gree of typhoid debility, from which the chief danger arises. The submaxillary glands often swell and prove troublesome. Hooping-cough is epidemic, and the paroxysms are so violent as frequently to terminate in apoplexy. Emetics administered in the commencement of the complaint pro ce the most benefit.

An appendix contains a short account of the mineral waters in the Portuguese Island of St. Miguel.

Upon the whole we have been gratified by the perusal of this little volume; should a second edition be called for, we hope the author will endeavour to make the department allotted to the natural history of the island more complete. We cannot avoid also remarking, that besides a full page of errata enumerated, various other errors, both of the press and of the editor, have escaped correction.

ORIGINAL PAPERS.

Some account of the use of the Polygala Senega in obstinate Amenorrhea.

BY N. CHAPMAN, M. D.

IT has been remarked by the celebrated Dean Swift, with his usual propensity to epigrammatic point, that he who raises two sprigs of grass where only one had previously grown, confers on his country a more substantial benefit than is derived from all the achievements of arms.

To the same species of praise, and certainly not to a less share, is the physician intitled, who, by new discoveries, adds to the catalogue of means by which the maladies of our nature are mitigated or cured.

Every practitioner of medicine, who is much consulted in the diseases of women, must have experienced the difficulty of managing some of the forms of amenorrhea, by the ordinary remedies. In a conversation with my friend Dr. Hartshorne, about two years ago, upon this subject, he mentioned to me that he thought he had used, with advantage, a decoction of the Senega in these cases. Confiding in the accuracy of his observations, I determined to lose no time in making a trial of the medicine. This I have since done, both in my private practice and in that of the Almshouse,* to a considerable extent, and with sufficient success, to warrant me in recommending it as among the most active and valuable of the emmenagogues. The ensuing cases, selected out of a much larger number, will serve not only to attest the decisive efficacy of the medicine, but may, perhaps, also, in some measure, illustrate the particular state and circumstances of this deranged function, to which it is best adapted.

The first case in which I gave the decoction, was that of a woman, aged thirty years, by trade a sempstress, of a

* The Almshouse, as the name imports, is an asylum for paupers. There is, however, a department of the establishment appropriated to the sick. This forms an extensive infirmary, and is among the best clinical schools in the United States.

frame slender and emaciated, and with a temperament apparently cold and leucophlegmatic. The disease had existed in a greater or less degree for ten years. At the commencement, and long afterwards, she menstruated irregularly, as well to the time, as the quantity of the discharge, and always with pain and difficulty. But for the three last years, there had been an entire suppression. Still, however, she occasionally felt, once perhaps in two or three months, " as if nature were making an effort." At these times, she had for days together, fugitive pains in the back, and lower part of the abdomen, accompanied with the uneasy sensations of fulness in the chest and head.

As almost every other remedy had been employed by the physicians who had previously attended the woman, I did not hesitate to put her on the use of the Senega. I directed her to take of the decoction* a table-spoonful every two hours, and to live on a diet generous and nourishing. No immediate effect from this plan of treatment was discernible. In about three weeks, however, she confessed that she was better, both as regarded the acquisition of strength, and the general comfortableness of her feelings. Towards the expiration of the fifth week, I was requested, in the evening, to visit her. I found her complaining of very acute pain in the stomach like the colic. Her bowels being opened by an injection, she took a large dose of laudanum. In the morning, I learnt that she had been speedily

* In making the decoction, I put a pint of boiling water to an ounce of the Senega, bruised, in a close vessel, and let it slowly simmer over the fire till the quantity is reduced one third. Where the medicine excites nausea, which it is sometimes apt to do, even in small doses, I have it prepared with the addi. tion of an aromatic, such as the orange peel or cassia. My rule, in the admi. nistration of the Senega, is to give about four ounces of the decoction, more or less, during the day, according to the circumstances of the case. But at the time, when the menstrual effort is expected to be made, and till the discharge is actually induced, I push the dose as far as the stomach will allow. I have given as much as two ounces every hour. In the intervals of the menstrual periods, I always lay aside the medicine for a week or two. Without these intermissions, if it does not lose its efficacy, it becomes nauseous and disgusting to the patient. While under a course of the Senega, the general system is to be kept properly regulated. Excessive excitement, or debility, is to be equally obviated by the use of the appropriate remedies,

