marked and immediate as in J. R.'s case. It will be observed that some amount of improvement took place in her mental state as the bodily nutrition improved before menstruation returned.

The melancholic cases, of which this of J. R. is the type, nearly all recover, in my experience. Out of twenty of very typical form which we have had in the Royal Asylum in the past nine years, eighteen have recovered.

About one-third of the amenorrhoeal cases were maniacal, with no melancholic tendency. Such cases were by no means so clearly connected with the absent menstruation as even the melancholic ones, nor did they show the same tendency to recover in mind coincidently with its restoration. In fact, I was by no means so sure of the same kind of direct connection between the amenorrhoea and the mental symptoms in most of them as in the melancholic cases.

It is commonly supposed that the sudden suppression of menstruation in a young, full-blooded, healthy woman of nervous heredity, through chill or shock, is very liable to cause an outburst of acute delirious mania. Some authors speak of this as if it were one of the common causes of insanity. No doubt it occurs, but I have not met with more than two cases in all my experience. One was that of J. S., a girl of 18, stout, florid, and healthy, who got wet through and chilled while. menstruating. The flow suddenly stopped, and at once a fearful headache came on, with maniacal delirium, a temperature of 103°, sleeplessness, and very great violence. A hot bath, with cold to the head, and with enormous doses of bromide of potassium, borax, and ammoniated tincture of valerian, frequently repeated, had the effect of diminishing the delirium and reducing the temperature. A condition of semi-stupor and confusion, inactivity and listlessness succeeded, and lasted for two months, when the usual mental health was regained, but it was several months before menstruation was restored. I would say that stupor is a more common mental result of suppressed menstruation in young women with a nervous heredity than acute mania.

OVARIAN INSANITY ("OLD MAID'S INSANITY”).

There is a somewhat ludicrous form of insanity that Dr Skae called "Ovarian," or more familiarly and more correctly, I think, "Old Maid's Insanity." There is really no definite proof that the ovaries are either disturbed in function or diseased in structure in those cases, but it consists no doubt of a morbid transformation of the normal affectiveness of woman towards

the opposite sex. The disease usually occurs in unprepossess ing old maids, often of a religious life, who have been severely virtuous in thought, word, and deed, and on whom nature, just before the climacteric, takes revenge for too severe a repression of all the manifestations of sex, by arousing a grotesque and baseless passion for some casual acquaintance of the other sex whom the victim believes to be deeply in love with her, dying to marry her, or aflame with sexual passion towards her, or who has actually ravished her after having given her chloroform. Usually her clergyman is the subject of this false belief. Out of ten such cases which I can recall, seven have had clergymen as their supposed wooers or seducers. In no case was there the very slightest possible ground for the notion. In two cases the ladies had never even spoken to their supposed lovers. Certain gestures, or, as in one case, the contents of the agony columns of the newspapers, were sufficient proofs to them of their beliefs. The annoyance to which unfortunate men are subjected in this way is often extreme. Lately a lady, J. T., now a patient of mine, went to a grocer's shop and ordered her supply of groceries in the name of a clerical acquaintance, saying she was his wife, telling the shopman to send the bill to him, and this as the culmination of a series of weekly letters to him of forty pages each. I have known grave accusations made to ecclesiastical authorities, and the beginnings of most injurious famas started by such insane women. Such patients are all of them between 35 and 43, and the reverse of sensuous in appearance. Some of them were most estimable ladies, whom it was impossible not to pity, the whole

thing was so contrary to the tenor of their lives, and so like a trick played on that higher being which they had always cultivated, by a lower and more animal nature which they had sedulously repressed. None of them recovered from this sort of delusion, but in two of the cases, as they passed into the senile period, and after the climacteric, the notion became so theoretical that they almost ceased to allude to it.

HYSTERICAL INSANITY.

