THE OHIO                6

MEDICAL  AID  SURGICAL JOUMAL.
Vol II,          Columbus, July 1,1850.          No. VI.
          PART FIRST.

ORIGINAL COMMUNICATIONS.
Art. I.—Account of the Epidemic Religious Monomania in Sweden, in
           the years 1841 and 1842.  By the Editor.

  Wide spreading epidemics, more or less resembling the one
we are about to describe, have doubtless occurred and recur-
red many a time and oft; sporadic cases are not uncommon;
but with the exception of Hecker's admirable description of
the dancing mania of the  fourteenth century, we have only
vague or incomplete accounts of them, and the medical world
is much divided in opinion as to their real nature.   It is with
the desire of adding a mite to the common treasury, that we
present our readers  with the following picture of the most re-
cent and best observed of such epidemics, the very first case
that occurred having been accurately noted, and the spread of
the disease subsequently studied by many fully competent phy-
sicians, and learned theologians.   A paper on the subject has
appeared in the  Journal Hygiea, by our friend, Dr. Sonden,
which we shall make use of, and we shall freely draw on all
such official reports  and documents as are accessible to us.
  The disease in question has received  quite a choice of
aliases, but we hope to show how little claim it has to the ma-
jority, by establishing  its identity;  and to this end we will just
glance at the great epidemic referred to, before we proceed to
the study of the more  recent and the milder one, drawing our
materials from the description by Hecker.
  The last effects of the " Black Death" had not yet ceased to
be feit—the  fresh earth that covered the remains of so many
millions had not yet sunk to its level—when a singular mad-
ness seized on the minds of the German people ; an affection
that for more than two centuries was by turns the wonder—
       31 
 482      Smith on Epidemic Religious Monomania.      [July

 by turns the dread of the age,  for  its unfortunate subjects
 seemed to be drawn body and soul within the magic circle  of
 a hellish superstition.  From their bacchantic leaps, and vio-
 lent gestures, as screaming, foaming at the mouth, and wear-
 ing the aspect of maniacs, they whirled  around in the wild
 ring-dance,  the disease was christened the dance of St. John,
 or of St. Vitus.  What these two saints had to do with a danc-
 ing mania, we shall presently see.  Rapidly the disease spread
 all over Germany and the countries to the North and West
 thereof—a true epidemic—in which the mere sight of one af-
 fected was sufficient to cause the disease in persons prepared
 to receive it, by the unequalled emotional and physical trials
 they had just passed through, or  were still suffering.
   In the year 1374 came to Aachen (Aix-la-Chapelle) from
 Germany,  troops of men and women, who in churches and
 public squares,  apparently  involuntarily and unconscious of
 the presence of spectators, danced round hand-in-hand in  a
 ring with frantic violence for hours together,  until they sank
 down frcm  exhaustion,  complaining of great oppression  and
 anxiety, and groaning as if about to  give up  the ghost, till
 somebody bandaged tightly their swollen bellies, when they
 came to their senses, and so remained until the next attack.
 People  also sought to relieve this tympanitic distension of the
 abdomen, which accompanied  the paroxysm of convulsive
 mania,  by kneading with the hands, striking with the closed
 fists, or trampling  with the feet.   Although the  affected nei-
 ther saw nor heard anything going on around them while danc-
 ing, they yet had visions,  in which spirits appeared  to them,
 whose names they groaned or shouted out.  Some in their lu-
 cid intervals, said that they seemed to be sinking into a river
 of blood, and  that they  exerted  themselves so  violently, in
 order to escape so horrible a fate.   Others saw  the heavens
 open, with the Holy Ghost sitting enthroned, accompanied by
 the Mother of God; showing how the belief of the age, in di-
 vers manners influenced their disordered fancies.   In all pro-
 bability the disease appeared in various forms ;   but  the
 descriptions of cotemporaries  are mostly from the  pens of
 those, who being unlearned in medicine,  and accustomed to
 myslify  natural phenomena by a constant reference to their
 own fantastic ideas of the world of spirits, took little pains to
record those particulars,  which neither interested  them, nor
chimed in with their preconceived notions.
  It required but a few months for the malady  to spread from
Aachen over the neighboring country of the Netherlands, and
the number  of those affected with it became so great as to
awaken the  greatest anxiety; for they filled the churches, pro- 
185 0.]     Smith on Epidemic Religious Monomania.       483

cessions were continually parading the streets, masses being
sung, and all hearts palpitated with affright at the prevalence
of an affection which no one doubted was originated by Satan
himself.  The clergy of Luttich had resource to exorcisms, and
put forth their utmost strength to crush an evil which wore so
threatening an aspect,  for  as they  grew in numbers  and
strength, the affected often called down curses on the heads of
the priests, and threatened to take their lives.  The authorities
themselves  became alarmed, and  for example,  because the
the madmen  expressed  their dislike to pointed shoes, and de-
clared that none but square-toe'd were  decent and proper, they
passed an edict forbidding the  use of any other.  Many were
the strange fancies about similar trifles that were indulged in;
some could not bear the  sight of any thing  of a red color,
some would not allow any person to shed tears in their pres-
ence.   Not without considerable semblance of probability did
they avow, under the influence,'tis said, of priestly exorcisms,
that in  a few weeks more, the spirits or devils would possess
the princes and potentates  of the land, and with  their aid
would entirely root out and destroy the clergy.  These avow-
als, which were made while in a condition resembling magnetic
sleep,  were every where  believed, and passed from mouth to
mouth  with  the most extravagant  additions.  The priests
meanwhile employed every means  at their  command to stem
the rising torrent of madness, and seemed unfeignedly to fear
that the stability of existing social institutions  was threatened.
Whether in consequence of  their exorcisms and anathemas,
or, which is far more probable, of the moral and physical re-
laxation that  naturally followed on such morbid excitement,
the evil ceased in Belgium in about ten or eleven months.
  A month after the disease first  appeared in  Aachen, it had
reached Cologne  and Metz.  Farmers left their plows, work-
men their shops, wives their  homes, to join the wild and mys-
tic dance.  The animal propensities were no longer controlled
by the dictates of morality, but were allowed full swing, and
found abundant opportunity for their unlawful and unrestrain-
ed gratification.  Hundreds  of unmarried women might be
seen desecrating the most sacred places, with  their disgusting
saturnalian orgies.   When at length  it became evident that
the prayers and the curses of the priests were as unavailing
to moderate the evil as the prescriptions of the physician, the
people themselves took the matter  in hand, and proceeded to
banish without pity or  exception all who were attacked;  but
it required four months before the authorities  of  the Rhenish
provinces could succeed  in  re-establishing order, in curbing 
484       Smith on Epidemic Religious Monomania.      [July

the unbridled license  which every  where  prevailed, and in
suppressing the luxuriant growth of crime.   The disease itself
was  indeed checked for a  time, but having once  been pro-
duced, continued to return every now and then, although in a
milder form, not only throughout the rest of the fourteenth,
but up  to the sixteenth  and even the seventeenth centuries.
In the year 1418, the city of Strasburg was visited by it, and
in addition to the usual tumultuous proceedings,  vast crowds
made pilgrimages to the chapel of St.  Yeit or Vitus.   This
Veit was a Sicilian youth, who suffered martyrdom along with
Modestus and Crescentia, in the year 303, during  the persecu-
tion  of the Christians by Diocletian.  The  legend wants dis-
tinctnesss,  and  its hero  would probably have remained  an
unnoticed member of the  army  of apocryphal martyrs, had
not the  removal of his bones to St. Denis,  and  later,  in the
year 836, to Corvey, conferred on him the dignity  of acknowl-
edged saintship, and when it became a matter of importance
to strengthen the cause of Roman Catholicism among  the Ger-
mans, many  were the miracles performed at the new shrine,
and  St. Vitus ere long had the satisfaction to  be  enrolled
among the fourteen holy " Helps-in-need."   The good people
were made to believe, that according to the legend, previous
to his having bowed his head to receive the decapitating blow,
he had prayed to God that  all who  fasted  the day before his
names-day,  and  properly  observed that,  should be freed
from the dancing disease,  when  a voice from  heaven was
straightway heard, saying, " Vitus ! thy prayer is  heard."
Thus St. Vitus became the patron of all afflicted  with the
dancing disease, just as  St. Martin  de Tours is of those sick
of the small pox, St. Anthony of those who have the  erysipe-
las,  and the holy Margaret of poor women in  the pains of
child-birth.*
   With regard to  the origin of this great epidemic, it may  be
worth while to relate that St. John's or  Midsummer-day had
been for ages—certainly from the fourth century—celebrated
with divers fantastic and extravagant ceremonies, a  precious
jumble of Christian and Heathen rites, in the mystic meaning
of which as much superstition as religion was blended.  The
  * The following charm against St. Vitus's dance, which was long actually car-
ried by an old woman in Devonshire, England, is not without its significancy :

                 Shake her, good devil,
                 Shake her once well,
                 Then shake her no more,
                 Till you shake her in hell. 
1850.]     Smith on Epidemic Religious Monomania.       485

