there be more of them, I confess that I shall not have fulfilled my intention, if I have not proved in a satisfactory manner that this substance possesses qualities truly active, and often injurious to the fœtus. Deceived by my first experiments upon animals, I believed that the Ergot did not act directly upon the womb; and that, when it did act, it was always by sympathy, and then only when the uterus was predisposed to it, by the irritation natural to it at the end of gestation. The twenty-seventh and twenty-eighth of my present cases, undeceived me; and, corroborated by facts already cited, appear to me to leave nothing more to be desired on the subject. I therefore say, with a sincere belief; that the Ergot is possessed of active properties; that it acts upon the nervous system directly, or by sympathy, according to circumstances; that its action may be salutary or hurtful according to individual susceptibility; that it is not always necessary for the womb to be previously disposed to irritation, in order to be influenced by it; that it acts principally as a tonic; and that its effects, in general, are very prompt, but may sometimes show themselves only at the end of one hour. Its dose cannot be determined with precision. It is better to administer it in infusion than in substance, as already remarked by Dr. Stearns. It appears to act in very small doses, repeated at longer or shorter intervals; as in the dose of ten grains in powder, or a table spoonful every ten minutes, of an infusion made by pouring two ounces of boiling water on thirty grains of the powder. The dose of one or two drachms, infused in two, three, or four ounces of boiling water, as I have prescribed it several times, seems to answer very well, and did not act with more force or promptitude. Whatever be its dose, its effects are always uncertain: it is sometimes inert, but oftener active. The Ergot may act on the mother only, producing giddiness, uneasiness at stomach, headach, and more or less copious vomiting. It may act upon the child, and produce suspended animation

or even death-or it may act upon the mother and child at the same time, and produce all these accidents. Finally, it may act on the womb alone, by ridding it of its contents, whatever they be, without affecting, in any manner, the being that it has protected and nourished for nine months.

These conclusions being the result of the present cases, and of those which have appeared in Vol. XX. of the Medical Repository, I think myself authorized to renounce the employment of the Ergot as a mean to facilitate delivery, because its effects may be injurious to the fœtus, whatever be its modus operandi on the mother in general, or on the organ of generation in particular.

On the Mania of Lying-in Women and Nurses, by M. ESQUIROL, Physician in Ordinary to the Salpêtrière. Translated for the Medical Repository, from the Annulaire Médico-Chirurgical of the Civil Hospitals of Paris for 1819.

ALTHOUGH Much has been written on the diseases of the puerperal state, little has been said on the mania of lyingin women and nurses. I have therefore chosen this subject, in the hope of advancing our knowledge of a disease which interests us as much, on account of the objects doomed to suffer, as from the frequency of its recurrence.

I shall not speak of that transient delirium which frequently occurs after labour, and is often only a symptom of milk-fever, and usually soon disappears, either on the return of the lochial discharge, where it had been suppressed, or its diminution, where it had been excessive; or the removal of the fever, and the recovery of the patient's strength. Moriceau and other accoucheurs have known this form of mental derangement to appear on the second day of confinement, and disappear on the fourth.

Neither shall I speak of that form of delirium, which has so frequently led mothers in their frenzy to destroy the child they have brought forth. Shame, perplexity of mind, fear, remorse, and crime, are not the sole causes of infanticide; delirium, by agitating and distracting the intellectual functions, often consummates the horrid deed.-An unmarried woman becomes unexpectedly pregnant; she does not conceal the circumstance from her family; she prepares apparel for the child; the evening before her confinement she conducts herself as usual; in the morning she is found in bed, and the child in the privy, disfigured with wounds which appear to have been made with a scissors. Soon after, the girl is seized, and conveyed several miles from her home. On the way, she refuses to be concealed from her enraged neighbours, and continually repeats to those about her, "that no person will harm her,” "that she has done nothing." Some days after, she is questioned, and acknowledges the crime: she neither justifies it, nor exhibits the least regret for what she had done; but refuses to take nourishment. I ask, had not this girl a paroxysm of delirium? But these facts appertain to legal medicine, and I leave them.

