the centres of innervation to the lower limbs and tongue. The emotional centres, however, were markedly hyperæsthetic, the general nerve debility assuming, in this situation, the same modification that it often does in the peripheral nerves. The paroxysms of agitation and crying appeared to me, as I witnessed them, of truly hysterical character, and were evidently the result of emotion, though of a pleasing kind. It is plain that that there was no irritation proceeding from the sexual organs in this young child. The disorder was essentially one of the nervous system, a state of neurolysis, which yielded to the steady employment of iron, quinine, nux vomica, cod oil, and cold bathing.

"Secondly. As regards the non-paroxysmal phenomena, I believe the very same holds good. There are cases, and they are common enough, in which symptoms, apparently just like those which are commonly called hysterical, occur under circumstances which make it certain that they have no connection with emotional or mental excitement, but are simply the results of physical derangement. The three cases which I shall presently narrate are instances in proof, and many more might easily be added. Dr. Palmer's case of functional aphonia (vide Lancet, 1866, Feb. 16) may be adverted to as one, which, had it occurred in an enfeebled anæmic needlewoman, would surely have been called hysterical; but as the patient was a laboring man, who lost his voice after a hard day's work, and regained it after a night's rest, and the aid of eight pints of porter, I presume the term will be considered inappropriate. The following histories relate to patients who have been recently under my care in the hospital, and about each of whom I have felt more or less doubt for some time, whether they were fit subjects for treatment by drugs. Yet, as the event has proved they were, the details are worth your attention, for you are certain to meet with similar cases yourselves.

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Pleurodynia: Aphonia: Neuralgia of Head: History of Malarious disorder: Tonic treatment: great improvement.

"E. A., a female, æt. 38, single, admitted February 16th, 1867. Tall, slight, hair quite grey. Has been ill one month; had first swelling of right knee, after that she got bad cough and pain in left side, which she has had a week. On admission she presented all the signs of a highly marked neurotic diathesis, tremor of the eyelids, aphonia, and panting hurried respiration; skin cool; pulse weak. Careful examination of the left side detected nothing morbid, the air was heard entering the lung fully without rale or friction. I was averse to taking

her in, as I feared she would prove an unsatisfactory patient, but was overruled. Liq. opii. sed., 10 min., was injected subcutaneously into the left side, and she was ordered potassi iodidi, 2 gr., ammonia carb. 4 gr., tr. valerian, 1 drachm, inf. valerian, 1 oz. ter die; linim. bellad. lateri; port wine, 4 oz. "18th.-Is much the same; has a most woe-begone nervous aspect; not suggestive to me of real suffering; face flushed; voice very whispering, but easily audible.

"March 6th.-Has regained her voice; is sitting up; has been faradized once or twice. Called out sufficiently loud to be heard across the ward this morning on being told that if she did the faradization should not be employed.

"9th.-Suffered very much yesterday from neuralgia in the head, confined to the right half of the head and face; speaks audibly; asks for iron and quinine, which always does her good. Ferri et quinæ citratis, 10 gr., spt. æth. chlor. 15 min., aq. 1 oz. ter die.

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12th.-Is better; gets stronger; the neuralgia is nothing like so bad as it was. She always has it, more or less. She gave the following history of her previous illness-Her hair turned grey at the age of seventeen, or rather began to, before this time she had typhoid, followed by rheumatic fever. Of late years has suffered much from low fever; had it much last night; her tongue was quite parched. In these attacks of low fever her skin gets very hot and rough, and afterwards she perspires a great deal; they make her very weak. They occur on and off all the year round. She was at Blackheath when the low fever commenced; lived there fifteen years. In 1851, while at Blackheath, she had so-called congestion of the brain; used to be light-headed every other day for a week, and then had low fever for nearly three months after. Is always better when taking iron and quinine; she always resorts to it as long as she can afford to purchase it. Cod liver oil has also done her a great deal of good. She went out about a week after, very fairly well; her voice was rather weak, but not more so than that of many persons; her neuralgia was in its usual amount. I have omitted to mention that during the first week or ten days of her stay in the hospital, she lay continually or almost continually, in bed half asleep. Subsequently she had no unusual drowsiness. I believe in thus yielding to her desire for repose, she took the best means for enabling her exhausted nervous system to recover strength. The aphonia in this female was plainly the so-called hysterical. But was it owing to want of will, or want of power? Some may think that the fact of her finding her voice under the stimulus of the wish to

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escape the faradization, is sufficient proof that her will was defective. I do not think that admitting this motive to have had some effect, she is thereby, in any degree, convicted of malingering any more than any of us would be who declined to move when we were very tired, but nevertheless started up and ran out of the house on hearing a cry of fire. There is no question (unless we disbelieve her tale altogether) that she had suffered for a very considerable time from a most wearying and enfeebling malady, chronic, obscure, remittent fever, with its attendant neuralgia, and that she improved very materially under an appropriate treatment. She had a bodily disorder, which was amended by physical agents, and I think it would have been sheer cruelty to have pronounced her a malingerer, and refused her the restorative remedies, which she herself asked for, from former experience of their good effects. I have recorded the case just as I took the notes at the time, and I am free to confess that my opinion of her was much modified, as I came to know more of her story. In another case, apparently very similar, faradization had no good effect whatever. The patient struggled a great deal, but I could not get her to utter a sound, and when it was repeated subsequently, she refused to attend any more. Here, I do not doubt, defect of will and not of strength was the real hindrance."

