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curred among his hysterical patients; and, therefore, the precise pathological condition of the part must be matter of conjecture.

The pain in the left side is next to be attended to.

"It is usually situated immediately below the left breast, in a hollow formed between the cartilages of the fifth and sixth, or sixth and seventh ribs; it is generally so circumscribed, that it may be covered by a shilling; and is of the gnawing kind. Occasionally, however, it is most acute, feeling as if a knife were being stuck into the spot, and the patient cannot forbear screaming. This pain is complained of for some time before the invasion of the Hysteria. The patient is often observed to incline the upper part of the body to that side, dropping the left shoulder, which relaxes the painful part and affords some relief. The act of raising the left arm above the head, or of bringing the body into a perfectly erect position, is attended with an increase of pain. I apprehend this pain is really seated in the intercostal nerve, although I have sometimes thought it must be situated in the nerves of the heart itself; as it is difficult to account for its perpetual preference for the left side. The right side, certainly, is often not exempt from pain; but, in nineteen cases out of twenty, the prominent grievance is in the former; and in the like proportion of instances, I can put a finger on the spot with as much certainty as if it were visibly marked." 43.

Mr. T. is convinced that many spinal curvatures have arisen in conseqnence of this pain, causing a tendency to lean the body constantly towards the affected side.

Palpitation is another symptom which is almost always present. So is pain in some part of the head, generally in the front or occipat, or both. Globus hystericus though not always present, is very often so.

HYSTERIA OF THE THIRD Degree.

It has been stated that the various forms of this kind or degree of hysteria, appear to be caused immediately by the spinal affection, which, in its turn, is the result of some occult association or sympathy between the spinal cord and the uterus. We have, therefore, two indications to fulfil the removal of the immediate cause of the hysterical evolutions; and the restoration of uterine vigour and health. The modes of accomplishing these objects are fully pointed out in the cases above detailed.

"In some instances, where the patient is very robust,-the cheeks highly flushed, the eye injected, the forehead red and polished, it may be useful to abstract blood by the lancet; but it rarely does much good, and, as far as I have seen, never relieves the immediate attack. But when symptoms so sudden and alarming make their appearance, a medical man is expected to do something instanter; and in strong young women, bleeding does no harm. In delicate girls, on the contrary, it aggravates the disease tenfold; and renders the cure infinitely more difficult and tedious than it would otherwise be. As a general rule, therefore, venesection should not be performed, without some very substantial reason. It neither removes the pains, nor the spasms; but very often

prolongs both.” 47.

Having made a careful examination of the spine, and ascertained the seat of pain, the first thing to be done is the application of the tartar-emetic, either by friction or plaster on the spot. If the symptoms be urgent, whether cataleptic, choreiform, tetanic, hemiplegiac, or Proteian, the application should be carried along the whole course of the vertebra-and this should be done every six or seven hours, until the pustulation is fully developed. "The hysterical symptoms will then yield, and the patient will become

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calm and sensible." But, as the cause of the spinal affection, the uterine disorder, is still in operation, it is sometimes necessary to establish the eruption, iterum iterumque, in order to secure the patient from relapse.

Leeching has always failed to relieve the spinal tenderness in our author's practice, and the same may be said of blistering. Purgatives are necessary, as auxiliaries. The evacuations are generally black and unhealthy at first.

"We have thus disposed of the immediate attack; but another important indication in the treatment remains to be considered. This is to re-establish a healthy and vigorous menstruation. Now the mal-performance of this important function may be of several different kinds; it may consist in absolute suspension or suppression; in being before or beyond the usual period; in being of a dark and grumous, or of a very pale complexion; in being too copious or too small in quantity; or in being attended with excruciating pain. Such being the various states of disorder, it will be seen how impossible it is to lay down any rule of treatment that can be universally applicable. Each must be separately considered, and treated according to the discretion of the practitioner, upon the usual principles; in first of all, improving the secretions, and placing the digestive apparatus in a state of reparation. After this has been effected, wholesome air, wholesome food, and wholesome exercise, with preparations of iron, and the use of the warm, tepid, cold, or shower bath, according to the circumstances, will generally be the best tonics, and restore the patient to her usual health and strength." 51.

Mr. Tate next introduces a number of cases, chiefly from the MEDICOCHIRURGICAL REVIEW, where the patients evidently laboured under hysteria, but where the diseases were designated by various appellations, according to the fancy or judgment of the practitioner. The criticisms on these cases are judicious and candid. The perusal of them will be advantageous to the reader.

With the following graphic sketch of the symptomatology of this third degree of hysteria, we shall close this section.

