high-coloured and scanty, or there is thirst, and disturbed sleep. These are the symptoms which in such cases should be the guide to our practice.

The genuine passive hæmorrhagy from the uterus is a much rarer species of the disease. It occurs principally to women in the lower ranks of life, and arises from a scanty and impoverished diet, laborious exercise, bad air, and long watching. I have noticed in dispensary practice, that washerwomen and night nurses who live much upon tea, and undergo great bodily fatigue, are those who chiefly labour under it. Whatever debilitates the body generally, will, under certain unfavourable circumstances of the uterine system, bring on atonic menorrhagia.

Causes.-Common or active menorrhagia, on the other hand, has for its exciting causes whatever will increase plethora, and determine the blood with more than ordinary force into the vessels of the uterus. In the upper ranks of life it is brought on by too full living, heated rooms, late hours, and the want of sufficient exercise ;-in the lower ranks, by the abuse of spirituous liquors;-and in both by exposure to cold. Akin to these causes of menorrhagia are those which operate locally,-excess in venery, costiveness, and consequent straining at stool, severe exercise, and even long-continued dancing.

Other circumstances, however, must be taken into consideration in developing the causes of uterine hæmorrhage. It is a very rare complaint with young unmarried women, and it cannot be doubted that frequent child-bearing gives a predisposition to it. It seldom originates even with married women before thirty years of age; but from that time to the period when the menstrual discharge ceases, the tendency to it greatly increases. Many women, indeed, who had never suffered from the disease before, experience it to a greater or less degree at the time of the cessation of the menses. It is well ascertained also, that there exists in some women a natural inherent weakness of the uterus, and consequent proneness to menorrhagia.

Prognosis.-Functional hæmorrhage from the uterus is not a dangerous disease. When very obstinate, it saps the foundations of the constitution, and induces more alarming complaints; but a fatal event from the mere loss of blood is hardly upon record.

Treatment.-Menorrhagia, when it occurs as an active

hæmorrhagy, attended with fever and bearing-down pains, must be combated by depleting measures adapted to the violence of the disease. Blood-letting is often necessary. If there be much pain in the loins, we should direct cupping in that part to the extent of ten or twelve ounces. Saline aperients should be given so as to ensure an open state of the bowels. A light spare diet is to be enjoined, and confinement to a bed or sofa. The bed-clothes are to be as light as is con

sistent with comfort. Napkins dipped in ice-cold water are to be applied to the lower parts of the abdomen. Cold injections holding in solution alum, or the sulphate of zinc, may be thrown up three or four times a-day; or in slighter cases the parts may be frequently moistened with a sponge dipped in some astringent lotion, such as the liquor aluminis compositus.

If the stage of active excitement demanding these vigorous measures should have passed by before assistance is required, the practitioner will be careful to regulate his treatment on the same principles, while he proportions his means to the strength of the patient's habit. A pill containing three grains of James's powder, and two of the pilula hydrargyri, should be given every six or eight hours, in conjunction with a common saline draught, and the same attention must still be paid to diet and regimen. If all marks of feverish action have subsided, the mineral acids, which are both astringent and tonic, will be found eminently serviceable. They are commonly given in the infusion of roses, to which a proportion of Epsom salts may be added, when necessary, so as to act gently on the bowels. The decoction of bark with acid is a favourite and very efficacious formula in those cases where the constitution is much enfeebled. In the event of its failure, we must attempt to check the hemorrhage by more powerful astringents, as alum, kino, or the cerussa acetata. Decoctions of pomegranate or oak-bark, containing alum, should be frequently used in the form of injection. If the discharge be so profuse as to create alarm for the safety of the patient, she should be freely exposed to cold air, and a lump of ice applied within the vagina.

To diminish the general irritation that often prevails in the passive forms of uterine hæmorrhagy, opium may be advantageously given. Five drops of tinct. opii, or a drachm of the

tincture of hyoscyamus, may, with this view, be added to any of the saline or astringent draughts already recommended.

Married women frequently suffer from profuse menstruation, recurring every three weeks, which, besides weakening the frame, prevents, in many instances, conception. To correct this propensity of the uterus, nothing is so effectual as cold bathing of the hips and loins, night and morning, continued steadily for many months.

LEUCORRHEA.