Germans, for example, in spite of the peremptory orders of
the good Boniface, would persist in lighting bonfires  on this
day, or its eve, and holding fast to the old heathen practice
and belief, that such  men or animals as passed through  the
the flame or smoke, would by  this fiery baptism be preserved
during the coming year from fevers and all other diseases, and
the  practice with  its accompanying superstitious notions is
absolutely observed and entertained by many European na-
tions to this day.*   Of these half-christian, half-heathen, festi-
vals, bacchantic dances and licentious orgies—veritable satur-
nalia—-formed an essential part.  We are not in possession of
sufficiently numerous and correct data, on which to found an
authentic history of the origin  of the great epidemic of  danc-
ing  mania, but with  the knowledge of the disease  we now
possess, if we consider that in the first observed cases, the af-
fected  perpetually  called on  the name  of  St. John, we can
hardly  resist the  conclusion that the celebration of Midsum-
mer-day, 1374, which as might  have been expected  when
pestilence had loosed the bands of morality, was probably
accompanied with  scenes  of unusual license, extravagance,
and mental excitement, fired a train which had long been laid
—kindled the flame of a  disease, a disposition to which had
long been ripening.  The reasons  why customs previously
observed  without being followed  by any such  consequences
(that is to a note-worthy  extent, for doubtless they did occur,)
should  on this occasion have given rise to so fearful and wide
spread  an epidemic, is to  be sought in the condition—physical
and  moral—of the people  among whom  it  raged; reeling
beneath the blows  of a  stunning grief,  worn  down by  the
gnawing  pangs of hunger, at best  appeased  with a scanty
meal of insalubri3us food, and feeling a general loosening of the
bonds that held society together;  all  after-effects of the most
fearful pestilence, that ever stalked  abroad and sowed death
broadcast.   Some  of the symptoms described—the anxiety—
meteorism—pains in  the  stomach and bowels, debilitated  by
the use of food of bad quality—point directly to one of the
factors of the disease, in a  way  that  cannot  but strike and
interest the reflecting mind.  The doctors in those days seem
to have altogether resigned  the treatment of the affected into
the hands of the clergy, at least such was the case in the fif-
  * This custom is of the very highest authority, and was common to Jews, Gen-
tiles, Christiansand Pagans,  In the Fourth Book of Kings it is thus written—"An d
Wanasseh built an altar to all the host of heaven, in the two courts of the Lord' s
house,and made his children to pass through the lire, >-S:c." 
486       Smith on Epidemic Religious Monomania.      [Juty

teenth century;  it was reserved for  the great  " medical
reformer" of the sixteenth, that arch-quack Paracelsus, to con-
quer back the disease from the realm of miracles and saints,
and having traced its causes to physical derangements of the
system, to treat it accordingly—indeed he  boasts in his  usual
style  of the number of cures he had performed—and other
physicians followed in his wake.   Their treatment was in ac-
cordance with the notions of the time;  but of a  truth,  the
disease itself  had become  much  milder  in  its character;  the
screaming, groaning, running and leaping, the tympanitic dis-
tension of the abdomen, were no  longer prominent symptoms,
and the desire to  dance but  seldom troubled the sick; it had
become more like the  St. Vitus's  dance  of our times—true
chorea—than the original frightful mania of  the fourteenth cen-
tury.
  While the disease  we  have been describing was still com-
mon,  another  form of it  was observed in  Italy, to which  the
name of  Tarantismus was given, in  consequence of the pre-
vailing belief that it was caused  by the bite of an insect—
the Aranea Tarantula—one  of the largest of the  European
spiders, common in the countries bordering on the Mediterra-
nean, the  effects  of whose bite are even now much dreaded,
and  believed  to  be curable only through the  influence  of
music.  Its venomous  powers have  no doubt  been greatly
exaggerated , but it should notbeforgotton  that there is a case
related in the New York Repository, in which a convulsive
disease supposed to have  been  occasioned by the bite of a
spider, was most effectually counteracted by music.  It  is not
conceivable that any  considerable proportion  of  the  great
numbers affected with  the dancing disease, could have been
bitten by the  spider, indeed the symptoms in those cases which
alone we can allow to  have been true tarantismus, were of a
purely nervous character, unaccompanied with any evidences
of mental derangement.   It  is easy to  detect in the descrip-
tions of the disease which have come down to our times, the
common mistake of attributing all apparently similar effects, to
the same known  and easily comprehended cause, in this case
the bite or sting of some insect or reptile.
   The dancing mania spread from the afflicted to others who
beheld them,  by what we shall call psychical contagion—that is,
through the influence of some emotion, as  fear, sympathy, or
the instinct of imitation, and as  somewhat analagous symp-
toms were known to follow the bite of the  tarantula, ignorant
people saw in all the cases that occurred, what they imagined
to be  the familiar consequences of a  familiar  cause.   The 
1850.]     Smith on Epidemic Religious Monomania.       487

extreme improbability of so many individuals being bitten by
the spider, however,  probably  led to the conjecture that the
bites  or stings of other insects or reptiles might produce the
same effects;  hence we find even learned men accusing rep-
tiles, and of these not only the  Lacerta Gecko, but the L. Steliio,
both most harmless fly-catching lizards.
   The more violent  symptoms  really produced by the poison-
ous bite of*the tarantula, lasted but a few days—from four to
fux—^nalogous  to  what is observed of the effects following
the bites of our common venomous reptiles, when such do not
prove fatal, as the  adder, the rattlesnake, &c, but when the
first more violent symptoms had subsided, they were said to be
followed by  a peculiar melancholy,  under the influence of
which the persons affected sought out solitary places—grave
yards and the like—and there  laid themselves out as if they
were dead, howled like dogs, groaned and sighed, leaped and
ran wildly about, rolled on the ground, stripped themselves
wholly, or otherwise  exposed their persons, assumed indecent
attitudes, expressed a liking for or a dislike to particular col-
ours, or were never better pleased than when soundly  drubbed
on the "breech, heels, feet, or back.  Now an attentive perusal
of the descriptions  of Baglivi, Sauvages, and others, reveals a
striking discrepancy, not hitherto noticed we believe, yet once
recognized, enabling us to see our way far more  clearly in our
nosographic researches.  Baglivi says, that "when  any are
stung, shortly after it they fall upon  the ground, half dead,
their strength and senses going quite from them.  Sometimes
they  breathe  with a great deal of difficulty, and sometimes
they  sigh piteously;  but frequently they lie without any man-
ner of motion,  as if they  were  quite dead.  Upon  the first
sounding  of  the music the forementioned symptoms begin
slowly to abate ; the patient begins to move his fingers, hands,
feet,  and successively all parts of the body; and as the music
increases their motion is accelerated ; and, if he was lying up-
 on the ground, up he gets, {as  in a fury,) falls a dancing,  sigh-
 ing, and  into a thousand  mimic gestures.  These first and
 violent motions continue for several hours, commonly for two
 or three.  After a little breathing in bed, where he is laid to
 carry off the sweat, and that he may pick up a  little  strength,
 to work he  goes again with as  much eagerness as he did be-
 fore, and every ,day  spends  almost twelve hours by the  clock
 in repeated  dancing ; and, which is truly wonderful, so far is
 he from being  wearied or spent by  this vehement exercise,
 that (as they say) it  makes him more sprightly and strong.
 There are, however, some stops made ; not from any weari-
•aess, but because they observe the musical instruments to be 
488       Smith on Epidemic Religious Monomania.      [July

out of tune ; upon the discovery of which, one would not be-
lieve  what vehement sighings and anguish at heart they are
seized with ; and in this case they continue till the instrument
is got into tune again, and the dance renewed.   This way of
dancing commonly holds four days, it seldom reaches  to the
sixth."
  According to the above description, the patients very soon
fall into a  condition analogous to that caused by the bite of
venomous serpents, from which state they are at once aroused
by music, and by after violent exercise with profuse sweating,
and intervals of profound repose,  are cured of their  disease.
Reasoning a priori, we should have said that such a method of
cure would be  very likely to prove successful in such a case.
  But let us see what the same author says in another place :
  " A few hours after the bite, the patient is seized with a great
difficulty of breathing, a heavy anguish of heart, and  a pro-
digious sadness," &c.   The malady, "after the sharp fit of the
violent symptoms,  which appear for the first days, is over, ends
at last in a peculiar kind  of melancholy which continually
hangs upon the sick person, till  by dancing, or singing, or
change  of age, those violent impressions are quite extirpa-
ted."   Again,  he  states that the disease like  the  German
chorea Sancti Viti, returned  about the same time of year that
the patient was stung; and seems much at a loss to under-
stand either how it was produced, or in what manner it was
cured.  He appears inclined, indeed, to account for Ihe  latter,
by the profuse sweatings induced by the violent exercise ; but
he admits that  the physicians could not  cure it by artificial
sweatings.   Sauvages, a great nosological authority, appears
to have suspected  that some error had been committed either
in observation,  or at all events in explanation; for he begins
by giving the  opinions  of authorities up to his  epoch, (they
are before the reader,) and then very distinctly says, " several
experiments have been made at Rome, with the tarantula; its
bite causes pain,  the parts  swell and become lividr and in a
few days the tumour is covered with a blackish scab.   These
symptoms  are  accompanied with sighing, cardialgia,  or op-
pression, at the heart, and afterwards pains in all the articula-
lations ; but no one has ever observed that those bitten have
danced,  or  evinced  any desire to dance.  They have been
cured by the use  of the ordinary diaphoretics."  Again he
shrewdly remarks, " no author mentions tarantismus before
the fifteenth century, although the tarantula was known long
before.  There are numbers in Sicily, Malta, Africa, and the
Southern provinces of Apulia."  However, we think he goes
too far when he asserts, that the effects of the bite of the tar- 
1850.]     Smith on Epidemic Religious Monomania.        489

