It was then her intellectual faculties gave way, under the moral affliction. She now became possessed with the idea, that her attorney was about to arrest her and all her family, and immure them in prison. She saw and she heard a thousand things to confirm her suspicions, and her whole time was occupied in devising stratagems to elude her pursuers. This hallucination had occasional remissions, during which she partially recognized the baseless fabric of her apprehensions. At other times she had exasperations of the terror above-mentioned, accompanied by violent pain in her stomach, at which periods she refused food, and the bowels were obstinately constipated.

When she came into the CHARENTON, she presented a triste picture of melancholy-paid little attention to what was going on around her and was evidently occupied entirely with the subject of her hallucination. "She was a lost woman-it was all over with her-she could not long survive, as her own feelings plainly told her-her head and stomach were the seats of dreadful pain-people were endeavouring to poison her." These ideas were so dominant, that she could speak of nothing else. She was in constant agitation-always wanting to get away-refused all aliment-bowels obstinately confined. These symptoms augmented in degree, but never changed their character. At the end of four months, this unhappy patient was in a melancholy situation. Her emaciation was great-she was harassed with violent cephalalgia, and acute pains in the stomach, sometimes accompanied by a burning heat of skin, and darting pains in various parts of the body. The greatest difficulty was experienced in exhibiting any food, as she was strongly impressed with the persuasion that it was always poisoned. She lingered out till the 28th March, 1820, when long sought death came to her relief.

Dissection. There was an effusion of a sero-sanguinolent kind between the membranes of the brain, and in the ventricles. The cerebral substance was softened, but the meninges were not thickened. There was considerable hepatization of the lungs, and three ounces of serum in the pericardium-heart sound. The stomach was remarkably contracted, and took a peculiarly lengthened form, from above downwards. The mucous membrane was covered with a thick layer of yellowish mucous matters, and underneath was very red throughout. The liver was gorged with blood, and its right lobe descended to within two inches of the os. ilii. The small intestines were very much contracted, and their mucous membrane slightly reddened. The colon was also greatly contracted, and singularly contorted in various directions. All the other abdominal viscera were healthy.

Although the gastric lesions above described cannot fairly be set down as causes of the mental alienation, yet there can be little doubt that the disorder of the stomach greatly assisted the moral causes of the cerebral disturbance. In short, we may conclude that in this, as in a thousand other cases of less serious character, the two organs acted and re-acted on each other--that the physical disorder aided the moral causes in deranging the mind, while the moral causes contributed not a little to the disorder of the stomach.

Case 3. M. A. aged 51 years, of nervous temperament, and eccentric character, was the son of a man whose intellects were rather suspected, and had a brother in a state of monomania. For a Jong time, M. A. complained of pain in his stomach, general discomfort, deranged state of his digestion, &c. which led him to consult a great number of physicians, and swallow an immense quantity of physic. He took a great deal of purgative medicine in particular, and thought he could not live without daily purgation. He became irritable, and quarrelled with most of his friends, though naturally of a good disposition. In 1814, he got into some trouble, in a public office to which he belonged, and was ultimately tried, for continuing an abuse introduced by his predecessors. He was however pardoned by the king in 1815, and in 1818 he got another situation under government. But he now became a violent Bonapartist, and denounced vengeance against the Bourbon race. It was plain that the man was deranged, and in 1820 he was confined in an asylum. He conceived that all the men of letters in Europe had conspired against him, and that it was impossible he could escape their machinations. He refused food and drink, and emaciated progressively. On the 10th May, 1821, he entered the CHARENTON, in the condition above-mentioned. During the first three months of his sojourn in this establishment, he presented the following phenomena :-Face pallid and sallow-answers pretty correctly to questions put to him, but shows imbecility of intellect-appears calm and tranquil. He conceived a violent friendship for an ideot in the same establishment, and was always at his side, attending to him and imitating his actions. When remonstrated with, he asserted that his friend the ideot was a personage of high rank, and that he himself was commissioned to wait upon him. He was put into another quarter of the asylum, in order to break this attachment. He then devoted himself to constant employment. He was never a moment idle. He complained of pains in his stomach, would eat very little, and began to suspect poison in his food. Emaciation now made great progress, yet still he got out of bed every day, and wandered about the house. On the 2d November, 1821, he suddenly fainted away, and never recovered.

