708

prise that the examiners of the Hall shouldptarticipate in this suspicion, and consider itrequisite to exercise a judgment themselves ;the more especially since a recent instanceoccurred of an M.R.C.S. rejected by theexaminers at the Hall for gross ignorance onthe subject of the anatomy of the eye : :

general and clear as were the questions putto him upon the structure of that organ.Wishing justice and 11 fair play to all par-ties, I remain, Sir,

AN ADVOCATE FOR IMPARTIAL REFORM.London, Jan. 28, 1830.

PUERPERAL MANIA.

To the Editor of THE LANCET.SIR,—An interesting case of puerperal

mania having within the last few monthscome under my attention, I am induced,from the shortness of its duration and thesuccess attending it, to give you the headsof the treatment, that you may, if you thinkproper, insert them in your valuable periodi-cal THE LANCET.The case in question originated with the

wife of a gentleman hereabouts, at the ageof 25,after giving birth to her first child, astrong and healthy babe ; her constitutionwas delicate, and of a phthisical tendency;notwithstanding, she went through her la-bour with a good deal of fortitude, duringwhich nothing uncommon occurred ; butmore haemorrhage than usual followed theextraction of the placenta, which was arrest-ed by the common method of stimulatingthe contractile powers of the uterus by thehand. For seven days after, she was goingon to all appearances well, but at the endof that time came on what I considered to bean attack of hysteria, slight causes elevating-.and depressing her indescribably, which 1suspected to proceed from her situation. Iordered her to be kept quiet, and the infant tobe removed ; mild nutritious diet, and wineand water to be given occasionally. The fol-lowing day she became delirious, and she con.tinued so, more or less, for three weeks or amonth, during which several of my profes-sional brethren saw her, and prescribed asthey thought proper ; suffice it to say, the- effects of dc-pletion, counter-irritants, opium,calomel, evaporating Il,tions, etc., were triedto the fullest warrantable extent, without

any permanent mitigation of symptoms. Allnourishment and medicine were refused tobe taken by the mouth ; pulse 120 and small ;faeces and urine discharged involuntarily, andshe became altogether unmanageable. ’ Inthis state of things, confinement was thoughtindispensable, and strong- broths, in whichfull doses of the sedative solution of opiumtfere mixed, were given twice and three

times in the day per anum, with a shower-t bath night and morning, while the body was; immersed in warm water, which was shortly! followed with beneficial effects, as she keptimproving ; was ca)mer and more rat:onal

after each application of the bath. Thepractice was continued for some days, andI firmly believe her recovery may be attri.buted to the refrigerant and salutary actioncaused by it, combined with confinementin adark chamber, and solitude. The mine andsurgeon are the only attendants requisite onsuch occasions, and they should possessgreatfirrnness. I feel convinced, the less rela.tives and friends make their appearance thebetter; they can do no good, but alwaysgive rise to fresh excitement in the patient.in about six weeks from the date of my firstattendance, this lady was capable of beingremoved into the country, where she nowis, perfectly collected and conraleseent,Seeing Alr. Ashwell’s case in No. 319, p. 96,of THE LANCET of last month, induced meto give you this brief statement, that I mightask you and the profession what probabilityis there of a second attack, provided thislady becomes pregnant again ; and whetherthis distressing affection might not hare

originated in some decree from the hsmor-rhage and nursing the infant, thereby in-creasing her debility, and as a sequitur, irri.tating her naturally too susceptible frame,which would produce, in my opinion, anover excitement and suspension of the men-tal powers.As the case is so well known here, and

the parties so respectable, you will, per.haps, pardon me for not giving you my sig.nature ; but believe me an admirer of yourprinciples, and your constant reader.

W. S. G.Norwich, 1829.

TREATMENT OF NEURALGIC DISEASES BY

COUNTER-IRRITANTS.

To the Editor of THE LANCET.SIR,—I read with much interest your able

review of Mr. T. P. Teale’s Treatise on Neu-ralgic Diseases; (page 323) believing thefacts given therein to be most important tothe medical profession, as developing thecauses of many painful and obscure diseaseswhich have hitherto too frequently baffledthe most skilful practitioners.But as the high merit of introducirg in

Leeds a new system of practice as reg-ardsthese diseases is evidently indirectly claim-ed by Mr. Teale (or it would have been im.pertinent to have published his cases) a senseof public justics obliges me to assert theprevious title of Mr. Chorley, the senior