antula have nothing in common with the disease called taran-
tismus, an  assertion which, taken along with  the context,
shows  that he did not recognize the possibility of any convul-
sive affection being  produced by such wound, of which we
have not only sufficient evidence, but the occurrence ought not
to strike any one as  more singular, than the phenomena of
tetanus or hydrophobia.  We must remember, that both the
true and the false tarantism, were—perhaps, only—certainly
in a very large majority of cases—observed during the warm-
est part of the year, indeed the author we have now before us,
says " heat  alone suffices to cause the disease, in those who
are predisposed to this species of madness."
  We  should have been inclined to wonder that the eyes of
the acute  Baglivi had not been opened by the observation he
makes, that tarantism would return annually, about the same
time of year that the  patient was  bitten, (although it is on
record that  the great  majority of those affected with the dis-
ease, had no recollection whatever of ever having been bitten,)
were we not aware of the  prevalence of a  popular  delusion
of much the same character with regard to the bite of venom-
ous serpents  in general, and the rattle-snake in  particular.
No one can  have any  difficulty in believing that the dancing
mania returned at about the same annual periods, who is fa-
miliar with  the natural history of that class of diseases, indeed
Baglivi appears to have been struck with its resemblance to
the German chorea Sancti Viti, in that respect.  He appears
also to have been  ignorant of the most ordinary phenomena
produced by the veritable bite  of the big spider, and that the
symptoms were relieved by the use of ordinary diaphoretics,
or he would hardly have failed to have been strnck by the ex-
ception to  the rule in the case of the dancers, whose cases
prove  refractory under the use of such medicines, but yet are
cured, as he is inclined to believe, by the sweating consequent
on their violent exertions.
   To these  three varieties of the  same disease—the dancing
mauia of the fourteenth century, the chorea Santi Viti of the
Germans, and the tarantismus of the Italians—we have to add
a notice of some other minor manifestations of related affec-
tions.
   In some  parts  of  Scotland, as  Forfarshire,  Angus-shirc,
Orkney and  Shetland, a disease known  by the name of the
" leaping ague" is endemic.  It is characterized by an irrisis-
tible  propensity  to leap or to run straight forward, without
stopping, sometimes for incredible distances.  " Those affected
first complain of a pain in the head,or lower part of the back,
to which succeed convulsive fits,  or fits of dancing at certain 
490       Smith on Epidemic Religious Monomania.      [Juty

periods.  During the paroxysms they have all the appearance
of madness, distorting their bodies in various ways, and leap-
ing and springing in a surprising manner, whence the disease
has derived its vulgar name. Sometimes they run with aston-
ishing velocity, and often over dangerous passes, to some place
out of doors, which they have fixed on in their own minds, or
perhaps even mentioued to those in company with them, and
then drop down quite exhausted.  At other times, especially
when confined to the house, they climb in the most singular
manner.  In cottages for example, they leap from the floor to
what are called the baulks, or those beams by which the rafters
are joined together, springing from one to another with  the
agility of a cat, or whirling round one of them with a motion
resembling the fly of a jack."   It is remarkable that the mus-
cular motions, though  in  a great degree involnntary,  are
performed with extraordinary agility and exactness, the affected
performing feats which surpass those of professed  tumblers,
balancing the  body with correctness, and dextrously avoiding
dangers, in which this disease  differs  very remarkably from
our modern  chorea.  The leaping ague—so called from its
paroxysmatic character—is propagated by imitation,and seems
to be accompanied with much  less aberration of mind, than
the disorders already mentioned.
  In the  epidemic which occurred in the Western districts of
America about the year 1800, accordingto Dr. Robertson, who
published an account of it in his inaugural essay, influenced
by religious  enthusiasm, new converts to the faith indulged in
alternate fits of coughing, laughing, singing, shouting, and
extravagant and violent gesticulations, until at length, to their
own astonishment,  they  continued to act from necessity  the
curious  character which they had commenced from choice, and
were sometimes thrown on the ground, where for some time
the motions resembled those of a live fish when thrown upon
land, more than anything  else.   By degrees the more violent
convulsions  subsided  into chronic chorea-like  movements.
But similar phenomena have been so common at revivals and
camp-meetings, as to need no further notice, except to call at-
tention to the evidence of propagation by psychical contagion
already  alluded to, which is afforded by the fact that children
who happen to have witnessed such scenes, are attacked with
similar disorders,  although incapable  of comprehending  the
feelings agitating  the bosoms of their older companions,  and
often have  retained for life incurable nervous  affections, em-
bittering their  very  existence.   The Jumpers  also,  a sect of
Methodists founded by two fanatics in the year 1760, present
scenes at their meetings, which if possible exceed in extrava- 
•]     Smith on Epidemic Religious Monomania.      491
 gance those of the French convulsionists, at the  tomb of a
 priest of the name of Paris, in the church-yard of St. Medard.
 " Ihe excesses of these last mentioned were carried to so fear-
 ful an extent, and their religious ceremonies were so debased
 by obscenities, that the police was obliged to interfere, and
 forbid these detestable  practices;  hence it was affirmed that
 the following somewhat impious notice was suspended over
 the church door:
               De par le Roi, defense a Dieu,
               De faire miracle en a lieu.
 The king was Louis XV.
   There are quite a number of anomalous forms of convulsion,
 bearing  more or less marked resemblance to that of the mad
 dancers.  Occasionally there have been movements uninflu-
 enced by music,  occasionally the patients  are haunted  by a
 certain tune, irrisistibly compelling them to dance.  Majendie
 describes a very extraordpnory case, in which the body of the
 sufferer was thrown into every conceivable contortion, but he
 never lost his balance, nor fell down.   In such cases there has
 been pain in the head, often  excruciating, sometimes in the
back,  occasionally when the patients were women in the
 uterine region ; and  in one case where there  was no  pain,
 there was intolerance of light.  " Three cases, occurring in one
 family in the county of Rutland, are related by Dr. Armstrong,
 in the ninth volume of the  Edinburg Medical Commentaries,
 in which the patients were affected periodically and suddenly,
 with fits  of shrieking, jumping, writhing,  &c.  The disease
 first occurred after hooping-cough, and Dr. Armstrong consid-
 ered it epileptic."  These cases were cured for the  most part
 very quickly by means of local depletion  and counter-irrita-
 tion ; one case which had proved obstinate under treatment,
yielded at once to a spontaneous diarrhcea.

  We shall now proceed with the history of the Swedish epi-
 demic, and commence with the mry first case that occurred.
  Case 1.   A  yeoman's  daughter, living at Alsarp, in the
parish of Hjelmseryd, province of Ionkoping, Lisa Andersdotter
 by name, 16 years of age, of good constitution, and who had
from childhood enjoyed good health, began to suffer  from gas-
tralgia and hemicrania, in the early part of May,  1841, and
these symptoms  steadily increased for six weeks.   She had
been bled several times, venesection being much in fashion in
the neighborhood where  she resided.  About Midsummer ob-
stinate hiccup,  and clonic spasms, especially of the arms and
shoulders, came on,  with,  at times, attacks  of dyspnoea,  so 
49)       Smith on Epidemic Religious Monomania.      [July

severe, that by the 26th of June her life was thought to be in
danger.  It was now observed that the  spasms returned in
paroxysms daily, and she became so weak as to be obliged to
keep her bed, and when able employed herself chiefly in read-
ing her  bible,  hymn-book, and other works  of a religious
character.  Her friends supposed her to suffer from Raphania,
Cereal Convulsion or Ergotism, a disease quite  common some
years, and which  had  been epidemic in the neighborhood
but a short time before, and therefore contented themselves
with asking the advice of an old wiseacre, having no real pre-
tentions  to medical skill.  She had  neither shown signs of
melancholy, nor of exaltation.  Towards the end of Septem-
ber, she began to sing psalms, by her own account involunta-
rily, and  the instinct to do so soon became so powerful, as to
leave her scarce time to eat.  At the very first  she only hum-
med without any set tune, but by degrees began to sing words
to real melodies, and at last her  voice became clearer and
stronger  than in her healthy state.   Two  weeks after this, she
began to preach, at first at long intervals, afterwards at short-
er, but never when alone.   She was now believed by the  people
to be, as she herself asserted, inspired by the Holy Ghost, and
crowds of the curious came to hear her sermons and prophe-
cies,  and their  admiration and blind faith so  stimulated her
desire to preach, that such paroxysms of sermonizing attacked
her several times a day, especially of an evening, and on  such
occasions she became so excited, that bathed in perspiration
she persisted until she fell back utterly exhausted.  She often
fell into  a state of incomplete syncope, and sometimes into  a
condition resembling magnetic sleep, during the continuance
of which, she was supposed to be receiving revelations  from
above, and out of which she waked up with violent spasms,
and  began to preach in the name of God the Father, God the
son,  and God  the Holy Ghost.  She preached about conver-
sion, regeneration,  against the sins of pride,  intemperance,
and  so forth, with now and then extravagancies about the day
of judgment.  All that she said, was by her account, inspired
by the Holy Ghost, she could neither  add nor take away one
iota.  Between the attacks, she was perfectly calm, sane, and
good-humored ; showing no trace of delusion, and conversing
very rationally even about her own condition.   She observed
that her  sufferings were so  severe during the paroxysms, that
certainly no one would wish to be in such a state ; that it was
not clear to her, whether  her  condition, was  the result of  a
special divine interposition, or was only disease ; at the same
time she expressed no desire to get well, but said  she was con-
tent as God willed it.   On the 13th of November, she prophe- 
1850.]     Smith on Epidemic Religious Monomania.       493

