struation, I ordered a grain of acetate of morphia, in two ounces of distilled water, a teaspoonful to be given every hour. I applied a plaster of opium and camphor to the pit of the stomach, and a plaster containing belladonna with oil of savine and rue to each of the ovarian regions. The pain abated, the patient could eat without impediment, but for some days the pain returned at intervals, notwithstanding four or five teaspoonfuls of the solution of morphia were daily taken. The abdominal pains became more and more intense, and menstruation, paler than usual, appeared three weeks after it was due. The abdominal pains, the leucorrhoea, the two sudden gushes of water, which the patient stated came away from the womb at two days' interval, after very severe pains, induced me to believe that this case was one of menstrual check, by the acute bronchial affection, and that it produced the intense pain of the solar ganglia.

The intimate connexion between the epigastric pain and menstruation was shown at the next epoch. After having suffered for several days from pseudo-narcotism, colics, &c., she awoke one morning with violent pain in the epigastric region, which, after having lasted an hour, went away, and was immediately replaced by intense pain in the dorsal region of the spine; this pain seemed to descend gradually to the sacrum, and then the menstrual flow began. pain, after this, gradually diminished, and was succeeded by pains in the thighs and knees. The urine was scanty, as it was always during menstruation, and previously it had been very thick.

The

This epigastric pain was so evidently connected with menstruation that it often came as its prelude; it was a nervous pain, relieved by pressure, and often intense enough to make a strong-minded woman weep. It was of a suffocating nature, and as it may have coexisted with a perfect state of the digestive organs, it cannot have been attributed to them, nor to any spinal affection, to which the patient was not liable. It was a result of deranged menstruation, but it could not be properly called hysterical, since the patient had no hysterical symptoms. Ever since the occurrence of this pain the patient has been liable to a spasmodic affection of the pharynx and esophagus, which she calls "her stoppage."

She will sit down to a meal with great appetite, and all at once will feel as if the food would not go down; and then it stops for a time, or else she is obliged to bring up sometimes the whole dinner, generally a few mouthfuls only, of food or of ropy mucus; after which she will return to table and eat a hearty meal. Any kind of domestic annoyance would bring on "the stoppage," and I have known it last for three days, during which the patient thought that none of the food she attempted to swallow could have reached the stomach.

Cold meat, bread and cheese, very cold drinks, are more likely to make it come on; whereas savoury dishes and warm drinks are usually taken with impunity.

Amongst other medical men, Marshall Hall was consulted; he considered it to be one of spasmodic stricture of the esophagus, and told me that he himself had once suffered in a similar way, and had been sounded by Sir B. Brodie, who had found no cause for alarm. Little did Dr. Hall then think that he was suffering from the cancerous affection of the esophagus of which he died some years afterwards. Since the publication of this case, eight years ago, the patient has been often subject to similar symptoms, but their intensity and frequency have much diminished. The improvement cannot be traced to strong remedies, for steel, quinine, and a host of anti-spasmodics, did no good. This was pro

bably the result of Marshall Hall's experience, for the only thing he advised was, keeping up a daily action of the bowels by aloetic remedies. This improvement is the effect of time, of better circumstances, and of immunity from household cares, for visiting or residing in the country always diminishes the nervous symptoms. I may, however, mention, that when "the stoppage" threatens, it has often been relieved by a glass of very hot ginger tea, or by a teaspoonful of aromatic spirits of ammonia in a little water, or by half a glass of brandy taken "neat."

There is a very similar case in Dumas' work On Chronic Diseases. The same temperament and age, the same difficulty of swallowing, epigastric pain and spasmodic contraction of the diaphragm, increased by laughing, and attended by menstruation. Both cases were partly caused by mental distress, lasted very long, and were more relieved by time than by

remedies, although one or two grains of extract of hyoscyamus, given three times a day, did good.

CASES 12.-Maria G., of a sanguine constitution, is now sixteen. She first menstruated at fourteen, but always irregularly, every two, three, or six weeks, and with great cerebral and abdominal pains. On going to Scotland the flow stopped for four months, and without any other cause, she was taken with a violent pain at the pit of the stomach; the pain returned two or three times a week, and though at times less intense, was constant. It was described as a gnawing pain, worse from sitting upright, or from walking. The tongue was clean, the bowels regular, and appetite variable. These symptoms disappeared by the use of sedatives, and on setting right the menstrual function.

Isabella B., a healthy-looking girl of eighteen, after sudden suppression of menstruation, first felt, twice a day, faintness in the epigastric region, and then a violent pain in the same part. This was relieved by lying down, and by vomiting. She brought up mucus, and then began to eat again, for her appetite was keen.