Dissection. The arachnoid was slightly thickened, and the pia mater injected. The cerebral substance was softer than naturalno disease in the chest. The stomach was very much contracted, and the internal lining highly inflamed and thickened in its structure, especially towards the pyloric orifice. The mucous membrane of the duodenum was still more intensely reddened. The lining of the upper portion of small intestines was red, which redness gradually decreased as they descended towards the caput coli. The colon was free from disease. The mesenteric glands were enlarged-all the other viscera were healthy.

The same remarks apply to this as to the former case. The state of the stomach can hardly be considered as a mere coincidence in this case. It was probably an active agent in the production of the

mental malady.

Case 4. Mad. B. aged 47 years, of nervous temperament, and delicate constitution, had a brother who died in a state of mental alienation. The storms of the revolution had made a deep impression on the young mind of the patient, and she received another shock in 1814, during the occupation of France by the Allies. This shock was not lessened by the fear that her husband would lose his place under government, on account of the part he took after Bonaparte's return from Russia. Towards the end of 1814, she fell into a state of deep melancholy, and now she became haunted with the suspicion of being poisoned-of being led to the guillotine, &c. She sought solitude, maintained obstinate silence, refused her food, and attempted suicide. In this condition, with alternate exasperations and mitigations of her complaint, she continued till the year 1821, when she entered the Charenton, on the 6th April. The predominant idea was still that of being poisoned --that there were enemies in the pursuit of her, and that her husband and daughter had deserted her. She had such an insurmountable aversion to animal food, that she could not be persuaded to taste it. When food was forced upon her, she said it made her ill, and she frequently vomited it up again. About the middle of May, 1822, she became remarkably debilitated, and began to spit up purulent matter, attended with diarrhoea. She lingered out a wretched existence till the 6th September, when she expired. Dissection. The arachnoid was natural. The pia mater was injected, as was the substance of the brain. The lungs were hepatized in some places, excavated in others, and tuberculated generally. The mucous membrane of the stomach was chronically inflamed throughout, but more intensely so about the pylorus. The same might be said of the small intestines, with the addition of many ulcerations, some of which nearly penetrated through the whole of the coats. The mucous membrane of the colon was reddened, and double its natural thickness. The mesenteric glands were considerably enlarged.

She lived on a few ounces of bread daily.

These, and other cases which are to follow, entitle us to conclude, M. Bayle thinks, that the chronic inflammation which takes place during mental alienation tends to keep up the intellectual disorder to modify its form-and especially to determine that peculiar dread of being poisoned-that aversion to food-and that tendency to suicide, so conspicuous in the above cases.

We shall take up M. Bayle's other memoirs on this interesting subject as they appear in our Parisian contemporary.

2. DISEASES OF THE BREASTS.
[St. George's Hospital.]

Nothing can be more important to the practitioner than to be able to distinguish true malignant diseases of the breast from those morbid growths which appear indeed formidable, but which may be removed with comparative safety and success. An instance of this occurred not long ago at St. George's Hospital.

Ann Dale, æt. 75, was admitted April 18th, 1827, under the care of Mr. Brodie, with disease of the left breast, of which she gave the following account. Six years ago she noticed two small tumours in the axilla; in a few weeks there followed a swelling in the breast, which was attended with very slight pain, but at times a little thin, bloody discharge oozed from the nipple. The swelling proceeded slowly and with little inconvenience, save that occasionally it became red and painful, with slight hæmorrhage from the nipple. She applied to several surgeons, and all concurred in advising an operation. On admission the left breast was as large as a full-grown melon, the enlargement being evidently in the gland itself, and moveable on the pectoral muscle and ribs, whilst a hard knotty process extended into the axilla, to all appearance an induration of one or more of the lymphatic glands. The tumour was irregular on its surface, having in parts a scirrhous hardness, in parts a doughy, miry feel, not exactly that of fluid; it was extremely heavy--not very painful on pressure-the cutaneous veins were full and tortuous, and in the situation of the nipple a livid looking fungus projected, discharging a little unhealthy pus.