cied that she should preach for the last time, just one week
after, and would soon afterwards die, and she named another
girl of  thirteen,  upon  whom her  mantle was  to descend,
that is to  say who  was  to  continue the preaching.   So
much of this prophecy  as relates to  the preaching, came
true,  insomuch that she  really  did  cease  to  preach  af-
ter the 20th of November.   However she not  only continued
to live, but the spasms continued as before ; indeed Dr. Carl-
son  found  her still  in  bed on the 11th of April, 1842, still
subject to the most violent contortions, grimaces,  and twitch-
ings,  although in  other respects apparently  healthy, being
fleshy, in good spirits, and all her functions properly discharg-
ed.  It was observed that she did not now loose consciousness
during the most convulsive paroxysms ; whereas at an earlier
period it had been remarked that in proportion as these dimin-
ished, and the general health improved, so had the instinct to
preach been developed.   One of the very excellent physicians
who have given us reports of this case, considered that gastric
derangement had been produced by the combined influence of
cold, damp,  and improper food; that  a hysterical condition
existed  perhaps  from some ovarian excitement connected
with the period of evolution, and that want of force of char-
acter, together with  the belief of herself and her neighbors,
that she was inspired of heaven, had occasioned the extraor-
dinary developement of the psychical phenomena.
   Both the sister of Lisa, 18 years  of age, and also the girl of
13, that Lisa named as her successor, were afterwards affected
in the same manner.
   Case 2.   Johanna  Persdotter, 16 years old, had always been
wilful, disobedient and  idle.  When compelled to do  her  les-
sons, used to throw herself on the ground, bite  the grass or
her clothes, and fall into convulsions, all of which was  cured
with a sound  whipping.  She was  attacked with symptoms
 similar to Lisa's, but not so violent.  This girl, who was good
 looking, with very pretty and lively eyes and fresh color, when
 she waked up from the trance-like  condition, was in the habit
 of seizing a  lighted  candle, and passing it rapidly about her
 face, now glowing with  excitement and apparent  inspiration,
 so as in the  words of the physician who related her case, to
 produce quite " a mystic, bewitching effect."   Her voice was
 soft, sweet,  remarkably agreeable; but her sermons, which
 lasted but from five to ten minutes, were a mere jumble of the
 most common-place phrases.  This girl afterwards  travelled
 about the country preaching, and at every place  at which she
 stopped, left a number of similarly affected. 
494       Smith on Epidemic Religious Monomania.      [Juty

  Case 3.  LottaOsterlund, 16 years of age, after having only
once seen and heard another already affected, was first attack-
ed with chorea-like spasms in the upper and lower extremities,
after which she began to preach, saying that she was inspired,
and had received revelations from above.   Her violence was
extreme, and if her hearers were not sufficiently attentive, the
spasms in her limbs and countenance became horrible to wit-
ness; she jumped and gesticulated,  while  screaming out her
anathemas at the top of her voice, until she fell down exhaus-
ted, when she lay in a sort of trance for the space of half an
hour, and immediately on waking up, again began to preach
such things as she  said had been revealed to her during her
trance.   Inflammation of the brain afterwards came on, she
narrowly escaped with  her life,  and at the latest date up to
which we have any accounts, her mind had not fully recovered
its normal condition, and she had lost all memory of every
thing that had  occurred from the commencement  of  her
preaching mania.
  Case 4.  The girl Hedda, 14 years old, of good constitution,
lively and good humored, had  heard Johanna  Persdotter
preach.   One Sunday afterwards, as she was reading the bi-
ble, she was attacked with spasms  in her arms, accompanied
with an agreeable sensation.  She lay down, when the move-
ments became slower, and she fell into a trance-like state.
The spasms afterwards returned daily, and in due time follow-
ed preaching.  In this case  the spasms  came  on  whenever
any one  mentioned anything sinful or if any idea of the sort
crossed  her mind.  She enjoyed otherwise the best possible
health, and was very  happy at what she considered her good
fortune.  Her whole  appearauce was  that of a person in a
state  of unusual agreeable excitement.   She  was  perfectly
cured by ten  days treatment in the Provincial Hospital, when
this excited appearance passed off entirely.
  Case 5.  Inga Lena, considerably  older  than either of the
foregoing, had been  anathematized by one of the preaching
women, took  it to heart, became disturbed in mind, and began
to creep on her hands and knees, as she said to humble herself
and find grace.  This woman soon became wholly insane, and
was not restored to health at the last accounts.
  Case 6.  Hallberg, a schoolmaster,  had been in constant
attendance on Johanna Persdotter, night and day for five or six
weeks ;  at last he began to have slight spasms himself, looked
wild, and his  eyes were brilliant, preached in a loud voice, but
when he caught  the  doctor's  eye  steadily fixed on him, he
stammered,  and  abruptly   closed  his  discourse  with an
" Amen!" 
1850.]     Smith on Epidemic Religious Monomania.       495

  Cask 7.  Inga Stina, domestic, 27 jears old, preached seve-
ral hours at a time, at the very top of her voice, with violent
gesticulations.   She  called  down curses  on the heads of all
who did not believe on her.   The  physician who relates her
case found on examination, that she was perfectly insane ; she
had not had any of the chorea-like symptoms, but had suffered
from anxiety and sinking at the pit of the stomach, with con-
siderable  dyspnoea.   Her general health had  been very bad
for a number of years, and she had been much troubled with
gastrodynia.   With a mere  modicum cf religious knowledge,
she had lost no  opportunity  of hearing  a fanatic clergyman,
whose ranting discourses  had finally upset her reason.   Not
the less had  she  abundance  of followers, and it was really
melancholy to see crowds  of people, so debased as to kneel in
the snow at the feet of raving lunatics.
  Our space has only permitted us to give a mere abstract of
these seven easel; we believe, however, that we have presen-
ted our readers not only with the prominent features of each
case, and above all of the  first case which  occurred, but with
fair  specimens  of the different  varieties.   The disease was
mainly confined to those of from sixteen to thirty years of age;
however, it was not only by no means uncommon in children
of from six to sixteen,but even occasionally attacked the aged.
The plurality of the  affected were women, and it is worthy of
note that the men did not  succeed  in making snch an impres-
sion by their preaching  as the women,  perhaps because they
were rarely capable of such extravagant demonstrations. The
disease, although mostcommon among the yeomanry, was seen
now and then in the more highly educated classes.  In  some,
the somatic, in others the  mental phenomena were most stri-
king, a few cases were marked by the total absence of the one
or the other group.   In the mildest cases, those affected were
able to control the symptoms, or to prevent their occurrence
altogether, by a powerful  exertion of the will; but in severer
forms of the disease, such exertions of the will were unsuccess-
ful, and in common with all other attempts to repress the out-
break  of the  paroxysm, seemed  only to exasperate it,  and
occasioned its protraction weeks or months.  All receive^the
disease by what we have already termed psychical contagion,
that is by seeing or hearing another affected with it; no one
is known to have  acquired it in  any other mode, except the
first affected, who may be  fairly said to have read herself into
it.  It was indeed vaguely rumored that some had sickened
after hearing a lively description of the  exciting proceedings
at these preaching bouts, but the physicians who were in the
midst of the epidemic do  not credit the story.  The number 
 496       Smith on Epidemic Religious Monomania.      [July

 attacked is not known with any certainty ;  but mnst at least
 have reached several thousand; three hundred observed cases
 were reported to the college of health by the provincial medi-
 cal officers.  Like most epidemics, this one also attained its
 maximnm of developement by degrees, and then slowly decli-
 ned,  The crowds who greedily swallowed the nonsense which
 these often half-naked girls uttered, (for their so-called preach-
 ing deserves  no better name,) took their part against all the
 first attempts of the clergy and the physicians to put a stop to
 the evil; and several of the  latter  mention hair-breadth es-
 capes from the violence  of the mob; Johanna Pehrsdotter,
 indeed,  appears  to have saved the  life of one  of them, by
 restraining the fanatic  crowd, for which he expresses himself
 duly thankful.  One  would have expected that none but the
 most illiterate and superstitious,  taken by surprise, would
 allow themselves to  be deceived by mad  proceedings that
 would not bear a moment's serious examination by the light
 of religion or  of reason;  and yet  the folks (many of whom
 bore a character  for  unusual  good  sense,) to the  number
 of, not hundreds, but thousands, filled and surrounded the hut
 in which a little chit of a girl, or a mad servant wench sawed
 the air in a paroxysm of mania, and reverently listened to the
 veriest ranting rubbish that ever insulted human understand-
 ing, driving away with violence, with clubs  and stones, the
 minister of the  gospel who would enlighten their miserable
 darkness, the physician  who came to heal the sick, or the ser-
 vant  of the state, who would bid them respect the majesty of
 the law.  The rector of one parish, after being severely beat-
 en, only escaped with his  life by the swiftness of his horses.
 One of the reporting physicians, was twice severely handled for
 attempting  to observe the sick more narrowly, and only suc-
 ceeds at last, by  the aid of a bodyguard of between twenty
 and thirty stout fellows, who were personally attached to him.
 He describes a scene in one place where, in a miserable hut,
 a dozen mad-men gave  their  feelings full swing, barking like
 dogs, howling like wolves,  hopping, jumping, dancing, rolling
 on  the floor; now praying, now crying; the tears running in
 streams down their cheeks ; they were crushed to the  earth
 by unbridled  and exaggerated emotion.  One would think this
 description was  taken  from  Dr.  Robertson's history of the
 American epidemic of 1800, already quoted, so exactly do they
 tally.
  Although in  the majority  of cases, no premonitory  stage
 could be detected, but the disease burst forth at once, a true
stadium prodomorum was nevertheless occasionally observed,
in the form  of anxiety, oppression, inquietude,  sensation of 
1850.]      Smith on Epidemic Religious Monomania.       497

