appreciable increase of their usual temperature, and there is developed a higher degree of temperature in the anthers of the Victoria regia. Valentin, however, states that menstruation has no influence on the temperature of the vagina.

The influence of the ganglionic nervous system in the distribution of animal heat has been experimentally shown by one of the most eminent physiologists of the day. Claude Bernard found that the section of the sensory and motor nerves was not followed by any increase of heat, but on dividing the nerve by which the superior and inferior cervical ganglia communicate, and thus preventing the influence of the great sympathetic nerve from proceeding to its central ganglia, great heat was developed in the capillaries above the point of section of the inter-ganglionic nerve. These experiments have been repeated by Dr. H. Jones, who observes, that the division of a sympathetic nerve causes the blood-vessels within its range of distribution to dilate, the pulsation of the arteries to become more energetic, and the temperature to rise as much as 10° and 15°. Something similar occurs at each reproductive crisis when there arises a partial paralysis of the sympathetic nerves leading to hyperæsthesia, elevation of temperature, increase of secretion and absorption. Flushing, like a fit of ague, has a period of concentration, a hot stage, and one of perspiration; but, as in ague there is often no first stage, so flushing frequently comes first, and often, without any previous congestion of the capillaries, perspiration is seen continually oozing out of the skin, where it stays until it is wiped away or rolls off. Why continued perspirations are so frequently met with at the change of life, and how they preserve women from worse evils, will be understood by those who are acquainted with the physiology of the skin.

Besides this partial increase of heat, Stahl, Bordeu, and Lordat have observed menstruation to be accompanied by shivering fits, paleness, stiffness of the limbs, in fact, by all the signs of active hemorrhage and fever. I have seen first menstruation preceded by these symptoms; they are also sometimes met with at the change of life. When occurring during regularly established menstruation, they are most likely caused by some serious disturbance of the ovariouterine organs.

Dr. Julius, of Richmond, related to me a

case which illustrates this, as well as several other points of the pathology of menstruation:

CASE 15.-A young lady, aged seventeen, born in India, well grown but anæmic, full of vivacity, but not hysterical, menstruated at eleven, has regularly done so, and has led a life of fashionable dissipation. For the last four months menstruation was regular, but very scanty, attended by habitual pain in the ovarian regions, and loss of power in the spine, with spinal pain; and for many months, every other menstrual period was preceded by symptoms of low fever; the tongue became dry and black, and the motions dark, tarry, and fœtid, although the bowels were kept regular by aperients. As soon as menstruation appeared, all these symptoms vanished.

This was an exaggeration of the slight febrile movement which so often attends each epoch, and is another instance of a too great ovarian influence on the spinal cord. Under steel and quinine the patient got well, but was soon after much troubled with palpitation.

There was under Dr. Jenks, at the Sussex Hospital, in 1849, a girl, aged nineteen, who had never menstruated; but for three or four monthly periods there had been decided attacks of fever, lasting about three days. These ceased under treatment, but the catamenia did not appear.

CASE 16.-Mr. Harvey asked me to see Miss B., a young lady of nineteen, with a pale face and dark hair; she had always been delicate, and had menstruated for the first time. three months before I was consulted. Six weeks afterwards she again menstruated so abundantly for twelve days, that the bed was saturated, and large clots were frequently passed. She was lying on her back, the face was waxy and had a typhoid expression, and when roused there was little life in the eyes. When asked to show the tongue, it was protruded, remained between the teeth, and was brown and dry. The breathing was anxious, the pulse weak and at 120; the skin was warm, the kidneys acting well, the bowels were regular, and the abdomen could be pressed without giving pain, which came on by paroxysms, and was often relieved by passing a blood-clot. Convulsions occasionally supervened. Ergot of rye had been ineffectually given with cold lemonade. I ordered

injections with opium and hyoscyamus to be given by the bowel, and to be repeated in proportion to the intensity of the nervous symptoms, tepid poultices well sprinkled with laudanum to the abdomen, mustard poultices to the thighs, a stimulating mixture and cold wine and water to be taken. I thought the patient would die, but the opiates abated abdominal pain and stupor. The bowels acted, the tongue cleaned, appetite became ravenous, and the flow stopped; strength soon returned, but since this attack there is strabismus.

