscular power called "the fidgets," and the strongest convulsions of hysterical seizures, there is no break, every intervening link being supplied by some women at one of the phases of healthy or of morbid ovarian nisus. When the same powerful influence produces permanent insanity, by what other mechanism can it act on the brain than by that of hysteria? The ovarian nisus rouses the centre of the ganglionic system to increased energy, so that without any structural change in the brain its functions may be totally perverted by the too powerful action of the ganglionic nervous system. I am thus led to look on this nervous system as a source of vital power, infallible when confined within the limits of the vegetative functions over which it presides, constantly reacting, therefore, on the cerebro-spinal system as far as its nutrition is concerned, but interfering with the proper functions of the brain when its influence becomes too powerful or perverted. And as the nature of this ganglionic force is to be impulsive and uncontrollable, it casts reason off the rails, as Galen might have said of what he called the lever of the vital forces, if railways had been an invention of his age. If this be true of those rare instances of insanity produced by undue action of the ovarian nisus, does it not lead to the conclusion that the cause of insanity in other cases should oftener be looked for in the ganglionic nervous system, than in the brain? Many of the habitual phenomena of insanity are referable to no other explanation. If in many insane women the menstrual function is regularly performed, despite the wet, cold, and other counteracting influences, does it not show an increase in that ganglionic force on which the ovarian nisus depends? If the insane of both sexes are capable of a surprising endurance of cold, does it not show an equally surprising increase of that ganglionic force on which depends animal heat as well as nutrition? I remind those who devote their time to the study of insanity, that to study it in asylums only is like studying tubercular consumption in its second stage. That its first stage is hidden in the midst of a domestic circle, either incapable of understanding its phenomena or anxious to hide whatever may be too well understood. If they look more carefully into the matter, they will agree with M. Moreau of Tours, who observes: "That almost all mental diseases are, as it were, foretold and preceded by symptoms which generally pass unobserved, such as fainting, giddiness, and vertigo, and by nervous sensations arising from different parts of the body like the aura epileptica, sensations which the patients themselves compare to excitements, or to electrical shocks." In giving this direction to their researches, mental pathologists will not venture into unexplored paths—they will merely return to an old one, and resume the broken thread of medical tradition which, in the time of Plato and Hippocrates, sought an origin for insanity in certain morbid conditions of the principal abdominal viscera. Thus have I incidentally shown that the study of hysteria should be the preface to that of insanity, and that the study of both leads to the conviction that there are two centres of nervous power, though not two nervous systems—the arctic and antarctic poles of the human microcosm, on the due equilibrium of which depends the moral and mental, as well as the physical, health of man. WHEN the organs of vegetative life are seriously disturbed in their functions or structure, pain is experienced sometimes in the viscera themselves, but more frequently in some portion of the walls of the cavities in which they are contained. The spinal nerves which are distributed through the viscera receive the morbid influence, transmit it to that portion of the spinal cord whence they originate, and the pain is then reflected through the spinal nerves which proceed to the cavities containing the viscera. The ovarian nisus is the function of the ovarian nerves. By forcibly attracting the fluids to the ovaria, these bodies. become congested, and by their reaction on the uterus this organ likewise becomes congested. This increase of nervous activity, heightened by the gorged state of the vessels placed within its sphere of activity, determines the pains which constitute the neuralgia of menstruation. The reproductive organs are, indeed, the only organs of the body whose function is painful even when healthily performed. Menstruation is a species of parturition, and it is seldom healthy unless attended by spinal pains, which are diminished in, or do not attend the unhealthy menstrual secretion of chlorotic women; but, as they recover, the spinal pains re-attend the menstrual epochs. The ovary may transmit pain to the spinal nerves by means of the splanchnic nerves. The upper part of the womb is supplied with spinal nerves from the intercostal branches through the medium of the splanchnic nerves and spermatic plexus, and any disease, seated in that part of the womb, may cause the reflected pains to be felt along the intercostal nerves, which arise from the same part of the spinal cord as the nerves furnished to the fundus of the uterus. The middle and lower portion of the uterus is furnished with branches of spinal nerves from the lumbar plexus through the medium of the hypogastric, and when this part of the womb is diseased, the pains are transmitted along these nerves, and reflected on those which arise from the lumbar plexus, and therefore along the nerves supplying the muscles of the lumbar portion of the back, the walls of the abdomen, inside of the thighs, the front of the leg, and even sometimes to the instep. The spinal nerves distributed to the vaginal portion of the generative intestine arise from, the sacral plexus; hence, disease of the vagina causes pains to be reflected along the nerves which come from this plexus, and as this plexus furnishes nerves to the sacral region, to the perineum, the posterior part of the thighs, and the calves of the legs, pains may be experienced in all this course, and in some rare cases even in the soles of the feet. It will therefore be seen that it is not possible to ascribe the dorsal and the hypogastric pains each to a distinct set of nerves. As anatomy and physiology do not suggest a classification of abdominal pains, I shall adopt that offered by nature, and divide them into dorsal and hypogastric. The following table will give an idea of the degree of frequency of the ordinary neuralgic symptoms of menstruation at successive periods of life. With regard to the progress of cerebro-spinal symptoms in general, I find that in the majority of cases the symptoms precede the menstrual flow, and abate as it progresses: Per cent. That they subside on the appearance of menstruation in . 28 That they subside on the second or third day in . That they last until the end in That they last several days after in. That there was back pain at the time only in 19 10 3 4 3 A great intensity of pain in the cerebral and spinal regions is seldom to be met with at the same time, for the two are, in general, so counterbalanced that when a great amount of cerebral symptoms exists, the spinal symptoms have not a |