weight  or absolute pain in the head and limbs, dyspnoea, loss
of appetite, cardialgia, tendency  to  more or less  complete
syncope, a general sense of sickness, loss of the power of will
over the voluntary muscles, disinclination to  labour, irritable
temper,  wilfulness, &c, with  shifting color, and change of
expression of the eyes, they commonly becoming very bright.
  The breaking out of the  disease  was marked by the spas-
modic movements, the ecstatic condition, and the irresistible
propensity to declaim on religious subjects,—or as the people
called it, to preach.
  The spasms consisted principally  in violent twitchings of
the muscles of the face, trunk and  extremities, oftener of the
shoulders,  sometimes frightful, at others irresistibly ludicrous,
occasionally in hops and leaps, sometimes  so  violent  as to
throw the patient from the chair  on  which he was sitting or
the bed upon which he was lying.  But nothing like the half
paralytic symptoms of ordinary  chorea were observed.   Any
thing which was offensive  to the sick, occasioned or increased
the  spasms.  A word dropped  in conversation, and in itself
innocent, might strike some chord, which the fantasy of the af-
fected  person caused to  vibrate in sympathy, and produce an
immediate  paroxysm.  For the rest,  the spasms returned at
uncertain periods, most frequently when wondering strangers
were present, seldom when the patient was alone, very rarely
during sleep.
  The functions of the system were but little interfered with,
appetite, dejections, sleep,  &c, Sec, were normal; the parox-
ysms however, were followed by considerable sense of fatigue,
weakness  and  debility.    Several  degrees of severity were
observed, practically we  need only mention  two—the milder
and the more severe.  Both were marked by the same spasms,
the same preaching mania, the same belief in the direct influ-
ence of the Holy Ghost.  That may be  properly styled the
severer form in which the trance-like condition was  most per-
fectly marked, or  the state of unconsciousness of an external
world, during which they might laugh, sigh, clap their hands,
and so on, but it was in one or other of these states, that they
had their visions—visions in all cases of  the same character,
namely, of  heaven or hell, angels or demons, &c, just as the
desire to declaim, always found a vent in what we may call a
rhapsody of religious commonplaces.  It would be evidently
wrong to  consider  those  cases  of  mania,  melancholia, or
dementia,  in which the  preaching-disease sometimes ended,
as a higher degree of the same ; the two laving  really little in
common, the original and distinctive characters of the prima-
     32 
Smith on Epidemic Religious Monomania.
 tv disease, being merged in another chronic mental disorder,
 displaying its  characteristic symptoms.
   It is well to  understand distinctly that this, like many similar
 preceding epidemics, was marked by two prominent groups of
 symptoms, the somatic chorea-like spasms, or involuntary mus-
 cular  movements,  and the psychical, namely the state of cat-
 aleptic ecstacy, and the irresistible desire to declaim on those
 subjects which occupied the mind during the ecstatic seizure.
   The therapeutic  means employed, varied somewhat accor-
 ding to the views of the different physicians with regard to the
 real nature of  the disease; the remedies may however, all be
 classed under the heads of antiphlogistics, antispasmodics, or
 narcotics.  The listcomprises depletion, generaland local—de-
 rivation, by means  of vesication, pustulation, or rubefaction—
 calomel, saline purgatives, nitrate of potassa, borax—oxide of
 zinc, assafcetida, castor, &c.—camphor, opium, and extract of
 stramonium.   It would be a waste of time to particularize, to
 dwell  on  the  accidental  complications, in  the  treatment of
 which such a  battery of remedies might have  been  wisely
 employed according to the indications, but we have our scru-
 ples as to their fitness in uncomplicated' cases.  Nevertheless,
 one effect of treatment, whether antiphlogistic, antispasmodic,
 narcotic, or what not, is of too great importance to be passed
 over so lightly, we mean the psychical.  When the patient who
 believes himself and is believed by others, to be  the favoured
 of heaven, possessed of a demon, or in some way or other
 under the influence of unearthly  powers, to which resistance
 would  be impious or vain, finds himself treated  as one sick—
 diseased—sooner or later he will come to the conclusion  that
 he is sick, and the moment that  conviction forces itself upon
 his mind, he is  half cured, the most important  symptom—the
 belief in superhuman influence—is relieved.  We should very
 frequently, beyond all question, effect a cure without the ad-
 ministration of one  single dose of medicine, by simply allow-
ing the affected person to continue his preaching unrestrained,
but removing his gaping audience, and letting him understand
that he was  considered sick,  and his visions and prophecies
merely the delusions and delirious ravings of a sick person—
this plan was indeed eminently successful.
  In the absence of post-mortem examination, and reasoning
from the phenomena  observed in analogous cases, there ap-
pear no grounds to suppose  the  existence  of inflammatory
action in any part  of the  cerebo-spinal system.   There may
be, doubtless is, some physical change or another necessarily
connected with the  disturbed mental  and nervous manifesta-
tions;  for we cannot conceive a deranged function, without 
1850.]
Smith on Epidemic Religious Monomania.
499
 physical change in the  organ which performs that function,
 although in this and parallel cases, it is of a kind that has
 hitherto escaped even modern microscopic investigation ; and
 we think it would hardly be worth the while  to search in our
 Materia Medica for a medicine to cure—religious ecstacy.
   The confining of the disease  to a certain class, shows that
 certain predisposing causes must have been in existence; these
 may have been physical or psychical, or both.   We  will com-
 mence with drunkenness; and here we must  quote Dr. Son-
 den's essay, lest we be thought  extravagant in our language.
   " Physical and psychical excitement, and both to an unusual
 extent, are the result of  the contest between the lust for strong
 drinks and the newly awakened temperance movement, com-
 bined with fanatic  sectarianism.  We  see on the one side a
 low and sensual passion for intoxicating beverage, paralysing
 the powers of body and  mind, lowering the standard of moral-
 ity,  destroying order, thrift, and the welfare of families, anni-
 hilating all feelings of honor and virtue, and finally debasing
 its slave below the level of the brute.  We see on the other
 hand,  stern preachers of temperance, fanatic teachers and
 sectarian apostles, who with the pains and penalties  of religion
 and the law, or with  blind superstition  and false  tenets,  now
 seducing, now intimidating, wake up in terror the slumbering
 conscience, and the smothered feeling of forgotten or despised
 religious and moral duty.   The poor heart becomes a prey to
 the most opposite feelings and desires;  and if self reproaches
 and regrets do not,  with their rending pangs, occasion insanity
 so often as we might expect, but rather degredation, ruin and
 misery, they are yet so agitating  as, with the aid of coin-
 ciding tendencies, to tear asunder the guiding reins  of reason,
 and to substitute the groans of despair and the shouts of insan-
 ity."  The  foregoing extract paints the condition  in which
 numbers were placed previous to and during the continuance
 of the epidemic, and the  causes of that condition.   There can
 exist no doubt as to the powerfully  predisposing effect of such
 a condition.
  To this must  be  added the influence  of food of bad quality.
 The crops had failed two years in  succession, and the  most
 important  article of  the people's  food—bread—was  both
 scarce and anything but good.   No  one  will  deny that un-
 wholesome and  insufficient food will lower the vital powers,
 directly occasion disease, or, which is of the greatest impor-
tance to this investigation, induce an unusual susceptibility to
the injurious effects of both physical and  psychical causes of
disease.  Many physicians indeed, persisted in attributing the
epidemic to the poisonous influence of foreign ingredients in 
500      Smith on Epidemic Religious  Monomania.     [July

the rye which almost exclusively constitutes  the bread-corn
of that part of Sweden, mainly to ergot, which was  particu-
larly common during the years in question.   But independent
of the fact, that minute examination detected no foreign in-
gredient of poisonous character in the corn, except ergot, there
is  no substance we are  acquainted with, possessed  of the
property of occasioning religious mania.  The idea, doubtless,
had its origin in the circumstance that Raphania had been
epidemic of late years in those parts, and in consequence of
the spasms common to both diseases, they actually were at first
confounded.  That the injestion of spurred rye will  produce
disease, there is no doubt,  but  that disease is not religious
mania.
  We have no observations on meteoric phenomena, from which
to draw any conclusiions as to the  predisposing effects of
weather  and the like, their  absence, however, is probably of
little importance.
  It has already been mentioned that the age of the majority
of those  affected,  was from 16 to  30 years; the next largest
class included children of from 6 to  16, and a small number
were over the age  of 30, or  were old people.
  With regard to sex, girls and young married women consti-
tuted a very large  majority; and in respect of constitution and
temperament, no conclusions can be drawn.
  The psychical causes we think more interesting, and, as being
less generally understood, more important than any of those
we have been considering; and first of Education.
  Education  among the people who were the subjects of this
disease, with the exception  of religion, was confined to the
business  of life, the mere mechanical  performance  of daily
labor. Religion is the  only  field in which the imagination of
such folks finds room to roam; and one thing is certain, that
even  where no false prophets disturb the balance of the mind,
the religious knowledge they do possess is so scant as  to leave
abundant space for unbelief, superstition and fanaticism. We
must remember too, that ignorance leaves people without a
guide, allows them to  entertain the most absurd ideas on all
subjects where common sense, or the positive doctrines of re-
ligion, are not sufficient to enlighten and to guide them.  Add
to this the  historical fact, that phenomena  of the nature de-
scribed, have always been observed among the least educated,
as was the case in Sweden, and another historical fact, name-
ly, that in the  portion of that  country in which  the disease
arose and spread, the minds of the people had for a consider-
able time been disturbed by the  prelections of sectarian and
fanatic priests, and by the reading of inflammatory pamphlets, 
1850.]     Smith on Epidemic Religious  Monomania.      501

