of the uterus, from which probably radiated the whole of the phenomena of the hysterical attack.

With regard to the treatment of the hysterical passion, some of the cases require therapeutical treatment, and some not: a patient may be brought to herself by letting her alone and leaving her alone; but in the wild and confused operations of the nervous and sanguine systems, with the impetuous force of the blood observed in some of the cases, there may be danger for some of the great vital organs. I have seen a case of pure hysteria resulting in coma, which terminated in the death of the patient, probably from sanguine extravasation in the encephalon. I believe that whenever the momentum of the blood is increased to a dangerous violence, by whatever cause, that danger ought to be obviated by the means best calculated immediately to reduce it within safe bounds. A simple antispasmodic medication will not do in these cases; and I think you will not do your duty to the patient, under the circumstances, unless by means of venesection you take away from the brain and the heart, the material power to excite, and to stimulate. You will diminish the production of neurosity by diminishing the intensity of the contact of the oxygenated blood with the neurine. It is a very common opinion, that in the nervous affections we do wrong if we take blood; and persons who dive not beyond the surface of things, for the most part hold to the opinion that you ought not to let blood except there be some inflammatory condition of organs, requiring that special therapia. I hope you will lay it to heart that a mere, simple, sanguine engorgement, the beginning of which has no connection with any inflammatory condition, or propensity, may speedily terminate in the ruin of the patient by allowing of effusions or extravasations, and that such propensities as clearly demand the use of venesection, as the most active and clearly marked inflammations. It is not true in fact that spasmodic, nervous, vaporous, hysterical disorders, neuropathias, require to be treated solely upon the principles of the antispasmodic medication, and he who adopts such sentiments, no matter by what school or by what authority they are instilled into his mind, thereby virtually ties up his hands in a thousand and a thousand instances, in which a perfect freedom from the bonds of such a prejudice, would render him a powerful and efficient practitioner of his art.

If you should decide upon bleeding in any case of hysteria,

you may, after the abstraction of blood, concentrate the confused, heterogeneous, disturbed perceptions upon a point, or points of the skin, by violent frictions, and slapping of the hands, or lower extremities; by hot, sinapised pediluvia, by mustard cataplasms, by Granville's lotion, by the powerfully concentrating sensation produced by the dry cup, especially if applied to the nucha, and on the interscapular region; after which you may avail yourself of the antispasmodic therapeutical power, which you can find in the assafetida, in the fetid gums, in castor, or in musk, or perhaps more than all in valerian, more particularly in the beautiful extract now prepared by means of ether. The inhalation of ether in this stage of the malady will be a safe and useful resource. I mean not the inhalation of ether to the extent of what is called etherization, and I advise you to make no appeal to such a power, since,-in the disordered and heterologue operations of the hemispheres, and of the tubercula quadrigemina, of the cerebellum, of the spinal cord, and of what is always a deep participant in the hysterical manifestation, I mean the medulla oblongata, and the vagus-no man ought to arrogate to himself the right to plunge these organs into the temporary annihilation of etherization; because, the co-ordination of their actions. being destroyed in the hysterical paroxysm, there may be no regular succession in the influences of the ether upon the several parts of the brain. In that regular succession, the part that last yields is the medulla oblongata; what, if in this heterologue condition of the brain, it should be the first to yield? It is the source of the respiratory power; when it ceases to act, the respiration ceases; and is not a woman dead when the breath is out of her?

I presume that there is not among the whole armamentarium medicum, an article possessing the exclusive properties of an antispasmodic so perfectly as valerian; and I beg you again to take an early opportunity of reading Prof. Trousseau's remarks upon it, in his article on antispasmodic medication in his therapeutics. If you should resolve, in your cases of hysterical spasm and excitement, upon its use, I advise you to administer it as the fluid extract just before mentioned; or, if that be not conveniently attainable, to give it in substance reduced to fine powder.

A large teaspoonful of the fluid extract in a wineglassful of sweetened water, is a good dose, which may be frequently repeated; or, a drachm of freshly powdered valerian root highly

fragrant, may be divided into four powders; of which, one is suitable for a dose. Mix it in half a tumbler of fresh water, and make the patient drink it. Don't tell me that she can't drink it, or won't drink it; or that her jaws are set, and you can't make her swallow it. Her jaws will never be set so tight but that you can open them. How? Take two bits of ice, each as big as an egg; wrap each of them up in the corner of a napkin; then press the cold napkin against her masseter muscles on each side. As a general rule, the cold contact will scarcely be made before the masseter relaxes. But, suppose you find a case in which it won't relax; then, get the end of a spoon between her jaws, open them a little with this, and then substitute the end of a tooth-brush handle, now pour the liquid into her mouth: do you say she won't swallow it? I reply she will swallow it, if with the end of the spoon handle you separate the base of her tongue from the velum pendulum palati, which will allow the mixture to get beyond the isthmus faucium, and when there, the œsophagus will transmit it to the stomach.

