down to write a letter to a patient, when he felt himself taken exceeding unwell; he rose, rung the bell, and sent for his son, saying, he was very ill, but desiring that Mrs. Wilson and his daughters should not be alarmed.

"Mr. Wilson called his house pupils to his assistance, and finding his illness still increasing, he sent for Dr. Baillie. In the mean time he was bled and cupped. On Dr. Baillie's arrival he was still capable of speaking, and laid his hand on his left breast, as the seat of his uneasiness. Dr. Baillie prescribed for him-a blister was put on the nape of his neck, and sinapisms to his feet.

In an hour Dr. Baillie returned, and other physicians saw him; but he was sinking, and died at half-past twelve.

"On examination of the body, the heart and vessels were found unusually empty of blood, and a serous effusion had taken place on all the surfaces of the brain: with the exception of some ossifications of the valves of the heart, all the viscera appeared natural." 514. Med, Repos, Dec. 1821.

Thus has been suddenly called away from us, in the zenith of his faculties, one of the best anatomists and ablest teachers of the present enlightened æra.

Abstulit clarum cita mors Achillem!

But what availeth grief for the dead? It is a wise and happy dispensation of the God of Nature that the daily sight of death induces not despair in the living. On the contrary, every one of us secretly aspirates, to the latest period of our existence, the following sentence of the poet :

Et mihi forsan, tibi quod negarit porriget hora.-HOR.

III.

De l'Alienation Mentale des Nouvelles Accouchees et des Nourrices :-that is, On Mental Derangement, as it occurs after Purturition, and during Lactation. By M. ESQUIROL, Physician in Ordinary to the Salpetriere. (Annuaire Medico-Chirurgical.)

MANY are the maladies to which woman is subjected while performing her allotted function of recruiting the species. Of these a very distressing one is that temporary alienation which so frequently succeeds parturition. It is a charitable, and we trust not a chimerical, supposition of M. Esquirol, that many of those shocking instances of infanticide, which we hear of, are the result rather of momentary derangement of the intellect than deliberate cruelty. Thus he knew a

young woman become pregnant, and who did not conceal her pregnancy. She made preparations for her accouchement. She lay-in in the night, and next morning the child was found lying in the privy mutilated by numerous wounds made apparently by scissors. The mother was found in bed. She was conveyed on a litter to some miles distance, and during the journey uttered some incongruous expressions. Being interrogated three days afterwards, she avowed the crime, made no defence, and did not appear to express or feel the slightest regret at the horrible transaction. She refused all kind of sustenance. Is it not evident, says our author, that this unhappy young woman laboured under some aberration of the intellect?-We are of his opinion.

The number of women who become deranged after parturition and during lactation, is more considerable, M. Esquirol asserts, than is commonly imagined. Of the females received into the Saltpetriere a tenth or twelfth have become insane under the abovementioned circumstances. This affection is much more common in high, than in low life. It is curious, however, that in the former class, it seldom takes place after weaning; whereas, it is of comparatively frequent occurrence in the poorer orders of females, after the removal of the child from the breast-a fact which may admit of some physiological speculation, but which our author accounts for by the care which the rich take, and can take, of themselves at such periods.

M. Esquirol refers to the 3d book of the Epidemics of Hippocrates for instances of this disease, and quotes the 14th case as a probable example, in the following words.

"Peut-etre l'observation XIV. est-elle une manie aigue. Il s'agit de la femme d'epicrate, qui, ayant accouchée de deux jumeaux, delira dès le deuxieme jour de l'accouchement, et mourut phrenetique le vingt et uniéme."

The practice of frequently quoting the works of Hippocrates, and finding descriptions of all diseases in these ancient records, induced us, many years ago, to carefully con over every line of the multifarious writings attributed to the coan sage. The result was not what might be expected. Instead of being impressed with admiration, or rather adoration of these writings, we became thoroughly convinced that they were a chaos of incongruous facts and absurdities which far from repaid the labour of wading through them. We shall probably be deemed Goths or Vandals for this declaration; but it has the merit of being a candid one. To shew how loosely, and sometimes falsely, the "divine old man" is often quoted, we shall here insert the original case, being a short

one, which our author has alluded to, as a specimen of puerperal mania two thousand years ago.

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Egrotus decimus quartus. In Cyzico mulierem, quæ gemellas filias magna difficultate peperit, et non valde purgata est, primum invasit febris horrida, acuta. Capitis et colli gravitas cum dolore. Insomnis ab initio, taciturna ac tetrica et non obsecundans. Urinæ tenues et decolores: siticulosa, anxia plerumque, alvus erroneo modo turbata, et rursus adstricta. Sexta, ad noctem mullum delirabat, nihil dormivit. Circa undecimam insaniit, et rursus resipuit. Urina nigræ, tenues: et rursus tempore interposito oleosæ. Et alvus multis tenuibus turbata. Decima-quarta convulsiones multæ, extremæ partes frigidæ, nihil amplius intelligebat. Urina suppressæ sunt. Decima sexta voce destituta est. Decima-septima mortua est: phrenitis." Popularium, lib. 111. Sect. 111.

Now we can see nothing in this case but a common instance of puerperal fever, not puerperal mania. She was seized, on what day after delivery is not stated, with ardent fever, and it was not till the sixth day-(not the second, as Esquirol says) that she became delirious. She died too, on the 17th day, (not the 21st as our author has it,) the discase being pronounced phrenitis by Hippocrates. Thus we see how many errors have crept into a single case, and how little satisfactory is the case itself after all.*

Levret and Zimmerman observe that mania is to be ap prehended when the lochia do not flow properly, and when the breasts do not swell by the afflux at the natural period; but experience shows that other affections are the more common consequences of disturbances in the lochial discharge.