while there is too much reason to fear  that the duties of the
regular ministry, in spreading a knowledge  of true religion,
and in the religious care of their flocks in general, had been
sadly  neglected.  From similar causes, similar consequences
have followed on several prior occasions, although the disease
never took on so serious an epidemic form.  Fifty years before
a number of persons  had been sent to the insane asylum at
Danvik, afflicted  with the "preaching  madness," of whom
only one recovered,  the others  remained incurably insane.
They  were sent to the asylum in order to stop the spread of
the disease ; a measure that proved perfectly successful.  Since
then, different parts of the country have at times been troubled
with partial  outbreaks of religious fanaticism, which if they
did  not merge into mania, were  very near it, having lead  to
naked dances, public  baptism in rivers, unbridled intercourse
between the sexes, &c.  Not without interest, are some of the
remarks of Deacon Ponten, who has been in the habit of treat-
ing insane, in his own house, for upwards of 40 years, and
lives just in the  very neighborhood of the place where the epi-
demic broke out.  He  says : " I think I have observed, that of
late, insanity has  more  commonly been caused by the influ-
ence of the mind, M'hereas 20 or 30 years  since, the contrary
was the rule.  The number of those affected with insanity, is
decidedly on the increase of late years," which he attributes
to the influence of fanatical preaching, and the  physical dis-
eases caused  by the abuse of  alcoholic drinks.   He observes,
that if an evil-minded person  be roused to repentance by a
ranting  priest, he  is very apt to become  a prey to a lasting
melancholy and anxiety, and to  be seized with  what the doc-
tor aptly calls " panophobia."
  An ignorantpeople, a prey to the malign influence of the pre-
disposing mental and  physical causes of such disease,  would
not require much additional impulse, to be driven on to abso-
lnte insanity; and this impulse was given, when a young girl,
rendered extremely excitable  and susceptible, by the effect of
a tedious chronic nervous affection, after much reading of the
bible and of  other religious books, fell into a  state of catalep-
tic ecstacy.   The disease spread like a prairie fire, among the
excited people,  numbers fell into the same condition,  many
suffered in different degrees, and almost every one felt the in-
fluence of the epidemic, even if not drawn into its vortex.   It
is rare indeed, as it appears to us, that the causes of a psychi-
cal disease, have been  so clearly displayed.
  If by the continued study of  religious works, giving free
play to the imagination,  and abandoning the  guidance  of the
understanding, a person becomes deranged—or if the same lot 
502       Smith on Epidemic Religious Monomania.      [July

befall a poor sinner, led by his newly awakened conscience to
despair of salvation—no epidemic dates its origin from their
visitation, none are affected  by psychical contagion, provided
those who come into contact with the sick, have not been pre-
disposed to the same affection, by having been exposed to sim-
ilar influences.  Were it not so, a whole nation might be in-
fected by a single maniac.   For a disease  to prove epidemic,
predisposition  in those who surround  the sick, is  commonly
necessary, and here we have a concatenation of circumstances
—suffering from want, food  of  bad quality as well as insuffi-
cient, intemperance, and the effect on the  minds of ignorant
and sensual people, produced by a narrow and one-sided study
of religious works, and the ranting declamations of fanatics—
those of a physical nature aiding, those of a psychical of  ne-
cessity ending, in the production of a morbidly excited state of
mind, constituting a predisposition to religious insanity, without
the existence of which no such  disease as  the one under con-
sideration, could ever appear as an epidemic.  Such predispo-
sition must have existed previous  to the celebration of St.
John the Baptist's day, in 1374, after the outrageous excesses
and  bacchanalian orgies of which, the dancing-mania burst
forth a frightful moral pestilence.
  The nature of the disease, and therefore its appropriate name,
have both given  rise to much  inkshed.  Its synonymes bear
witness to the  different views which have been held  on  the
subject; Enthusiasmus, Galen;—Saltus Valentini 1. Viti, Pla-
ter ;—Chorea  Sancti Viti, Sennert and others;—Melancholia
Saltans,  Sauvages;—Ballismus,  Svediaur,—Tanzwuth, (St.
Johannis, St.  Veits Tans,)  Hecker;—Daemonomania, Brous-
sais; Theomania, (Mai de St. Jean,) Esquirol;—Religious Ecs-
tacy, Sonden.   The following names have  been applied indis-
criminately to  this disease, to some of its varieties, and to very
different ones :  Scelotyrbe,  Tarantismus,  Carnevalette delle
donne, Scelotyrbe Festinans, Hieranosis, Choreomania,Orches-
tromania, Chorea  Sti Modesti, Epilepsia Saltatoria, Dans de
St. Guy, Leaping Ague, ond some others.
  A little  investigation and reflection suffice to show, that in
their observations and the conclusions drawn from them, some
have only paid attention to the physical phenomena, and then
applied  the term " chorea," or its equivalents, to the disease;
others, on  the other hand,  have exclusively considered  the
mental,  and hence the terms " Theomania,"  " Demonoma-
nia.n
  We shall never, medically speaking, acquire any real know-
ledge of the nature of mental diseases, until  we learn to con-
sider man as one whole—body  and soul—duality in unity; 
1850.]     Smith on Epidemic Religious Monomania.       503

and receive as an axiom, that somatic and psychical phenom-
ena  never occur independent of each other.  It is true, that
under different circumstances, now the  one now the other pre-
ponderate, even  to such a degree that the one maj be entirely
lost to view in the  exaggerated development of the  other.—
True, also, we distinguish two great classes of disease affect-
ing the brain, namely, organic, such as congenital deformities,
inflamation, extravasation, suppuration, effusion, degeneration,
the consequences of external violence, &c; in a word, visible,
tangible, organic changes—and functional, as disordered sus-
ceptibility  to impressions, paralysis,  disordered mental and
moral manifestations, exaggerated passion and  emotion, par-
alysis of the will, &c; science very properly makes a distinc-
tion  between these two  classes, but experience teaches  us
their mutual dependence and intimate relation in the majority
of cases, and we are compelled to believe that however dimly
revealed, sometimes indeed concealed from us, this intimate
connection and dependence is  invariable as  it is necessary.
How impossible, how unnatural then, to draw a line of de-
markation between psychical and somatic disorders, if we re-
gard the  fact that organic  derangements of the cerebrum may
and  do cause modifications in mental  and moral  manifesta-
tions, and that mental and moral affections may and do cause
organic derangements of the cerebrum.
  The characteristics of true chorea, are tremulous, irregular,
involuntary motions of the muscles  of voluntar}r motion, with-
out pain, and more marked on  one side than on the other, oc-
curring sporadically, and chiefly affecting females between
eight and fifteen years of  age, to a  certain extent under the
influence of the will.   The disease is, we believe, never con-
tagious by intercourse  with other sick, and when it occurs
past the  age of puberty, is very apt to prove incurable.  The
eyes lack lustre and expression, the  look is vacant, the temper
irritable, and the emotions are  exagerated, often indeed  no
cause for their manifestation can  be discovered.  The only
diseases  of importance to our investigation, in which chorea
terminates, are idiocy among the psychical, and convulsions,
epilepsy, apoplexy, palsy and hydrocephalus,  among the som-
atic.
  In  the disease which has been confounded  with it, the con-
vulsive moments are  commonly symmetrical, are  less under
the influence of  the will, and alternate with intervals of sleep
or of cataleptic ecstacy.   The majority of those attacked are
females,  from 16 to 30 years of age; and when  the disease
once makes its appearance, it spreads rapidly among the pre-
disposed  who come into contact with those already affected. 
 504       Smith on Epidemic Religious Monomania.      [July

 The eyes are brilliant, the countenance lively and expressive;
 the patient believes that he or she is under the direct and ir-
 resistible influence of spiritual powers, and acts on the delu-
 sion; on all other subjects is perfectly sane.  The very great
 majority recover;  the disease  now  and then  terminates in
 phrenitis or mania, and is then very  rarely completely cured.
 In the disease under consideration,  a muscular  organ is af-
 fected in its totality; in chorea, each individual  muscle com-
 posing such organ, is liable to  independent convulsion, so that
 in  the former the  convulsions consist in  exaggerated and in-
 voluntary muscular movements, in natural order and combi-
 nation;  in the latter, of  such movements  without a trace of
 order or combination, each individual muscle contracting as it
 were " on its own hook."   And indeed the striking differences
 between the two diseases, may be figuratively expressed thus:
 in the dancing or preaching monomania, the fancy has broken
 bounds,  and the muscles are bound to follow her mad career;
 in chorea,  a number  of  individual muscles have thrown off
 their allegiance to volition, and become insane.
  Having, we trust, shown that the  disease is not chorea, it
 remains for us to show what it is, and to place it in its appro-
 priate nosological position.   A simple  definition will save
 many  words.  A disease  characterized by delusion—(the af-
fected believing himself inspired, that he  has visions, and holds con-
 verse  with spirits,) irresistible propensity to declaim on the subjects
 occupying his mind during his visions, coming on in paroxysms, of-
 ten  preceded or accompanied by involuntary  muscular movements;
 the paroxysm sometimes terminating in a condition more or less re-
 sembling  cataleptic ecstacy, the eyes throughout the disease  being re-
 markable brilliant, and the expression of countenance animated and
 inspired—is a mental disease,  is insanity, and  we think  the
 best epithet by which to designate this particular form, is the
 one proposed by Dr. Sonden, Religious Ecstacy.
  No  doubt the convulsive affection conjoined with the psy-
 chical, is an important complication, and certainly a very in-
 teresting one, for experience teaches, that in no other form of
 mental  disease are such affectious so common or so violent,
 as in religious mania, for the  reason we are inclined to believe,
 that nothing so  thoroughly deranges the  normal relations of
 mind and body,  and especially of volition and the  muscular
 system, as excited fancy, most  especially when exercised on
 the mysterious, the awful, the superhuman,  and hence too, the
 unusual tendency to important sympathetic and  reflected af-
 fections  of the digestive  and  generative apparatus, &c,  as
 well as of the muscular system, in all forms of religious insan-
 ity.  The  importance of such complications, however, is not 
1850.]      Smith on Epidemic Religious Monomania.       505