That form of mental disease which is complicated with some of the protean symptoms of hysteria should really be called ovarian insanity, if that name were used in any correct sense, for there is but little doubt that undue excitation or disturbance of the functions of the ovaries has more to do with hysteria than anything else. But perhaps it is more convenient to retain the name of hysterical insanity. Typical hysteria, pure and simple, always has a mental complication. The volition, or the feelings, or the morals, are always affected along with the purely bodily symptoms. But these mental symptoms, not forming the chief features of the disease, or not being of such a nature as to make the patient irresponsible or unmanageable, are not reckoned as being of the nature of technical insanity, at least among the rich. Among the poor, with no one to look after them, hysterical young women are often enough sent to asylums. And I have seen most admirable results from this. The principles of asylum life and treatment are the very best principles of treatment for hysteria too. To put the patient under control, to give her no harmful sympathy, to make her work and walk out regularly, to improve her bodily health, are always very good for a hysterical girl. We have had three cases of almost typical hystero-epilepsy, with a suicidal tendency in two of them, and general unmanageability at home in the third, in addition to the purely motor and other symptoms, sent to this asylum within the past few years, and I have not seen or heard of any home or

hospital treatment so effective as the asylum treatment proved to be in these girls. But such patients are rare in asylums. The usual type of case classified as hysterical insanity consists of mania or melancholia in a young woman with one or more of the following characteristics well marked, viz., a morbid ostentation of sexual and uterine symptoms, feigned bodily illness to attract attention and secure sympathy, marked erotic symptoms cloaked by something else, a morbid concentration of mind on the performance of the female functions, semi-volitional retention of urine, hysterical convulsions, a morbid waywardness, ostentations and unreal attempts at suicide. The fasting girls, the girls with stigmata, those who see visions of the Saviour and the sains and receive special messages in that way, the girls who give birth to mice and frogs, and those who live on lime and hair, are all cases of this disease.

Hysterical symptoms are exceedingly apt to occur in the insanities of puberty and adolescence, and along with the symptoms the habit of masturbation is common. It is some times difficult, therefore, to know whether to classify such cases as adolescent, hysterical, or masturbational insanity. All one can do is to ascertain if the hysterical symptoms are the m marked and prominent features of the case before we call it hysterical insanity.

The following case of hysterical insanity fairly illustrates the general features of the disease.

J. U., æt. 21, of a nervous and excitable temperament; habits correct. An aunt epileptic. Had on one occasion at home a mild attack of what must have been subacute mania excitement. The cause of the present attack, which has laste for four days, was a fright which first produced onlinar hysterical symptoms, and then maniacal symptoms engrafted on them. She shouted and screamed, spoke of hearing G speaking to her, and would rush to the window to jump She imagined she was a most important person, attitudinis

1 Two of these are recorded by Mr T. Inglis in the Edinburgh Meis Journal, December 1878.

and did everything to attract attention to herself. Attention and sympathy were craved by her, and if she could not get them in one way she tried another. She refused her food, saying it was poisoned, but took it rather than be fed with the stomachpump. She had menorrhagia, and was most minute and circumstantial in the details as to her female health. She was tried with hyposcyamine, valerian, and mono-bromide of camphor with apparent benefit; but I considered the greatest improvement was produced in her case by discipline, work, open-air exercise, tonics, and good plain food in abundance. She improved at first, and once or twice relapsed, but in two months she recovered and was discharged. I do not like to keep hysterical cases too long in the asylum after convalesence as a general rule, for they sometimes get too fond of the place, preferring the dances, amusements, and general liveliness of asylum life, even with its restrictions, to the humdrum and hard work of poor homes.

The following very characteristic letter of a maniacal hysterical girl, J. V., very well illustrates the trains of thought in such a

case:

"MY DEAR MAMMA.-It is time that I leave to return home. I have been tremendously changed for the better. I think papa will be able to get me a commission under Garibaldi before long. There are three to whom I am especially indebted-one Mr C., the modeller, the other the doctor, a Eunuch, who modelled me at the fire, and attended on me and bathed me. He is I am sure a gentleman, a splendid doctor. Could not papa get him into a regiment abroad? And there is the nurse. Could not papa get him any situation away from Morningside Asylum where I am at present? I should like papa to come for me as soon as possible. Do you remember the verse, "There are," &c. (12th verse 19th chapter of Matthew). About Eunuchs? Then I beg to inform you that according to Scripture and my conscience, Jessy, your cook, is a man; and Janet, the mad devil is a man; and D. and H., boys who can have children. Aunt I. is a man, and yourself also, both made of men, and I am a boy, made of Dr C. and Dr Z. Mrs T. is a man, made of men. They are very ignorant on this subject here; but as for me it is certain that at least

1 "Morisonian Lectures" for 1873, by Drs Skae and Clouston, Journal of Mental Science, vol. xix. p. 500.