be consensually excited by the sight or sound of the act in another, it may also be excited (at least in persons already predisposed to it by fatigue) by the very mention of the subject. The emotional actions are regarded by Dr. Carpenter as bearing the closest relation to the ideo-motor; but as distinguished from them by the association of sensorial pleasure or pain with the fundamental idea, and he thinks it one of the most characteristic peculiarities of the hysterical state, that pleasure is morbidly associated with many ideas which ordinarily excite pain. Thus the hysterical girl, though originally amiable and disinterested, derives a strange satisfaction from the sight of the anxiety, and even the distress, of her friends; and, though previously truthful, enjoys the idea of deceiving them.1

The greater energy and longer duration of all automatic acts, as compared with voluntary ones, may be used to distinguish between complications of the former kind, and those bearing some resemblance to them, which are purely simulative. Moreover, the latter are perfectly under command, both with regard to termination and commencement, but the former, in many cases, with regard to commencement only, because it would seem that every emotion generates a certain amount of force, and continues its operation until this amount is exhausted. This diagnosis is of some importance; for, although the object and intention of the

1 Dr. Carpenter's views on these subjects were first developed in the 'British and Foreign Medical Review,' vol. 22, p. 488; but they will be found fully expressed in his Human Physiology,' 4th edition, chap. xiv. The term ideo-motor, as expressive of the reflex action of the cerebrum, when uncontrolled by the will, was first employed by him in a lecture at the Royal Institution, in May, 1852.

patient is the same in either case, and is only carried into effect by different agencies, yet it will be seen hereafter, that exact knowledge of the methods pursued very much facilitates the conduct of treatment, and adds materially to the prospects of success.

The congestive complications of tertiary hysteria may be referred for the most part to that effect of attention which has been before alluded to, as working permanent changes in the circulation of organs brought under its influence, and their occurrence is farther due to the insalubrious and debilitating practices implied in the existence of the disease itself; which, by weakening the tone of the heart, and of the system generally, and by impoverishing the blood, tend to the production of local congestions of a passive or asthenic character. These often arise as the result of sedentary habits, even when there is no apparent circumstance to determine blood to any one part of the system in preference to others; and the liability to them is of course greatly increased, when such circumstances are in active and continual operation.

The methods by which attention can be fixed upon any individual organ are threefold; and depend, in the first place, upon its known subserviency to the kind of emotion which has been excited; in the second, upon sensations arising within itself; and in the third, upon the operation of external agencies, as from witnessing or hearing of the diseases and sufferings of others. The first kind of action can scarcely be exerted except upon the reproductive system, but the other two are not subject to any limitations.

The hysterical affections of the uterus and ovaria have always held a most prominent position among the

disorders under consideration, and from their frequency and variety have been, in all ages, looked upon as having some share in the causation of the associated conditions, an opinion which is certainly so far correct, that all the phenomena of secondary hysteria are frequently aggravated at each menstrual period. But reasons have been given in a former chapter, for believing that sensations connected with the catamenia act simply by the recall of emotions; and in every instance of this kind which the writer has been able to observe or hear of, menstruation has been a painful process, and therefore especially likely to exert such an influence. In one, the particulars of which were kindly furnished by Dr. Carpenter, and in which the periodical increase of severity was strongly marked, a very considerable degree of dysmenorrhoea existed independently of the hysteria, and was cured after its cessation, by gradual dilatation of the os uteri, the latter disease having first yielded to emotions counteracting those by which it was produced.

The female reproductive organs having a cause peculiar to themselves to make them the subjects of attention, and being equally exposed with all the rest of the body to the influence of sensations and of suggestions from without-suffer from determination of blood more frequently and more severely than any other parts. The power of the last-mentioned cause has been greatly extended and increased by the researches of gentlemen engaged in the treatment of uterine disease, and by the consequent discovery that a very large number of our countrywomen are invalided by some of its numerous forms. It is scarcely possible at present for an hysterical girl to have no acquaintances among the many women who are subjected to the

speculum and caustic, and who love to discuss their symptoms and to narrate the sensations which attend upon the treatment. These patients would probably give the impression that a little leucorrhoea, a backache, and a few blushing affirmatives to leading questions, would be deemed sufficient to justify an examination; and that this might be expected to reveal abundant grounds for farther treatment. In many cases ladies are quite ignorant of the nature of the remedies administered to them; and even if they heard the name of Indian hemp, would scarcely know the purposes for which it has long been used by the Hindoos; but still they may possibly find out by observation that the speculum becomes more grateful to their feelings the oftener it is applied, and that the wish for it is in some degree excited by each successive dose of the medicine; an induction which, when arrived at, they are very likely to communicate to their friends. So much has been written on this subject by abler men, that some apology is demanded for alluding to it here; but this may be furnished by the plea that the indiscriminate employment of the speculum is both a disgrace to the medical profession, and a misfortune to the female sex, in a nation where chastity and modesty have been esteemed and practised as amongst us. Not long since I travelled in a railway carriage with a stranger, who presently entered into conversation, and said (without knowing the profession of his fellow-passengers) that he had applied caustic to the wombs of twelve women on that morning, making the statement with an air of great exultation, and proceeding to describe himself as a country general practitioner, and a resident in South Wales. Soon afterwards, wishing to test the efficacy

of the treatment, I requested a friend, who was medical officer to a large metropolitan parish district, to allow me the charge of twenty cases, for which he deemed the caustic suitable. The women were all poor, unhealthy, and badly nourished—and in all the uterus was congested, with a voluminous cervix, and patulous orifice. The majority of them had some degree of prolapsus-all had leucorrhoea, and nearly all the condition described as exulceration. From their condition in life, constitutional treatment was attempted under very disadvantageous circumstances, and it was impossible to obtain the recumbent position; but scarification and cauterisation of the cervix uteri were diligently had recourse to, and injections of various kinds were also employed. Six months of this treatment left nineteen of the women in exactly the same state as when it was commenced, but in the remaining case the patient went to Hastings during the latter half of the time-was separated from her husband, had abundance of good food and plenty of rest, and came home perfectly well, having used no local remedy but the daily injection of cold water. Every one of the patients promised to abstain from sexual intercourse; but, of course, this promise was not kept; and there was a certain appearance of the exulceration, which always seemed to indicate the recent contact of seminal fluid.

If these twenty cases may be considered as throwing any light upon the true value of local treatment in congestive affections of the uterus, it surely behoves. every practitioner to be most chary of its employment, and to leave no other means untried before recommending its adoption; even if only on the ground that it is liable to abuse by designing and dishonest men;