nosological, and therefore we leave them without further no-
tice, only reminding our readers, that they were not only,ac-
cording to the Bible, common in those " possessed," but also
to the heathen Sybils and Pythias, as well as to modern Meth-
odists, and to those declaiming in " unknown tongues," in the
Rev. Mr. Irving's church, in London.
   Religious Ecstacy is by no means  to be  confounded  with
demonomania, theomania, &c; for these are characterized by
a chronic character, a more permanently insane condition,
with few or incomplete remissions, commonly ending  fatally,
and not contagious.
   For the related disorders —leaping-ague, one form of taran-
tism, and such cases as those of Mr. Kinder  Wood, Dr. Watt,
&c, unaccompanied by delusion, the old term choreomania,
seems to us eminently applicable, as the Greek  word  from
which the term chorea is taken, signifies " a  dance."   As this
disease, too,  is sometimes epidemic and contagious, the  term
epidemic should in such cases be prefixed.  Dr. Haygarth has
published a remarkable occurrence of this  kind, which took
place in the  Isle of Anglesea, in 1796, where 23 females, of
from 10 to 25 years of age, and a lad of 17, who  ^ad all had
intercourse with each other, were seized with slight pain  of
the  head, or of the stomach and left side, followed by twitch-
ings or convulsions of the upper extremities, continuing with
little intermission and with much violence for a  considerable
time.   The pulse was moderate, the  bowels costive, and the
general health not much impaired.  There was usually hiccup,
and when the convulsions were most violent, giddiness, with
loss of hearing and recollection.   During convalescence, the
least fright or sudden alarm, brought  on a slight paroxysm.
   The principle which should govern  the treatment of  Reli-
gious Ecstaey, appears to us to be contained in this little sen-
tence—as much common sense, as little emotion as possible.
Separation from the  gaping  audience,  the friends and ac-
quaintances whose  open mouths too  often reveal the stupid
wonder with which they regard the unusual phenomena, and
in the absence of whom the disease in the greater number  of
cases, never would have been developed, must form the  basis
of all treatment.   As well might we  expose the inflamed ret-
ina to the glare of the mid-day sun, as allow that which can
but feed the flame of excited fantasy; especially when we re-
 collect that in this case it is most commonly kindled at the very
 age when the desire for sympathy is apt to overleap the ra-
tional bounds, within which it is normally and usefully con-
 fined.   Isolation—which in religious monomania is frequently
 injurious — suffices for the speedy cure of uncomplicated cases, 
506                 Johnson on  Cholera.                [Juty
and stems at once the current of an epidemic.  For the  rest,
the physician should be as a father to his patients; but his pa-
tients must respect his directions as becomes  children.  The
only real difficulty in the treatment of cases, during the  pre-
valence of an epidemic of this nature, arises from  opposition
on the part of the ignorant and superstitious, to interference in
any way with what they  believe to  be a divine  dispensation,
especially when the means proposed to be  employed  are sd
simple  as temperance  in diet, wholesome employment,  and
sufficient as  well as appropriate amusement, which with  tem-
porary  isolation, where necessary, constitute all  that is re-
quired,  not forgetting the treatment called for by special  indi-
cations in individual cases.
   We have, in the  foregoing pages, confined ourselves to the
purely practical consideration of the subject, convinced that as
Voltaire said, "the greatest  enemies the devil has, are  the doc-
tors," who are continually robbing him of some portion of his
dominions.  We have much to say  on the psychological  phe-
nomena of this most interesting disease, but are fain to leave
the completion of the subject to another opportunity.
-------------- -'  imtmmim-----——---------------------------------—----.—.——————

Art. II.—  TV T.RKS.''— The Illinoit Bap&it of January  By R. H. John-
      f *   fhat " Thia strange infatuation is again revived
      / • ^immediate vicinity.  It made its appearance ia
      /  Motracted meeting among the Methodists at Indian
   T n? c-fnve   Theministers who  conducted the meetings iPflv fn oPrmoiTit
 ,   Pi moved[them from Indian Grove to Aveca, and brought ■*"? t0 acquaint
the r^ JJrjth them five orsix of the jerkera, andthus the con- the treatment of
                                              pith its phenom-
ena,
so w
spec
chol f i tagion commenced in the latter place.   Oar informant
      was present at several fflf their meetings in Avoca and
      describes the scenes as very exciting.  From fifty to a
      hundred were jerking atthe same tune.  Their hands,
      sbottlders, feet, and head would be violently thrown into
      the most grotesque and apparently painful shapes.
ha vp ^*e *ronien'8 bonnets would fly off, their hair become
nave ^hovelled, and in some instances snap like a whip,
givei Ineome instances it attacked unbelievers in it, and un-
p>  t pcojverted men who tried to resist it by folding  their
 'u-1 j. arms and wrapping them tightly around their bodies,
      but in spite of themselves, their  shoulders,  first one
      and then the other, would be jerked back, till  they
      lost all control of themselves.         r£* #^9i
this
a vt
cifio
tofi
se that which is
jht be used, re-
nications which
 Europe,) could
  the  treatment.
Titers agree  on
iw out of such
dthough  a spe-
lave  been  able
          ., iui ciiictii°J»W?]BJ!y,p,nus or scariet fever, yet we may
draw from this great store-house, modes of treatment which
shall come as near fulfilling the noble object at which we aim,
as it is possible, or as He who may justly be styled the Great-
est of Physicians, designed we should come.   In looking back
to the origin of physic, to those  early times when this and all
other arts and sciences had their beginnings, though they were
rude and imperfect, we may derive wisdom from their con-
templation.   Herodotus, and after him Strabo, observe, that 
1850.]             Johnson on Cholera.                 507

it was  a general custom among the  Babylonians, to expose
their sick persons to the view of stranger-travelers, in order to
learn of them whether they had been afflicted with the same
distemper,  and by what remedies they had been cured.   The cus-
tom in the  days of  the famous Hippocrates, was, for all per-
sons that had been sick, and were cured, to put up a tablet in
the temple of iEsculapius, wherein they gave an account of
the remedies that had restored  them to their health.  That cel-
ebrated physician caused all these inscriptions and memorials
to be copied out, and derived great advantages  from them.
Let our tablets be — our Medical Journals, and our temples —
our libraries, that advantage  may  be derived from recorded
experience in  the treatment of disease.
   No disease to which human  flesh is heir to, makes such rapid
and dreadful inroads upon  every vital  organ  of  life, as  does
" Asiatic" Cholera.  It has its  primordial origin in the nervous
system;  its secondary, in  the alimentary canal.  And it is
with a view to the restoration of the last power of these two
systems, that  our treatment must mainly be directed.   The
utter paralysis  of  the vis nervosa, causes  the flood-gates of
every part of  the body to open passively and discharge their
contents into the stomach and  alimentary canal, whence from
this gulf it is carried off, leaving the system drained, withered
and dead;  as in like manner we see a frail flower, its moist-
ure extracted,  dying beneath the rays of the burning sun. And
here it will be  said, that the system must be replenished with
that of which  it has been  drained; not so!   And this  is the
point at which our treatment begins.  This is the rock on
which  I believe that most,  if not all,  of my cotemporaries of
the profession founder.  In pouring fluids into the stomach in
cholera, you do not replenish the capillary vessels ; nor, more
important still, the great vessels—the blood-vessels — and thus
supply them with the stimuli of which they have sustained
so great a loss.  The  nervous filaments distributed to these
smaller and greater vessels, are paralysed ; and  the last drop
is pouring forth to the common receptacle and outlet — the
stomach and alimentary canal.  What is to  be done ?  Give
the patient no  fluids.  To this  will be answered, as the patient
often says—"Doctor,  I shall die if  I don't have drink."   Not
so; you  will die if you have  it.  Better give nothing.  But
what then  is to be done?   Give medicine in the dry form, and
apply mustard cataplasms externally—to the limbs and feet-
over the stomach, bowls and heart.  I have said, give no flu-
ids.  I  mean  to  say, give none  so long as there is any dis-
charge from the stomach or bowels.  After this has ceased,
o-ive strong green tea or coffee, and the camphor and ammo- 
508
Johnson on  Cholera.
[July
nia mixture in some form such as that prescribed at the close
of this article.  But give no fluids of any kind in malignant
cholera, till reaction takes place; their effect is to poison the
system, as  shown by the aggravation of every symptom, and
the patient is hurried  into collapse and death.   No kind of
medical agent will stop these discharges, especially the  vom-
iting, if any form of drink is given.
  The following  are  the  therapeutic agents which  I  have
employed with almost universal success, in all stages of the
disease:
         ft  Pulv. Kino Compos:
             Plumbi Acetatis:
             Camphoroe aa. gr.  xx:
             Hydrarg. Submur:
             Pulv. Capsici aa. gr. x:
             Pulv. Opii. gr. v:

  Mix, and divide into ten powders.   Give one of these  pow-
ders, in brown sugar, every half hour  or hour, according to the
urgency of the case.
  The brown sugar will be found the best vehicle for the ad-
ministration of the  powder, as when melted in the month, it
creates just sufficient moisture to form the powder into a mass,
and to enable the patient to swallow it.  But should any fluid
be taken after it, the stomach will surely reject it.  And here
it may be  observed, that vomiting  is the most prostrating
symptom  present.  It  hastens the patient on to the  collapse
stage,  with the most rapid and fatal certainty.  Let it  be
checked by withholding fluids from the patient, and action of
the bowels will also be checked!   It  is needless to speak of
the character of the remedies composing the above prescrip-
tion.  The calomel may often be left out  altogether, as the
liver is passive in the disease,  and will resume  its function
upon the restoration of the circulation  of the  vital  fluid, of
which it is  deprived through the  morbid action of the bowels.
So soon as reaction takes place,  convalescence is rapid under
the influence of stimulants, and  a generous diet.
  For  congestion of  the brain  and  spasm of the stomach,
leeches applied to the temples and epigastric region, give cer-
tain relief.   For children, and mild cases, and the early stage
of the disease in adults, the powders  may be divided and sub-
divided.
  Having the fullest confidence in the efficacy of the method
of treatment above recorded, I  deem it a  duty to  make  it
known for the use of others who may think proper to give it
a trial. 
1850.]
Johnson  on  Cholera.
509
  One grain doses of calomel, with chalk and ipecacuan in
powder, every two hours, till five or six are taken, in the con-
secutive fever of cholera, will be found of much value as an
alterative; but I do not concide with those who believe it to be
essential to the cure of cholera, to produce salivation.  I de-
precate the use of mercury to the extent of salivation, in this
and in all other diseases, if it can possibly be avoided; and
cholera can be cured without salivation.  It may here be ob-
served, that it is far  more important  to employ this agent for
the purpose  and to  the  extent  of correcting the  secretions.
after reaction has taken place, than before.
   The following medicine for either choleraic or bilious diar-
rhoea, will be found  efficacious :

          #   Pil.  Hydrarg:
             Plumbi Acet.  aa gr. xii:
              Pulv. Opii gr, vi:

   Mixed and divide into six pills—one to be given every hour.
   When  the tongue is found free from billious coats, the fol-
 lowing may be substituted, either in the choleraic or bilious
 diarrhoea:
          #   Plumb. Acet. gr. xii:
              Camphorse:
              Pulv.  Opii aa gr. vi:

   Mix and divide into six pills.   One to be taken  every hour.
   The following as  a stimulant in the collapse of cholera, after
 the  vomiting and  discharges from  the bowels have ceased,
 may be used with much success :

           #  Aquae Camphorse 3vi:
              Ammon. Carb. 3i:
              Syrup. Zinzib.  9. s.:

    A table spoonful to be given every hour or two.
    The Camphor Julep of Ellis's  Formulary, page 154, is the
 preparation I have  used with the best success, and is prepared
 as follows:
           #   Camphorse 3i '•
              Aquas Bullientis, 3viii:

    This preparation should be set aside in a covered vessel for
 half an hour, and then strained.  A table spoonful for a dose,
 pro  re rata. 
510            Hoffman on Endemic Fever.            [Juty

Art.  III.— On Endemic Fever.   By David A. Hoffman,  M.
                D., of Jackson county, O.

  Since December, 1849, Typhoid Remittent  Fever has pre-
vailed pretty extensively, in a low, wet, marshy district known
as the Cove, seven miles west of Jackson; and as it  differed
somewhat  from Enteric or Typhoid Fever, as  described by
authors, I have concluded  to give a short account of it.   It
did not appear to be confined to any particular class of inhab-
itants, but attacked all ages and sexes, and in the commence-
ment of its ravages, proved fatal in several instances; but I
do not think death resulted in any case, from the disease pos-
sessing  any peculiar malignancy, more than our ordinary
febrile diseases, but  from neglect in using proper remedial
measures before the patients were " in articulo mortis." The
laity considered it eminently contagious, but I have not seen
any evidence to justify such an opinion; on the contrary,  am
convinced  that it was no  more so than our  usual remittent
fever.  Some  contend that it was induced by "marsh mias-
mata," from the fact that  the country was favorably  situated
for the production of miasm; but I think it extremely  doubtful
whether  this peculiar agent had anything to do with it;  be-
cause heat, moisture, and vegetable decomposition combined,
are essentially necessary to its formation, and this  endemio
epidemic committed its greatest ravages in December and Jan-
uary, when the temperature of the atmosphere was below the
point necessary to produce miasm ; and furthermore, it ceased
upon the approach of warm weather.  These facts I think  are
sufficient to justify us in throwing aside the  idea that miasm
produced it. I believe it was induced by an endemio-epidemic
constitution of the atmosphere, assisted doubtless by the usual
exciting, causes of disease; further than that I cannot say.
It differed from enteric or typhoid fever, as described by  au-
thors, in the  absence of tympanitis  and  the rose-colored
eruption, both of which are characteristic phenomena of En-
teric Fever.  It differed also in the length of time it continued,
as there  appeared no more difficulty in arresting  it, than  we
usually meet with in common remittent fever, provided it had
not  run on too long.  If proper treatment was used in  the
commencement, the disease could be arrested in from 3 to  7
days, but if allowed to progress uninterruptedly, it would con-
tinue from one to two months, or longer.  When first called to
a patient, we  invariably learned that he had been troubled
with the premonitory symptoms of our ordinary bilious  re-
mittent fever; these were followed sooner or later by a slight
chill, fever of a very low grade, pain in the head, sometimes 
150.]            Gordon on  Difficult  Labour.             511

very severe, but generally dull, dulness of mind, dejected coun-
tenance, indisposition to talk, tongue dry and covered  with a
dark brown fur, teeth  covered with sordes, extremities cold
and clammy, pulse from 110 to 150, but feeble and wiry.  The
stomach was irritable, and diarrhea, or an extraordinary sus-
ceptibility to the  action of  cathartics,  was present in every
case.   The  urine when voided was very scanty and straw-
coloured, but was generally suppressed; (in some cases none
was passed for seventy-two hours,) and  a peculiar and  of-
fensive odour  was emitted from the body, resembling very
much the smell of cat's urine.  This smell was so strong that
the disease could be  readily recognized  upon  entering the
house, by  it alone.   A complete remission occurred every
morning, with an exacerbation in the evening.  If the dis-
ease was not arrested, the symptbms became more alarming,
the pulse disappeared, subsultus, stupor and profound  coma
supervened, and all efforts  to arouse the patient were futile.
As to the anatomical  character of the disease, I say nothing,
as  I was not permitted to make a post-mortem  examination.
With regard to treatment, I  used generally powders composed
of calomel  and camphor aa 4 gr.,  and pulvis Doveri 3 grs.,
every four hours, until the diarrhea was checked, and  a slight
impression made upon the  gums, spiritus  mindereri, artificial
heat to the extremities, and blisters.   Whenever a remission
occurred, I gave quinine freely, combined with small doses of
camphor, and wine, brandy, or carbonate ammonia.  The pa-
tients  would improve from the first upon wine and quinine.
After continuing the  above treatment, modified as occasion
required, for a  few days, the tongue would become moist and
clean off, the urine would be discharged properly, and the pa-
tient rapidly recover.   Such is  a brief and imperfect history of
the disease and the treatment.  Whether the treatment was
correct or not,  I shall leave for older heads to decide, but I was
successful in every case;  while those  who used antimonials,
drastic cathartics and venesection, lost several.
Art. IV. — Difficult Labour, Hydrocephalic Fatus; Cephalotomy.
           By Thos. W.  GoRroN, M. D., Bazetta.

  February 23d, 1848,1 was called in consultation on the case of
Mrs. c----, aged 19£  years, engaged in labour with her first
child.  I found her lying,  or rather half sitting on the edge of
the bed, with her feet resting on two chairs; the accoucheur in
attendance sitting on a third, a la  mode Francaise.  There
was  no  pulse at the wrist, the countenance was  extremely 
512            Gordon on Difficult Labour.            QJuly

pale, the eyes were rolled back, and the patient was appa-
rently unconscious.  There was no appearance of uterine con-
tractions, nor had there been for the last 36 or 50 hours.  I
was requested by the physician in attendance, to make an ex-
amination, when I found the os uteri extensively  dilated, the
head of the foetus in the first presentation, occupying the su-
perior strait, and so large as  to make it impossible  for  it to
engage  in the inferior.   The anterior fontanelle was distended
with fluid, the parietal and frontal bones were separated about
half an inch at the coronal suture, and were quite movable.
The attending physician having asked my opinion respecting
the case, I told him that I believed the foetus was  hydroce-
phalic, and I  had  ascertained  by auscultation, that it was
dead; and therefore no benefit could result from  further de-
lay, but infinite harm.  He replied, that not knowing  whether
the child was  dead or not, he had delayed, in the hopes that
nature would accomplish the  delivery; stating that the pains
had ceased, he knew not why, but that they had been active
for some sixty or seventy hours  since  he was called on the
preceding Sunday, this being the afternoon of Wednesday.
  As I could see no reason for any further delay, but  strongly
felt the  importance of a prompt delivery, I employed  the per-
forator, on the introduction of which 50 or 60 ounces of bloody
serum  escaped.   The blunt hook was then made use of, and
gentle friction employed over the abdominal surface ;  in a few
minutes the uterus began to  act,  and with the aid of slight
traction, the fetus  was delivered, the  head having collapsed.
The patient being much exhausted,  ammoma and  spirits of
lavender were administered, but not succeeding, "hot sling"
was given  until the pulse rose.
  Appearance of the child : the  frontal, parietal,'and occipital
bones  were separated, and the temporal were displaced, so
that there was no  union  at the squamous  suture; the  brain
was found unfolded as it were, forming a lining to the cranial
cavity  of about  half an inch in thickness.
  With the exception of some after-pains and diarrhsea, easily
relieved by the usual remedies, the patient recovered  more
rapidly than a majority of parturient women.
<^QX^>