An increased secretion of mucus from the vagina constitutes leucorrhoea, or fluor albus; a very frequent, troublesome, and obstinate complaint. In several respects its pathology is associated with that of menorrhagia. It frequently accompanies profuse menstruation, and is one of the most constant attendants upon the natural decline of the menstrual discharge. It appears also in many cases to depend upon the same causes. Slight symptoms of feverish excitement attend it, or sometimes the more obvious marks of plethora. Occasionally, but I believe more rarely, it is connected with general weakness, as indicated by paleness of the skin, a weak pulse, and oedema. Lastly, it depends in certain cases on local irritations.

The treatment of leucorrhoea must of course vary with the character of the accompanying symptoms, but will readily be understood from the remarks already offered on the management of menorrhagia. Where the system is heated, antimonial diaphoretics, laxatives, and cupping-glasses to the loins, are indicated; the cold bath, tonics, and astringent injections, when the constitution is debilitated. Injections of the argentum nitratum (of the strength of three grains to the ounce) have lately been recommended by Dr. Jewel. In some cases the checking of the discharge might possibly be prejudicial. In many this fear is groundless, the disease continuing, but without injury to the general health, notwithstanding every

effort.

CHAP. V.

HYSTERIA.

Marks of an hysterical Habit. Phenomena of the hysterical Paroxysm. Prognosis. Diagnosis. Pathology. Dependence of Hysteria on the State of the nervous System-of the uterine Functions of the Stomach and Bowels. Treatment. Influence of Antispasmodics.

OFTEN as I have had occasion to animadvert on the inconveniences and difficulties of nosological arrangements, in no instance, perhaps, are they more strikingly displayed than in that before us. Hysteria, indeed, has in all ages proved a fertile theme of nosological controversy. So various are its symptoms, so widely extended and so obscure its pathological relations, that the very assigning to it a situation, presupposes some theoretical notions concerning its nature, which have been and may still be disputed. I have here placed it among the diseases of the uterine system, following, in this respect, the opinions (or perhaps what some might call the prejudices) of an early period of medical science. The objections, however, which may be urged against this arrangement will be of little moment, if the student derive his notions of the disease from the pathological views which will be taken of it, rather than from the division of the work in which they happen to be discussed.

The hysterical habit.-The symptoms of hysteria may be subdivided into such as mark the hysterical habit, or constitute the hysterical paroxysm. The hysterical habit is characterized by great irritability both of body and mind. There occur sudden fits of laughing and crying, without any cause, or from causes wholly inadequate; the patient crying where she ought to laugh, and laughing where she might be expected to cry. There is a great dejection of spirits, a causeless dread of evil, a hurried manner, and a variable temper. With this morbid condition of the mind are associated many symptoms of bodily derangement-dyspepsia in all its shapes, the globus hystericus, or sensation of a ball rolling about in the stomach and gradually ascending to the throat, costive bowels, fits of difficult breath

ing, palpitations, a peculiar kind of nervous headache commonly called the clavus hystericus, and a copious flow of limpid urine.

Character of hysterical convulsion. These symptoms afford, of themselves, sufficient evidence of the hysterical disposition; but in all severe cases the more striking characters of the disease are developed by the occurrence of paroxysms of convulsion. These are often very violent, evincing a force that overcomes all opposition. The trunk of the body is writhed to and fro, and the limbs are variously agitated. The fists are closed so firmly that it is difficult or even impossible to open the fingers. A frequent symptom is that of beating with the closed fist upon the breast violently and repeatedly. There is an involuntary utterance of shrieks and screams, with fits of laughing and crying, sometimes accompanied with, or succeeded by, an obstinate and distressing hiccup. this state the patient continues for a longer or shorter time; often for twenty-four hours, though of course with occasional remissions.

In

More or less suddenly, and frequently with repeated sighing and sobbing, the patient returns to the exercise of sense and motion, generally without any distinct recollection of the circumstances of the fit. For some time afterwards she appears quite spent, and lies stupid, and careless of what is going on around her.

Diagnosis.-Formidable as these symptoms appear to the bystanders, they are attended with no real danger, at least for the time. Where the hysterical habit, indeed, is very strong, the fits gradually acquire more and more of an epileptic character, until at length (though probably not until after two or three years) the disease merges altogether in epilepsy. It cannot therefore surprise us, that in many cases the diagnosis of epilepsy and hysteria should be a matter of considerable difficulty. I believe it to be often impossible. The symptoms which are chiefly to guide us, are the globus, the variable mind, the flow of limpid urine, and the degree of coma subsequent to the convulsive paroxysm. But it is not only from epilepsy that hysteria is difficultly distinguished. There is hardly a disease in the whole nosology, of which it has not imitated the symptoms, and that with surprising accuracy. I have seen hysteria accompanied by constant vomiting; by a