The number of women attacked with insanity, in consequence of child-bearing, during and after lactation, is much greater than has been commonly supposed. Nearly onetwelfth of the maniacal females received in the hospital of Salpêtrière, owed their derangement to one of these causes. For some years the proportion has been as great as one-tenth. Thus-Of eleven hundred and nineteen admitted during the years 1811, 12, 13, 14, ninety-two were of this kind, and sixty of them were admitted in 1812 and 1813, during which the aggregate number received was six hundred. If a third be subtracted from the total number received in these four years, for those that had passed the fiftieth year, when they are beyond the influence of such causes, the remainder will leave a larger proportion than I have stated. The result of my private practice makes the proportion still greater;

nearly one-seventh. Astruc observes, that depositions and milky congestions are very frequent among the higher classes of society; but it is nevertheless certain, that mental derangement after lactation is not so common among them as the poor; arising, no doubt, from the precautions which they are enabled to employ; whilst nothing of this kind will avail to secure their extreme susceptibility against the dangers of confinement, and of suckling their children.

It is important to ascertain the period of confinement and lactation when this malady is most apt to occur, since it will furnish useful practical indications. Hippocrates, in his third book of Epidemics, relates many cases of serious disease with delirium, in lying-in women during the epidemics which he describes: they were, however, mostly cases of fever. Perhaps case xiv. of the wife of Epicrates was an acute mania: she had been delivered of twins, was attacked with delirium on the second day, and died on the twenty-first. Levret informs us, that fatuity is to be apprehended after delivery, if the lochia be deranged, especially if the breasts remain empty and flaccid. Zimmerman, in his work On Experience, relates examples of insanity and melancholy, preceded by suppression of the lochia: among others he gives the case of a woman who was cured after six months. Dr. Berger published at Gottingen, in 1745, a thesis De Puerperarum Maniâ, which I have not been able to procure. Doublet, in a memoir read before the Royal Society of Medicine in 1786, says, that the irritatio lactea is sometimes transferred to the brain, either immediately after delivery, or on the cessation of lactation. In some of these cases, adds this author, there is a fixed pain of the head; in others stupor, with haggard countenance, and wandering of intellect. Of my ninety-two cases, sixteen commenced from the first to the fourth day after delivery.

Puzos says, (Mémoire sur les Dépôts laiteux) that milky depositions do sometimes occur in the brain, and

produce mania by compressing this viscus and distending its fibres. These depositions, according to him, occur from the tenth to the twelfth day after delivery. He relates two cases of this kind. Of my ninety-two, twenty-one occurred from the fifth to the fifteenth day; seventeen from the fifteenth to the sixtieth day, the extreme limit of the lochial flux; nineteen during lactation, and from the second to the twelfth month after delivery; and nineteen immediately after weaning the child.

From these data I conclude, 1°. That women are more liable to mania soon after confinement, than during lactation. 2o. That the danger is lessened in proportion as they are removed from the period of delivery. 3°. That there is much more danger of the disease on weaning the child, than during the period of lactation.

The disease is sometimes announced during the pregnancy by sinister forebodings, as sadness, and groundless and exaggerated alarms; at other times it appears suddenly, without any such warning. At first, there appears to be a febrile condition of the system; the skin is moist and pleasant, the countenance pale, the tongue coated with a white fur, the breasts flaccid, the abdomen neither tense nor painful; sometimes, however, there is great pain in the region of the uterus, the pulse is small, feeble, and corded. In some instances, the derangement is partial, confined to one set of objects; most generally its form is mania, rarely fatuity. This affection has sometimes been confounded with phrenitis; but the redness of the eyes, the dryness of the skin, the tinnitus aurium, the state of the pulse, the subsultus tendinum, the ataxic symptoms, and their rapid increase, serve sufficiently to distinguish this latter disease. Moreover, phrenitis proves fatal in three or four days, rarely continues to the seventh, whereas the duration of mania is often several months, and even longer.

This form of mania differs very little, in its character and progress, from that arising from other causes; yet there is something peculiar in the expression of the coun