Anybody can swallow; I was almost ready to say, you could make a dead man swallow. I beg you never to say of your patient, he is past swallowing,-unless he be laboring under a paralysis of the pharynx and œsophagus; but you may practice for forty years, and never meet a case.

But to return, if the patient does swallow the powder, you will probably witness a very speedy diminution of all the spasmodic innervation, and a return of the constitution to a state of the profoundest calm.

Some time ago, I was summoned, in a hurry, to see a beautiful little chilu seized with most intense convulsions, brought on by her ingesta; among the attendants was a faithful nurse, who had lived a long time in the family-a highly hysterical and nervous individual. Having been very much excited and alarmed, on account of the condition of her little favorite, she went into an adjoining apartment, where she fell into a most violent fit of hysteria. My attention being called to her, I wrote a prescription for half a drachm of powdered valerian, which was immediately brought to me, and I said to a young lady, standing near, "Please to mix the powder in half a tumbler of water, and bring it to me, and, with it, a tablespoon, and I'll show you something very curious. Now, see here," said I,-"here is this woman,

whose mind, for the time, is abolished, and her body is, as you see, tortured by these violent spasms; now, I'm going to make her swallow fifteen grains of the powdered root of valerian, and do you look on, to observe what strange powers are possessed by certain medicinal articles over the human body. You shall see that, in about fifteen minutes, this great storm shall become a great calm." The woman could not swallow, but I made her swallow the fifteen grains. "Now,”—said I,-"look at her." In two or three minutes, her spasms became less, and in a quarter of an hour, she was perfectly well. "Now, what do you think of that, my dear?" said I. "I don't know what to think of it, doctor, but it surprises me very much."

I have said nothing about opium; what need have I to mention the name of opium in connection with such circumstances? It commends itself, by its very name, in all such cases; provided that you can render yourself sure, that there is not connected with the paroxysmal manifestations, some element of meningitis, or cerebritis, which you have not deprived of its mischievous nature, by the salutary interposition of your lancet.

With regard to the treatment of persons in the intervals of the hysterical paroxysms, to which they are liable, I should be guilty of the fault of iteration, were I to say much upon that subject, since I have so clearly expressed the conviction of my mind, that hysteria is truly hysteria, and not merely nervous sur-excitation. But, if hysteria be truly hysteria, it follows that, in the intrahysterical periods, you should address your inquiries and your remedies to the condition of the reproductive organs, and those morbid states which are the "ipsissima causa morbi."

But I have spoken so much at length, in these letters, upon these morbid conditions, that I shall here close the present one, referring you to many of the antecedent pages of this volume.

C. D. M.

LETTER XXXVII.

GENTLEMEN :—The change in the condition of the reproductive organs brought about by pregnancy, is too great to fail, in the majority of instances, to produce phenomena approaching perhaps to the nature of disease.

It is necessary that the physician should render himself familiar with these phenomena. The pregnant state, in fact, is one full of interest to the medical student or the practitioner of physic. I feel it a duty, therefore, to say in these letters something to you of the state of pregnancy, and the maladies and the inconveniences with which it is accompanied.

The fecundated germ, in attaching itself to the lining surface of the uterus, may affix itself to any part of the internal superficies of that organ. I say the fecundated germ, because I wish to express the opinion, that the germ may become fecundated without being followed by pregnancy. The germ is fecundated by the contact of the male sexual element, which imparts to it the power to develop the organisms, and the whole nature of the animal in question. But pregnancy cannot be deemed to take place, until the germ has established a mesenteric connection with the living surface of the mother. When, then, the mesenteric attachment takes place, the woman has conceived. Doubtless, thousands and millions of germs become fecundated, but which never form mesenteric attachments, and are consequently lost; the womb is only pregnant when the mesenteric attachment is made. No matter where this mesenteric attachment is, the woman is pregnant when it is made. It may be effected in some part of the tractus of the Fallopian tube; or it may be made upon the surface of the ovary, the ovary being covered at the time by the fimbria of the tube. If the porule of the Graafian cell have been formed, and the male sexual element have been translated through the channel of the tube, and come in contact with the exposed ovule, still contained within the Graafian crypt, the ovule may be there fecundated, and may form its mesenteric attachment within the crypt, and then you will have an ovarian pregnancy, and there