at last sent here. On admission she was markedly depressed, and the mental working of her brain was enfeebled in such way that she would begin a sentence in answer to a question, and would stop in the middle, her volitional power having run short apparently. She rambled in speech and mistook the identity of persons round her. She had the delusion that she

was to be burned at the stake. She was thin, pale, muscularly feeble, lacking in energy, with blunted sensibility. Her special senses were blunted, pulse small and weak, temperature 98-8". After admission she was sleepless, restless, and acutely excited for a week. Then she became more quiet, with short intervals of almost sanity, but with impulsive action. Sitting quietly sewing in a room with others, she would suddenly drop on her knees and pray aloud. Was put on extra diet, with porter and quinine and iron. She always got worse and more delusions in the evening, this fact probably indicating that by that time her brain power was getting exhausted. But she steadily picked up in flesh and strength, mental and bodily, and in ten months was discharged almost recovered, having gained 24 lbs. in weight, and looking fresh and healthy. What will happen if she has more children, and nurses each of them fifteen months, can easily be conjectured.

The treatment of lactational insanity is simple and physiologi cal. Stop the nursing, give nourishment in abundance with some malt liquor, change the scene, free the patient from family cares for a time, give quinine, iron, cod-liver oil, and tonics generally. The suicidal tendency must be thought of and guarded against if present, as it is in a very large proportion of the cases.

A survey of my nine years' clinical experience in the Royal Edinburgh Asylum, 1874-82, in regard to lactational insanity is instructive. We have had altogether fifty-two cases that I classified as lactational. But some of these were old cases of the disease transferred from other asylums, or readmitted, and these I shall take no notice of. Their study would lead to no good clinical results, and would merely tend to confusion. Forty of the cases were admitted labouring under recent lactational insanity, and of

these only I shall speak. As classified on admission, twenty-one of these were cases of mania and nineteen of them of melancholia. Only about half of these twenty-one cases of mania had mental exaltation as their predominant feature throughout their whole course, the others beginning with marked melancholic symptoms or ending with them. But the fact that half the cases were maniacal during their most acute period shows that the insanity of lactation is by no means exclusively a melancholic form of mental disease. It shows that bodily and nervous exhaustion and malnutrition, though their first mental symptoms may be mental depression, yet tend in a large number of cases towards morbid mental exaltation in the long run, mania being in fact another and a further stage of the convolutional brain disturbance. When classified according to the acuteness or mildness of their symptoms, independently of psychical exaltation or depression, I find there were twenty-two acute cases and eighteen mild ones, the majority (eighteen) of the acute cases being maniacal, and a majority (thirteen) of the mild cases being melancholic.

As regards the months of nursing in which the disease occurred, my records do not state this point in seventeen, but of the remaining no less than ten occurred within the first three months, seven in the next three, four in the next three, and only two in the last three months. I confess I was surprised at this. It is a different result from that arrived at by Dr Batty Tuke from an examination into the statistics of fifty-four cases of the insanity of lactation that had been in this asylum previous to May 1865. Only two of his cases occurred within the third month, and only eight within the first six months of nursing, while twenty-one cases, or 51 per cent. of those in whom the period was recorded, occurred after the ninth month of nursing, my percentage for the same period being nine. Such a diversity of results is enough to make one despair of the value of looking at clinical facts in a statistical form. My statistics distinctly point to the causation of this form of mental disease being largely due to the disturbance of the puerperal period aggravated by the reflex excitation