Commenting on these and other cases, Dr. Jones says:

"Lastly, all men of experience must agree, that not unfrequently all the manifold phases of hysterical disorder are more or less wilfully, and of set purpose simulated. Abundant instances of this kind are on record, and we have certainly only ourselves to blame, if forewarned we are not forearmed. Let me remark, however, how the old adage, that naturam morborum remedia ostendunt,' is verified here. The success of such moral treatment, as Mr. Carter has so excellently described in his work, and carried out in practice, proves absolutely that the disorder in such instances is not of material origin; while vice versâ, I may fairly argue that where drugs and ordinary hygiene avail without moral treatment, the body is much more at fault than the mind.

"But you will ask me how are we to distinguish the one class of cases from the other, how are we to recognize those whose disorder is chiefly physical, and those in whom it is mental. In some instances there is no difficulty, and in others it is no easy task. You must look to the patient's history, you must try to ascertain under what circumstances the disorder has come on. You must note whether she has suffered in mind or

body, whether she has been depressed by prolonged anxiety, grief, care, or any other mental trouble. You must inquire whether she has been debilitated by menorrhagia, hæmorrhoids, over nursing, some recent acute illness, malarious influence; whether there is reason to think that a toxic condition of blood, such as gouty, or some remote irritation, intestinal, uterine, or ovarian, may be vexing and depressing the nervous system. You must note whether she can take thought for others, or whether she is utterly selfish and absorbed in her own troubles. You must observe whether she has an ear for the call of duty, or only for that of pleasure. You must not be too harsh in your judgment even when circumstances may look rather suspicious, especially when you are dealing with the over-strained and over-worked, whether in high or low station. Remember that sympathy under suffering is naturally and lawfully desired by us all, and that it may be hard for you to appreciate the amount of distress which another may be enduring. The Psalmist, writing prophetically of the purest and noblest that wore human form, makes him say, 'I looked for some to have pity (margin, to lament with me), but there was no man, and for comforters, but I found none.' If He, the sinless one, felt this need, much more may we.

"So long as the desire does not warp the moral sense, and lead to downright selfishness, or wilful deception, we should lean in our judgment to the side of charity. But when once this limit is passed, and we feel that the patient is no longer trustworthy, we may and ought to suspend medicine, for otherwise we become, as Mr. Carter tells us, most helpful accomplices in her impostures. The most difficult cases are those (and they are far from being infrequent), where there is unquestionably bodily disorder as well as mental, and it is a hard matter to discover whether the latter is or is not (as it surely may be), dependent on the former. Here we must watchfully observe the effect of physical and moral agencies, and according as the one or the other avail, must we frame our judgment of the individual case.

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"I conclude this lecture with the earnest counsel that you will not allow yourselves to call all cases of obscure and anomalous nerve disorder, hysterical. The term is unquestionably often used to denote unreal, imaginary, self-produced, or encouraged illness, and to such cases I would have it restricted. Other more frequent cases would be better designated as neurolytic, an epithet which I proposed many years ago, and which has the advantage of expressing a fact, without affirming anything as to its causation. I may add that you will find

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in a little work recently published by Dr. de Berdt Hovell, views which go still further in some respects than mine.". Medical Press and Circular.

Hydrophobia: its History, Pathology, and Treatment.-Dr. T. C. Shinkwin, at the late meeting of the British Medical Association, read a paper on this subject, of which the following is an extract:

"An inquiry into the antiquity of a disease naturally necessitated, first, the question, at what period the disease took its origin. With regard to hydrophobia, we might come to the conclusion, from the facts to be laid before the meeting, that dogs and wolves have from time immemorial become mad, and that man has always been one of the recipients of the disease. Another question to be considered was, When was this disease first recognized? It was most undoubtedly known in the time of Socrates; for, on referring to Hutchinson's Xenophon's Anabasis, lib. v. p. 409, Cantab. 1785, we find: They did no injury, but feared lest a sort of madness had seized us as if dogs.' From these and other reasons, it appeared that canine madness was known to occur in animals four hundred years before Christ. The third question was, When was this disease known to affect the human species? Democritus, who lived about the period above mentioned, described the treatment and seat of hydrophobia; for he says, Ait enim hydrophobiam esse incendium nervorum;' and even enters on the treatment of this disease. The next question was, What animals were capable of propagating the disease to man or to other animals? Can this disease, after being communicated to man, be transferred by him to his fellow-man or to the lower animals? Is it possible for this disease to result from the human subject or animal who is not laboring under this affection? Has geographical position or time of year, etc., any effect on this disease? What are the causes of hydrophobia? A poison placed in a wound made by an enraged animal. Some author supposed it to come on from terror; and others again supposed it to be a form of tetanus. But it was, he believed, a totally distinct disease. As for the symptoms of it, fortunately, there was not much opportunity for observing them. The Association was referred to the symptoms in detail of 120 cases. There appeared to Dr. Shinkwin to be two periods in this disease, that of incubation, and the period of development. As to the pathology of this disease, the author confessed that none of the autopsies made, threw much light on 15

VOL. II.