She was affected besides with symptoms of inflammatory action within the chest, but otherwise had always enjoyed robust health, and her appearance was not altogether unfavourable. She had been married, and borne children-the catamenia had ceased long before the commencement of her complaint. By means of bleedings, and salines with antimony, &c. the chest affection was got under, and towards the middle of July she appeared neither unfit nor unwilling for the operation. The breast was accordingly, on the 19th July, removed with great ease. The bleeding was trifling, but wine was given to the patient to encourage it at the time, and all the vessels of the least size secured by ligature. The flaps of integument were brought together by sutures and adhesive straps, and pounded ice applied. On examination of the tumour, which weighed three or four pounds, it was found to be, as had been predicted by Mr. Brodie, neither true scirrhus, nor fungus hæmatodes, but composed of a yellowish, transparent, jelly-like substance, contained in small cysts or compartments, formed by membranous bands or septa intersecting each other in all directions. In the centre of the tumour was a small cyst containing serum. For the next two days she went on very well, but on the 22d there was anxiety of aspect-pulse quick and evidently intermitting-surface hottongue inclined to brown. She had had since the operation only one scanty motion. 23d. With the aid of the senna draught, in a mixture of haust. salinus, antimonial wine, and tincture of hyosciamus, the bowels have been freely opened this morning. Pulse 126; intermits at every 10th beat-some anxiety and heat of skin. The dressings were removed for the first time, and the greater part of the wound was found to have united; just, however, under the head of the clavicle was a small, and rather painful tumour, apparently formed by coagulated blood. 25th. Pulse distinctly intermitting-anxiety-restlessness-some thirst-much pain in the upper part of the breast-tongue brownish. The wound was

dressed, and looked not amiss, but the swelling above-mentioned, being very painful, was lanced, and dark, semi-putrid blood, with some highly offensive matter evacuated. 26th. Relieved. 27th. Not so well to-day, there being another swelling below the line of the wound: it was punctured, and pus, mixed with a little blood, evacuated. From this time all the bad symptoms rapidly disappeared; whilst, in consequence of opening the two or three small abscesses which had formed, the matter was prevented burrowing, and the adhesions which had taken place were preserved. At present, Aug. 20th, the wound is nearly healed-the cough is trifling-little or no expectoration in the mornings, in short, the good woman looks, and declares she really feels, "many years younger" than before the operation.

Remarks. This case shows at what an advanced age these large tumours may be removed from a tolerably healthy patient, with success. The tumour was evidently not true carcinoma; for it was of considerable magnitude, was attended with trifling pain, and had not the stony hardness of cancer, besides which it had lasted for upwards of six years, without having gone on to mischief, which, speaking generally, is not the case with carcinoma. In an excellent clinical lecture* delivered on the occasion by Mr. Brodie, that distinguished surgeon observed that he had removed several such breasts, and the patients had survived for many years afterwards, without any return of the disease.

In No. 205 of the Lancet, there is, we perceive, a case of fungoid disease of the breast related.

æt. 32, of spare habit, light complexion, and unhealthy appearance, was admitted into Guy's Hospital, under Mr. Morgan, with the right mamma enlarged to three times its natural size. The long axis of the tumour was from side to side, it was purplish, especially on the inner side; skin bright-cutaneous veins loadedlarge subcutaneous veins ramifying over the tumour. The tumour was tense, harder in some places than others—-very heavy, and moveable upon the parts beneath. Axillary glands unaffected. The woman had felt a small lump in the breast for ten years or more, but the enlargement has assumed its present size and appearances within the last fourteen weeks. She had borne several children, and suckled them from this breast. Amputation was performed by Mr. Morgan, on the 28th July. The skin was so far affected, that it could not be saved; the wound was, therefore, dressed in with lint, and left to fill up by granulations. The tumour was enclosed in a dense capsule; it was firm at its base, but, at its circumference, there were small cysts, containing serum.

* Mr. Brodie alone, of the Physicians and Surgeons to St. George's Hospital, is in the habit of delivering clinical lectures. Is this as it should be? Are bad examples only contagious?

P. S. We have just learnt, with great pleasure, that Mr. Rose has caught the infection of giving clinical lectures. We are sure that few can be found better qualified.