of the brain through the physiological act of suckling the infants. Dr Tuke's statistics clearly point to a preponderating causation by the exhaustion of mere long-continued nursing Both causes operate I have no doubt, but why they should hav operated so differently in the cases in the same asylum at different periods I am unable to explain. My records were so deficiert in regard to which nursing the disease occurred in as to be worthless. They merely show that lactational insanity may occur after the first child or the seventh. The suicidal in pulse is common, seventeen of the forty having had it in greater or less intensity. The temperature shows a very marked differenc from the puerperal form of insanity. A glance at the highest tem perature shows that only about one-third of the cases (thirteen) were over the normal standard, and of these, the great majority (eight) were only between 99° and 100°. Three were betwee 100° and 101°, leaving only two that were over that, in one of whom it was caused by an inflamed breast. The temperatur record shows clearly the milder type of lactational insanity as compared with the puerperal form. The thermometer, though the readings seldom reach very high in uncomplicated mental disease, yet I look on as being simply invaluable as showing the intensity of the brain action. Its readings upwards, from normal to 102° or 103°, are usually in the exact ratio to the intensity of the mental disease. Only, it must be remembered. that half a degree in the estimation of the intensity of brain overaction is equivalent to two degrees in the measurement t febrile disturbance. I attach especial importance to the realings of the thermometer in all acute mental diseases, and have used it in every case under my care in the Carlisle and Royal Edinburgh Asylums for the past sixteen years.

Heredity to insanity was known to be present in fifteen of the cases; but then in twelve of the forty no reliable informa

tion on this point could be got. And as proximate causes, mental and moral disturbances occurred in nine of the cases.

Let us look now at the results of treatment, that most interesting of all questions to the physician, and still more so to the relatives of the patients. Thirty-one of the forty cases recovered, and three more were removed from the asylum uncured but improving. This is 77 per cent. of actual recoveries, and a still higher figure of potential restorations to mental health. The lactational cases recovered in slightly larger numbers therefore than the puerperal cases, and only one case of the forty died. I find that the maniacal and the melancholic, the acute and the mild cases recovered in somewhat equal proportions. The six who did not get better, but are still under treatment, were three of them patients who had repeated attacks of insanity before, the other three looking phthisical. The lactational cases did not recover so soon as the puerperal. Only sixteen recovered within three months, but twenty-five, or 62 per cent. of all the cases, and 80 per cent. of the recoveries, recovered within six months, and all of them within eighteen months. And they made good and lasting recoveries, few of them relapsing. Recovery in all the patients was accompanied by a great increase in body weight, in strength, in appetite, and in fatness. In some menstruation continued during the disease, and in its earlier stages acted as an excitant and exhaustion of strength. It was often menorrhagic in such cases. The function when absent usually returned of itself without any special treatment as the nutrition improved.

One instructive fact I came across in relation to this disease.

1 Of the twenty-one cases of mania fifteen recovered; of the nineteen cases of melancholia sixteen recovered; of the twenty-two acute cases fifteen recovered; and of the eighteen mild cases sixteen recovered.

* Within 1 month 6 cases recovered. Within 7 months 1 case recovered.

Out of 166 admissions of ladies to our higher class departments there were only two lactational cases, while there were among them the usual proportion of puerperal cases. Out of 1383 pauper and poorer private female patients, there were thirtyeight lactational cases. In short, the puerperal cases wen sent for hospital treatment in as great a proportion among the rich as the poor, while the lactational cases were only sent in half that proportion. This points clearly to the greater mildness of type of the latter, and the possibility of treating it at home, if not to the greater infrequency of the disease among the well-fed classes, who have nurses to attend their childrer and doctors to tell them when to stop nursing in time. Probably the custom among the poor of nursing each child a long time in order to delay the conception of the next has some thing to do with the greater prevalence of this form of mental disease among them.

THE INSANITY OF PREGNANCY.

Few women carry a child without being influenced mentally thereby in some way or other. The psychology of pregnancy has yet to be written in a scientific way. There are innumer able facts on record, but they are scattered and undigested. Without going into the domain of mental disease in any technical sense, we find examples of partial mental exaltation, mental depression, mental enfeeblement, mental paralysis, and mental perversion. No doubt the alterations are chiefly in the affective faculties, but the reasoning power, the moral sense, the volitional power, the imagination, and even the memory, are often enough affected in pregnant women. As a part of the nervous disturbance the bodily appetites become changed, the physiological functions altered, and the nutrition of organs profoundly affected. In this state many women have endless caprices, unfounded dislikes and likings, cravings for foods and drinks never before desired, unnatural desires for indigestible things,