patient was attacked by carcinomatous degeneration of the uterus, I have, on further exploration and diagnosis, been led to the institution of attempts to cure, which have been entirely successful.

I repeat to you here what I have said in a former letter, that I do not boast of curing cancer, but in the course of many years of clinical experience, I have met with many extraordinary escapes from what I believed to be carcinoma, but in which I had doubtless made a false diagnostic.

I shall not trouble you with further observations in this letter on the precise treatment of these cases, but refer you to the earlier letters of this volume for the principles and the treatment which you should adopt in their management-it would be but useless iteration to speak of them again here.

And now, my young friends, comes the question, as to the time. when the change of life takes place. As a general rule, it is safe to adopt a public opinion, though it may not be absolutely true that vox populi is vox Dei.

That public opinion holds that the change of life takes place at forty-five years, and all our women look for the change at that time; but all our women do not change at that time; some women definitively lose their menstrua at thirty, and some even earlier. A lady with whom I conversed in March, 1844, told me that she became perfectly regular when she was twelve and a half years old; she bore twelve children; at thirty-five she definitively ceased to menstruate, and in her whole life never had the least trouble with her menstrua; she was as well at its cessation and since as she ever was. She was upwards of 40 years of age.

I have a patient now under my care, who at the age of 73 years, is as regular as a young girl, and has been so since an early age. Allow me to cite for you a passage from M. Brierre de Boismont, p. 209.

"It has been said in a general way, that the cessation of the menstrua takes place about the forty-fifth year in this country,a little sooner or a little later:-the fact is true, but we believe that a better appreciation would be made by presenting a table indicating the different periods of the critical age; we have here collected one hundred and eighty-one cases of women indicating the age at which they had ceased to see, and here are the results.

This informs us that the cessation of menstruation may take place at very different periods of life, since here we have cases showing that it may take place in years, varying from sixty to twenty-one. But the proportions at which it occurs at these several ages are very different, for, while it rarely happens in the young, it happens very frequently about the fortieth year, is very common about the age of fifty, at which time it sensibly diminishes, and in the last years of the table it follows the proportions observed in the early years.

I will not trouble you with any further statistical details on this point, which I consider as useless, preferring to refer you to the voice of public opinion, which, you perceive by this table, coincides with the truth.

You should be careful, in your early wants as to clinical experience, not to take every assertion as the truth. A young Doctor would do well to adopt as his motto, the new-fangled French word Panoptism, which, to translate in an expression very common in America, would be set down in the words "wide awake." You are not to take it for granted, because a woman thinks that she has arrived at a critical age, that she is at the crisis; you and not the patient, are to be the judge. If she be in the crisis, it is well, and you will act accordingly; you will not pester her with your vain emmenagogue treatment; if she be not in the crisis, you will provide such ordinances as may seem to be conformable to the requirements of the case.

C. D. M.

LETTER XXXVI.

GENTLEMEN:-There is a disease called the Protean malady, because it simulates so many other disorders, that, like the fabled Proteus, it is assumed to be capable of taking on all forms. In common language, it is called Hysteria, from vorpa, the womb. The ancients used to call it suffocation of the womb, suffocatio matricis, and præfocatio matricis. It has been called яuš voteρizy, and also arvous arroa; the rising of the mother; and an Irish girl who came to our clinique, in 1843, as some of you may remember, replied, in answer to my question as to what ailed her, "The winding arrow, sir." "The what?" said I. "The winding arrow," rejoined her mother. "The winding arrow? I don't understand you," said I. "Why, it begins at the bottom of her stomach, sir, and it goes winding up along the course of her bowels until it gets to her throat, and then it chokes her, and she has a fit." So, we'll put down among other titles of hysteria, if you please, Irlandice, the winding arrow.

The question that first presents itself, after pronouncing the word hysteria, and when a person has already some knowledge of the phenomena of the disease, is this, videlicet, is it hysteria? that is to say, has the womb anything to do with it? and if the womb has anything to do with it, can a man, who has no womb at all, have hysteria? This is a question which has long divided the profession. Many authors of rare merit, and great powers of discrimination, averring, that it is a hysterical, that is to say, a womb malady; while others declare that it is wholly independent of the womb, and that males may have it as well as females. To reason this way, may be said to be a reasoning after the Baconian or inductive method, which is not always the best way to reason, since a rational method may, in many circumstances, lead to results as perfect, as clear, and as stable as those obtained by the most careful induction.