relieved, by the anodyne, of the colic, but that she was at the moment, suffering from strong bearing down pains. She seemed also to be distressed by great restlessness and anxiety. As her pulse too, was somewhat full, and her skin warm, eight ounces of blood were drawn from her arm. The medicine was now increased to an ounce every hour. When I saw her again in the evening, no very sensible change had taken place. I prescribed the warm bath, and the continuation of the medicine. The next morning she was evidently better. The bath, the over night, had composed her; and after a few hours' sleep she began to menstruate. The discharge, however, was by no means natural. It looked like a mixture of the sanies of an unhealthy ulcer, and the fluid of leucorrhoea. During the day and succeeding night, the medicine was continued. Part of this time, the discharge was more abundant, and of a different appearance. It consisted of pretty tenacious mucus, so blended with grumous blood as to have a dark sanguineous complexion. The menstrual paroxysm now ceased. After a fortnight, she returned to the Senega, in the dose of an ounce four times a day, and persevered in thus taking it for three weeks, when she was again attacked. I was not called to see her till the third day of her illness. It appeared that she had been affected precisely in the same way as formerly: in the first instance being seized with colic, which was soon followed by bearing down pains. These lasted, with slight intermissions, for twenty-four hours, when a substance of an unusual aspect coming from her, I was sent for to examine it.* I found it to be a membranous lining of the uterus. It was exactly of the triangular figure of the inside of that organ, and of the dimensions of its cavity at the close of the second month of gestation. The external surface of it was shaggy or flocculose: the internal smooth. In consistence, it resembled firmly impacted mucus, or that structure denominated by anatomists parenchyma. In color, it was similar to the decidua, but twice or three times

* I ascertained that the Senega, in an increased dose, was the only medicine which had been given prior to my visit. No other remedy was afterwards employed during this attack.

as thick as I have ever seen that membrane.* The expulsion of this substance was neither preceded, nor followed, by hemorrhage, or other discharge, except a weeping of serum tinged with red blood.†

The woman, after a short interval, once more reverted to her medicine: and in the course of three weeks, I received the very satisfactory intelligence that she was menstruating naturally. Three cloths, which were shown to me on my visit to her, were thoroughly imbued with the genuine catamenia. Eighteen months have elapsed since this event, and she continues to do well, without any medical aid. The menses flow freely, but with no sort of periodical regularity. In every respect, however, her health has vastly improved.

I have traced the more minutely the history of the above case, because it strikes me as being interesting in several points of view. It at least corroborates an opinion which I had reason early to adopt, that in most, if not all the instances of obstinate and long continued amenorrhea, the membrana decidua exists; and that radical relief, under such circumstances, is to be alone sought in the riddance of this adventitious produc

tion.

The cases that follow, came under my care while in attendance at the Almshouse last winter. They will be more briefly related. Disappointed in procuring the records which are preserved, or ought to be preserved, in the clinical journal of the

Morgagni was the first, as far as I know, who noticed this membranous substance. He describes it very accurately. By Denman our attention has been more recently called to the species of amenorrhea to which it is incident. He mentions, among many other particulars relating to this substance, that he has known it to be generated, in more than one instance, by the vir gin uterus. Such a case has never occurred to me.

†There is commonly in these cases, as much hemorrhage as in early abortions. It is said by Morgagni, that the expulsion of the membrane is succeeded by the lochial discharge. I have never observed it.

Dr. Denman seems to entertain the same opinion. He, indeed, suspects that this membrane exists in every case of "habitually painful menstruation.” There are two reasons why it is not more frequently observed. Women, in the first place, are reluctant to have their menstrual cloths inspected; and secondly, the membrane, in a great majority of instances, comes away insmall pieces, or flakes, so that it may be overlooked, even when we have opportunities of an examination.