"As there is no regular set of symptoms that admit, as in common diseases, of being set forth as universally present to mark its nature, I must content myself with a general description of this form of Hysteria, leaving the body of the picture to be filled up by a report of cases. As before stated, in the most tedious form of Hysteria, menstruation is always more or less faulty at the onset, and as the case advances, this becomes suppressed altogether, or is performed very sparingly, perhaps only once in many months, and then with great pain. Where this function is quite suspended, there is, generally, neither any periodical pain, nor any sensation, to show that nature had not forgotten this customary duty. Shortly afterwards, the patient becomes weak and desponding, loses her appetite, and the bloom from her cheeks. She has still nothing particular to complain of, and, generally, keeps up her flesh, although it has every appearance of relaxation. If a medical man sees her now, he will find her with a moist and tremulous tongue; being foul at the root, and having the papillæ, at that part, larger than natural, and like little tubercles; with a tainted breath; depraved taste; little or no appetite; with a weak, languid pulse; with a sickly, yellowish complexion; black or clay-coloured alvine secretions, and the urine highly coloured and scanty. In a little time, she will have pain under the left breast; which is increased by deep inspiration, and by reclining upon that side,-sometimes pain also in the right side, palpitations, flutterings, sinkings, and, together with these, there will be pain upon pressure in one or more parts of the spine: 'first of all, in three or four of the dorsal vertebræ ; generally, also, in the lum bar, and, if the case be very lasting, it sometimes extends up to the very summit of the cervical portion. In such cases, the head-aches are intolerable; being in

some instances constant, in others interrupted, but always violent. The pain is often continued down the arms and into the legs; the extremities are generally clammy and cold.

"In the midst of all this, the patient is not much reduced in flesh, and, for a considerable time, it is not sensibly diminished. As the disease advances, a number of anomalous pains of a neuralgic character, become associated with the other symptoms. Thus, if pressure be made upon the supra or infra-orbital nerves, upon the inferior maxillary, &c. as they issue from their foramina, considerable pain is produced, but I never found these spots complained of, in the absence of such pressure. It is not, however, the facial nerves that are alone implicated, for almost every nerve in the body becomes, at the same time, endued with a similar increase of sensibility. This sort of neuralgic affection is seldom observed until the case is far advanced, and has become equally inveterate and puzzling.

A condition of this kind will frequently prevail for eighteen months, before any particular notice is taken of it by the patient, or her friends: she gets gradually worse, until some sudden spasmodic affection, or other unaccountable symptom, commands attention; and then medical advice is obtained. At other times, where more solicitude is felt, earlier application is made to the followers of the healing art; and the patient is called a dyspeptic, or a hypochondriac, or a nervous lady; and, if judiciously treated, will gradually recover her health." 93.

A remarkable and protracted case is next detailed, of which we can only give some of the more prominent features in this place.

Miss became our author's patient in March 1825, after ten years' illness, and having been under a pretty long list of learned doctors. She bad menstruated at fifteen, and her illness commenced soon afterwards with a total suppression of the catamenia, referred at the time to cold. She was now so weak as to be incapable of walking across the room, complexion was sallow-her lips bloodless-pulse small and quick-tongue furred-bowels torpid-dejections various but morbid-urine clear.

Her

"There was a fixed and lancinating pain in a hollow, between the cartilages of the fifth and sixth ribs of the left side; pain under the margin of the ribs of the right side; considerable difficulty of breathing, and frequent violent palpitations. The head-aches were almost incessant, and often nearly distracting by their violence. There was pain upon pressure throughout the cervical and dorsal vertebrææ; and pressure between the shoulders, aggravated the dyspnea, She was sometimes seized with an uncontrollable vomiting, which lasted seven or eight days together; at which times, not a spoonful of cold water would remain upon her stomach; these attacks were ultimately tranquillized by opiate suppositories, leaving her strength completely prostrate. She scarcely ever closed her eyes to sleep, although her sufferings were so great, that she was lying in a recumbent posture, at times for days and nights together, with her eyes shut in silent agony. She appeared literally not to eat anything. She had not menstruated since the beginning of her illness, when she was near sixteen years of age.

Slight vexation or surprize threw her into a paroxysm of hysteria. A tartar-emetic plaster was applied to the spine, which occasioned great distress, and as sickness came on about this time, it was placed to the account of the plaster. Mild aperients were given, and she gradually regained a little strength. As she improved, the carbonate of iron was cautiously tried, but brought on the sickness again, and was discontinued. She went to Cheltenham, and a caustic issue was established over the seat of pain in the side, without effect. “After a short interval, the carbonate of iron was

again taken, and it now did not appear to offend the stomach. The quantity taken at each dose, was increased, by slow degrees, from a scruple to half an ounce, three times a day; so that, at last, she may be said to have lived upon iron." Under this plan she rallied wonderfully. The pain. was relieved the bowels acted favourably-the head-aches were triflingand the spinal tenderness scarcely perceptible. The catamenia returned once, and then ceased. She was able to walk and ride. She went to Bath, where a surgeon bled her once a fortnight, for a whole year. She returned to Cheltenham, and presented the following phenomena.