If hysteria depend upon the womb, then a man, who has no womb, cannot have hysteria; then, hysteria, you will say, cannot depend upon a disturbing force emanating from the womb alone.

We seem to have come to a term in speaking in this way; but we have not spoken the whole truth, because while hysteria may, in fact, proceed from the uterus, hysteria may, in fact, likewise attack the male. As to this point, I think there can be no doubt, since the medical records are full of testimony bearing upon it.

The medical writers who have asserted that hysteria proceeds from the womb or the reproductive organs, for which the word womb should be taken as a general expression,-have probably not understood themselves; doubtless they have intended to assert that, modifications of the reproductive power of creatures, which might be characterized as the aphrodisiac sense, or, if you will have it, the aphrodisiac force, are the causes of the protean, or the hysteric malady. I say they could not really mean to say that the uterus alone, disengaged from, and unconnected with, the other reproductive organs, is, by its disturbing force, the cause of the hysterical malady, for that organ itself is probably far less immediately connected with the development of the aphrodisiac force, in the economy of creatures, than certain other parts, as the ovaria or clitoris, for example. But, as the constitutional aphrodisiac force is an appurtenance of both sexes, then, if modifications of that force can produce that malady, they may be deemed equally capable of causing manifestations of the same phenomena in the male and in the female. To say, then, that an affection of the womb, as an organ, is capable of causing all the strange modifications of the innervative power, which are witnessed in hysteria, would be saying too much; but, the aphrodisiac power is, in some incognoscible manner, connected with a modality of the reproductive apparatus as a whole, it would not be traveling beyond the record to say so.

That force, you will not deny, is capable of influencing the whole physical, intellectual, and psychological nature of the subject of it; and, if even the conscience and the free-will must be admitted to be subject to morbid modifications, what hardness do you find in admitting, likewise, that morbid modifications of a power, so intense, so universal, so determinative of the whole constitution, might be capable of exhibiting itself in any or all the parts of the constitution in the strange and, so called, incomprehensible phenomena of the hysterical paroxysm?

I have already told you, in former letters, that very slight

modifications of the state of the womb, as to its level or its direction in the pelvis, may exert a disturbing force upon the economy of the female, and it has been the custom, for two or three centuries past, to assign to the uterus the power of dispensing an aura, which might be translated a vapor, or a halitûs,—which, pervading different organs of the body, draws them into diseased sympathy with the distressed womb itself. This term, aura, is probably at the foundation of the word so commonly used in speaking of the maladies of females, I mean the word vapors, for a nervous, fitful, wayward woman is said to have vapors,—which I have regarded as synonymous with hysteria,-so that a woman with vapors is a woman who suffers from an aura hysterica, an exhalation, a halitûs from the womb; but we have got too deep. into the nineteenth century, to entertain any further faith in the theory of vaporous exhalations from the organs, affecting other and distant organs.

Nevertheless, this word, aura, may be admitted to have some usefulness, as it has an important signification in medicine, and is a common parlance, for it refers to the sensible progress of an irritation from some ascertained point of the body, to some other point, as from the womb to the throat, where it produces a phenomenon, called globus, or, from a distant point on a nerve in the leg or arm to the brain, resulting in epilepsy, from the os uteri to the pylorus, or the breast, exciting vomiting, in the one case, and tumefaction or pain in the other; and, so from one organ to some other organ, calling its powers into sympathy with its own.

The dilatation of the cervix uteri in labor, is, by many persons, supposed to be the not unfrequent exciting cause of eclampsia, which it produces by disturbing the brain, excited beyond all tolerance by the pangs of the dilatation, which you might take as a strong example of the power of the aura hysterica.

Let me repeat that the rigorous meaning of the term aura, as aura epileptica, aura hysterica, etc., was, that a vapor, a halitûs, or an exhalation, arising from an organ, and proceeding to involve another organ within the scope of its influence, is the absolute cause of the morbid phenomena in the organ which is secondarily affected. Now this term does express the fact that the suffering condition of one part of the body is capable of calling into sympathy other and very distant parts. It might be better, perhaps, and more precise, to use the word sympathy to