Our French brethren, of all other people, pride themselves the most on being strict disciples of Hippocrates-that is to say, of carefully watching diseases, and religiously avoiding all interference with their progress. The wildest absurdities of the coan sage, are as much respected by these lively and ingenious people, as those common truths or facts, which the "divine old man" could not help stumbling on. Thus, our author seems to marvel much that Hippocrates should be wrong in the following aphorism: "Mulieribus quibuscunque ad mammas sanguis colligetur, insaniam significat." Lib. V. Aph. 40. He quotes several instances of a directly contrary nature. We believe there is hardly a charlatan in London-even the water-doctor in Berners' Street, that would not be ashamed of issuing such an aphorism as that which lies in immediate sequence of the one quoted by M. Esquirol. "Mulierem si velis cognoscere, an prægnans sit, ubi dormire volet (incænatæ) aquam mulsam bibendam dato. Et siquidem tormen habuerit circa ventrem, prægnans est: si vero non, prægnans non est." Aph. 41, Lib. V. Such are the absurd puerilities that command our respect merely because they are enveloped in the rust of antiquity! But why should it be called antiquity? Is not the world older now than it was three thousand years ago? and are not we consequently the antiqui, both in time and knowledge?

Of 92 cases of puerperal manin, in our author's establishment, sixteen became insane between the first and fourth day of confinement. Twenty-one became alienated between the fifth and fifteenth days-seventeen between the fifteenth and sixtieth days-nineteen between the second and twelfth months of lactation. Nineteen were immediately affected with insanity on weaning their children.* From these facts it would appear-1st, that mental derangement is more frequent among those recently confined, than among those giv ing suck-2dly, that the danger diminishes in proportion to the length of time that has elapsed since the accouchement-3dly, that women are much more subject to the complaint immediately after weaning, than during lactation.

Puerperal mania is sometimes presaged, even during pregnancy, by melancholy presentiments in the mind; while exaggerated or unfounded apprehensions immediately prelude the explosion of delirium. Sometimes, however, the mania breaks forth without any premonitory symptoms. At the commencement of the disease there is a febrile state of the system present. Yet the skin is soft and moist, the countenance pale, tongue white, breasts flaccid. The abdomen is neither tense nor painful; but sometimes there is acute pain in the uterine region. The pulse is generally small, feeble, and concentrated-mean time there is either exclusive delirium; that is monomania, or aberration of intellect, on a single subject; or, more commonly, general mania. Sometimes profound stupor precedes phrenitis, which may be confounded with puerperal mania, unless attention be paid to the head-ache, redness of the eyes, aridity of the skin, tinnitus aurium, anomalies of the pulse, subsultus tendinum, &c. which attach to the former malady, and distinguish it from the latter. Phrenitis, under puerperal circumstances, is generally mortal about the third or fourth day-rarely passing the seventh-the duration of mania may be prolonged to many months. Those mental alienations which arise during or subsequent to lactation, differ very little from those attendant on parturition, excepting a peculiarity of countenance which can only be known by experience.

The age at which this complaint most frequently occurs is that between twenty-five and thirty years-a period of life most prone to maniacal disorders from whatever cause.

* Dr. Gooch, in his excellent paper on puerperal mania, analyzed in the first volume of this series, page 615, does not appear to allude to weaning in the etiology of the disease. Yet the 4th case, p. 620, seems to be one dependent on this cause, and exemplifying M. Esquirol's observations.

Etiology of Puerperal and Lactation Mania. Hereditary predisposition-extreme susceptibility-former attacks of the same disease-these predispose to, and even in a few instances excite the malady. What is curious there have been women who became insane only when they bore a malé child-others who suffered after every second accouchement -and some who became alienated regularly in the third or fifth month of suckling.

The exciting causes are, for the most part, errors in regi men and moral affections. Of the former class, impressions of cold, however applied, form the most considerable proportion. The sudden weaning of the child, where proper precautions are not taken, becomes a frequent cause of this disease. The moral causes are to the physical, as one to four in proportion. In all ages the influence of mental emo. tions on parturient females has been duly appreciated. In ancient Rome a crown was suspended over the door where women were confined, to intimate that the house was a sacred asylum for the time. A nearly similar custom exists at Haerlem to this day. The panic of 1814, when the allies entered France, was a prolific cause of puerperal mania. Eleven out of thirteen that entered the Saltpetriere that year, were attributable to this cause. The same happened in 1815, when Napoleon recommenced the scene of warfare and desolation. Causes which, under ordinary circumstances, would be productive of no inconvenience, act most powerfully and often destructively on the parturient female. Thus, 1st, a woman was safely delivered. Next day she sprinkled her bed with odoriferous distilled waters. The lochia are immediately suppressed-no milk comes to the breasts-mania is evinced the same evening, and continues ten months. 2d. A man threw a pail of water over his wife who had lately been confined. She became immediately maniacal, and never recovered from it! 3d. A young woman, 18 years of age, concealed herself and was confined in a granary during very cold weather. She became maniacal, and continued so for twelve months. 4th. A woman giving suck was overtaken by a storm-heated herself by running fast-and in that state crossed a brook knee-deep in water. The milk was suddenly suppressed, and melancholia ensued. 5th. Another woman, during lactation, was frightened by a thunderstorm. The milk disappeared from the breasts, and she instantly lost her reason.

Although a very rare occurrence, yet our author has known a few instances where puerperal mania took place without any suppression of the lochia. The same may be said of the lacteal secretion. Our author enters into some Vol. III. No. 10.

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