She had now an irregular pulse-violent palpitations-oedematous legs, even to the knees-cold extremities-shortness of breath-and a countenance indicative of exhaustion and distress. The left breast was very much wasted, as were also some of the muscles on the side of the chest: producing a degree! of deformity, that was evident through her clothes. I earnestly entreated her to subject herself to no more such ruinous experiments; but to take wholesome food-to take as much exercise, as her strength would bear, short of fatigue; to take no medicine, but a tonic-aperient pill; and to use the shower bath twice, and the warm hip-bath, three times a week. She then proceeded to Leamington, where she has followed these directions. Her health improves, but the wasting, and numbness, of the left breast and side, are making gradual progress. There appears little hope of her complete recovery, although she has already endured little short of a quarter of an ordinary life of diversified suffering." 99. Mr. Tate thinks that this must be considered as an instance of prolonged and established disease," resulting from original error, and continued series of mal-practice." If it be denied that this was a case of hysteria, Mr. T.. asks what it was? The case is by no means a solitary one. Daily are young females, afflicted with this very pain under the left breast, bled, blistered, leeched, cupped, and passed through a long course of depleting and' enervating medicines, when there is no earthly necessity for it." We fear

this is but too true.

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But our limits are far overstepped, and we believe we have shewn samples enough of Mr. Tate's little work to induce the reader to peruse the original. It is really a very meritorious performance, and the coincidence of ideas between Mr. Tate and Dr. Addison, whose books were published on the same day, clearly proves that these ideas are taken from actual observation of facts.

IV.

OBSERVATIONS ON THE DISORDERS OF FEMALES, CONNECTED WITH UTERINE IRRITATION. By Thomas Addison, M. D. Assistant Physician to Guy's Hospital, &c. &c. 8vo. 1830. DR. ADDISON is already favourably known to the profession, and the present little work will not lessen him in public estimation. It is not the less interesting because it formed the subject of some clinical lectures delivered to the students of the hospital for the illustration of "a very prevalent and important class of diseases which had long engaged his attention"-nor is it the less original because another observer, Mr. Tate, came to nearly similar conclusions as himself, and published them at the very same time...

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After a running commentary and pretty acute criticism on the doctrines of ancients and moderns, respecting general and local diseases, in which we one party contending for the constitutional origin of local diseases, and another party, with equal plausibility, contending for the local origin of disorders formerly believed to be general; whilst a very numerous class of important diseases constitute, at the present day, a sort of neutral ground, concerning which there appears to exist a truce amongst all parties,” our author comes to the immediate subject of the work—UTERINE IRRITATION. SYMPTOMATOLOGY.

"The most frequent symptoms of uterine irritation are, irregular menstruation, the discharge being preceded or accompanied by pain in the back, loins, or thighs, or in the region of the uterus itself, and attended with forcing or bearing down; the discharge being in excess either in point of mere quantity or in continuance, or in recurrence; tenderness of the womb itself upon pressure made either externally or per vaginam, a tenderness in some instances so great as to interfere with the privileges of matrimony; and, lastly, leucorrhoea. The most frequent symptoms, however, are, unquestionably, painful menstruation and leucorrheal discharge, although the former is often the only symptom acknowledged by the patient herself. Such, Gentlemen, are the few plain, simple indications of a state of uterus which is repeatedly overlooked, although productive of the most serious disturbance both of the general health and of particular organs; disturbance which, when once produced, stamps a character upon the general and local ailments of the sufferer, strongly indicative, to the experienced man, of uterine irritation; a character which confirms him in the belief that it is from such irritation that the evil originates, and that it is to correct the condition of the uterine system that his chief attention is to be directed." 12. '

The most powerful predisposing cause of uterine irritation is constitutional irritability, commonly called the nervous temperament. The other predisposing causes are such as create morbid susceptibility, namely, sedentary and luxurious habits, late hours, mental perturbations, &c.

The exciting causes again, are active exertion of any kind during the flow of the menses; frequent child-bearing, especially if the patient suckle her children herself; excessive venery, and, indeed, venereal excitement of every kind. Married women, I think, perhaps suffer most from child-bearing, and from imprudence during the menstrual period; unmarried women, on the other hand, from similar imprudence, and, peradventure, from causes of excitement of the genital organs, concerning which it is unnecessary to be very explicit." 14.

The first complaint usually made by females suffering from this irritation is, of feeling nervous, and perhaps low-spirited-we find a tremor in the hand when we feel the pulse and such a mental agitation, if it be a young and susceptible female, that, when we attempt to sooth her, "she will begin to sob, her lips quiver, and she bursts into a flood of tears."

"She tells you, that, without any assignable cause, she gradually declined in health and spirits; that she has lost her wonted alacrity, has become indolent, and is easily fatigued by comparatively slight exertion; that she is readily furried; that her heart often beats, flutters, or palpitates; that the impressions made upon her mind are altogether disproportionate to the causes producing them; that she is very prone to weep, and occasionally experiences sudden and transitory feelings of alarm and dread, especially during the night, without being able satisfactorily to account for them; in short, that both body and mind are in a morbidly sensitive condition, whilst general distress is strikingly depicted in her pale or dejected countenance. If you proceed in your inquiries to ascertain the state of the uterus, you are perhaps informed that she is regular; but if

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