S. E., aged twenty, a delicate girl, in whom menstruation was regular, except at the last epoch, when, instead of the menstrual flow, there came violent epigastric pain, increased by pressure, by moving, or by eating. She vomited clear water; the breasts were painful.

A case is related by C. M. Adolphus, Art. Acad. Nat. Cur., Tom. II., of a woman, who, after two years of imperfect menstruation, became subject to periodical cardialgia, recurring immediately after taking food, lasting for two hours, and sometimes producing syncope. Many plans of treatment were ineffectually tried, and the patient was at last cured by repeated bleeding from the saphena vein and foot-baths.

I mentioned that in one case the patient was three days without being able to eat, and Pomme says, that a patient of his remained seven days without eating, owing to spasm of the esophagus, which fortunately disappeared after a fainting fit. Pedelaborde relates, that a patient, aged thirty-two, suffering from chronic uterine disease, amongst other hysterical symptoms, could not eat the smallest quantity of food without causing suffocation and vomiturition, so that she

dreaded the time for taking food, although abstinence was very painful to endure, as in my cases. It appears that there

is a case recorded in the Memoirs and Observations of the Medical Society of Edinburgh for 1718, of a young woman, who, losing her father while menstruating, was suddenly seized with an impossibility of swallowing, convulsions occurring whenever she tried to do so. She is said to have died on the fifty-fourth day of this abstinence from food, but nothing abnormal was detected in the esophagus.

Sir B. Brodie also speaks of two ladies, subject to the ordinary symptoms of hysteria, in one of whom, the slight pressure of the finger on the precordial region, brought on a paroxysm of suffocation and constriction of the chest, while, in the other, the same act caused convulsions similar to those of chorea.

My next case will illustrate other ganglionic symptoms, as they occur in lactation; for the similarity of symptoms point to a common origin, to the disturbance of ovarian nervous energy, reacting first on the cerebrum abdominale, then on the brain.

CASE 13.-Elizabeth H., aged thirty-two, tall, thin, with a sallow complexion, brown hair, and hazel eyes. After twelve months of pseudo-narcotism, first menstruated at fifteen, and continued regular every four weeks, suffering little in the back, but much in the head. She married at twenty-two, has been pregnant eleven times, and miscarried seven, from some slight emotion. When admitted to the Dispensary, on the 12th of October, 1851, she had been confined two months, and had plenty of milk. She complained of an epigastric "sensation of weakness, but not downright pain." It sometimes lasted the whole day-sometimes only came before or after meals, it was not increased by worry. She felt in the throat a sense of stoppage and a choking feeling, particularly on taking liquids; but she did not retch. She was heavy, stupid, forgetful—and inclined to sleep. Sometimes she had fits of laughter or of crying, and although in every way comfortably off, she was distrustful of everybody, and very jealous of her husband-circumstances quite contrary to her usual character. I ordered the compound camphorated mixture, as in the previous case, a belladonna plaster to the

pit of the stomach, and as much food as she could take; but the symptoms remained the same, until the child was weaned. This woman was in a perfectly sound state of mind and body previous to her confinement, but after strange, epigastric sensations, experienced the first symptoms of insanity, and I have often seen this to occur.

Dr. J. Conolly considers that insanity, so frequently brought on by lactation, is merely the result of weakness consequent on poor diet. I have so often seen impending insanity in nursing women, who were well fed and seemingly in good health, that in such cases, I believe, mental derangement to be a result of a morbidly affected ganglionic nervous centre reacting on the brain.

Several cases of cardialgia occurring at cessation, will be found in my work On the Change of Life.

CASE 14.-The following case will throw some additional light on the question:

Paul D., aged twenty-five, short, sturdily built, with blue eyes, fair hair, and sanguine.complexion, is a butcher, and was admitted at the Farringdon Dispensary on Sept. 2, 1852. He had always enjoyed good health, until two years ago, when, after drinking hard, he felt a sort of beating at the epigastric region, then a violent palpitation, followed by swimming and strange sensations in the head, great prostration of strength, and he was obliged frequently to lie down. He did not foam at the mouth and bite his tongue, and was quite conscious; but felt as if his strength was leaving him. Ever since then the fits have returned, every week or every month, always beginning by the strange sensation at the epigastric centre, and followed by palpitation. At all other times the action of the heart is natural. There was no sign of bodily ill-health, but he looked anxious, and carried his head as if a heavy load were on it. The pulse was weak, the debility great. I gave him the compound camphorated mixture, ordered every other night a pill composed of three grains of blue pill and extract of henbane, and a pitch plaster on the pit of the stomach. I thought the man exaggerated his state, but having witnessed one of the attacks, I entered more fully into his case, and in addition to the mixture, prescribed a large belladonna plaster to the epigastric region, and