COLD SENSATIONS.-I have mentioned the chills and shiverings that usher in menstruation, conception, quickening, pregnancy, and cessation. The perspirations are sometimes cold and clammy. A patient of mine has been pregnant three times, and always knew she was so by an intensely cold feeling in the abdomen, which lasted three or four months.

Another lady, a martyr to uterine disease, has often complained of a very distressing sensation of cold at the lower part of the back and sacrum. I was not able to relieve it by the strongest stimulating applications, nor even by having the part ironed with a well-heated flat iron.

H

CHAPTER V.

Hysteria is the key-stone of mental pathology.

CEREBRAL SYMPTOMS.

NOTWITHSTANDING all that has been written about the brain, we know very little concerning its functions and its pathology. Its complicated structure bears evident relation to its most complicated phenomena; but of the connexion of its special portions with its special faculties we know scarcely anything. Leuret has shown the utter absurdity of the phrenological interpretation of the surface of the brain, and its central portions are like the old maps of Central Africa, a perfect blank. Again, why should an organ which has so little fluid to secrete receive so prodigious a supply of blood? Doubtless to furnish the required phosphorus, and otherwise to repair the mental wear and tear: but probably this blood intensifies the imponderable nervous power centred in the brain. This may not be a fluid analogous to electricity, but without the admission I can understand nothing of the cerebral functions. As what relates to the brain is so obscure, it is not surprising that there should be great laxity in the interpretation of cerebral symptoms, and in their nomenclature. Many distinct cerebral states are confounded under the traditional name of Hysteria, and sometimes one and the same condition is described under a variety of names. Neither am I the first to deplore that this should be the case, for Sir H. Holland has observed that the difficulty of getting a correct nomenclature for morbid sensations applies particularly to the head.

The influence of the ovario-uterine organs on the brain and on the mind is unanimously admitted; likewise that this influence is often morbid; and I have shown that the reproductive organs may react on the brain by the medium of its ganglionic nerves, and in virtue of a force derived from that

nervous system. This influence varies, being made up of symptoms opposed in their nature, or only analogous. The difference of cerebral symptoms may depend either upon a variable intensity of the ovarian nisus, or upon the reaction of the same on different portions of the brain.

Following Bacon's precept, and beginning my structure at its lowest foundation, I have carefully analysed the influence of the ovarian nisus on the brain, and have found it susceptible of the following classification:

1. Nervousness.

2. Pain in the head.

3. Sick-headache.

4. Pseudo-narcotism.

5. Hysteria.

6. Epilepsy.

7. Insanity.

The annexed table gives an idea of the per centage of the principal cerebral symptoms of menstruation experienced by dispensary patients, when free from all other morbid influences; but it must be borne in mind that as the patients belong to the lower class of society, it will afford no criterion of the frequency of hysteria at different times of life in women of the highly civilized classes.

1. NERVOUSNESS OR MORBID IRRITABILITY.

I first draw attention to nervous irritability because it is the "materia prima" of all nervous affections, the basis on which they all rest, and the soil in which they grow; but to speak of nervousness as hysteria is to perpetuate the state of confusion out of which the pathology of the nervous system has scarcely emerged. The frequency of nervous irritability at puberty, at monthly periods, as a result of connexion, pregnancy, cessation, and ovario-uterine diseases, is well known. By nervousness I mean that the nervous system is more than usually susceptible to external impressions, such as cold, light, noise, to the stimulus of the internal organs and to that of emotion. There are not only innumerable degrees, but various modes of nervousness. If patients are asked if they are nervous, they always understand the term to mean hysterical, and are often