fully watched. The areola, the scab, and even the eschar, should engage the attention; and unless we are perfectly satisfied that the general system is affected by the local disease, re-vaccination should be performed. I am sensible that it will be urged by many physicians, that the small remuneration received for vaccination, will not compensate for the trouble and expense of time which must necessarily ensue from this close attention. But I would ask, does the public require a physician's service and attention without a suitable remuneration? Such is not the case in other instances in which his services are required. May it not rather be attributed to a mercenary and ambitious spirit; an illiberality and want of good feeling towards our fellow practitioners, and an undervaluing of our own services? A state of insecurity renders a person unhappy through life; and those of us who are parents can alone experience the fears, anxieties and solicitudes for our children, arising from doubts of their safety from infection. I would again ask, would a reasonable compensation be refused for satisfying the minds of such persons respecting the safety of themselves and families?

4. Care in preserving the vesicle entire and free from injury. Proper instructions should be given to parents and nurses, to prevent, as far as possible, the clothes from rubbing and the child from scratching the pustule, and to suffer no person to take lymph from it in the absence of the attending physician. I am satisfied from my own experience, that where lymph is intended to be taken, vaccination ought to be performed in two different places, so as to suffer one of the vesicles to remain entire.

These are some of the means which, it appears to me, if properly applied, will prevent the occurrence of small-pox after vaccination. Many other might be mentioned, were it necessary, and would time permit. However much has been said respecting idiosyncracy, or peculiarity of constitution and temperament, in producing this event, I believe the true causes to be what has already been stated-imperfect vaccination, and neglect in observving its progress. If, however, in some few instances, small-pox does occur after vaccination, we may rest satisfied that is a mild and a harmless disease. It has been shorn of its terrors and of its malignancy; since the commencement of vaccination, scarcely a person dying under the disease, where it could be clearly ascertained that vaccination had been properly performed, and where constitutional affection followed. How much more then is vaccination to be preferred to inoculation for small-pox, which does not in all cases secure the individual from future attacks, especially in epidemics, where the malignancy of the contagion is greater than in the inoculated disease, and where it does not

even modify its severity, but rages with all its native horrors and fatality?

Before I close this address, suffer me to say a few words on the subject of obtaining and preserving pure vaccine virus. Every physician knows the difficulty of procuring pure virus when most wanted. They have no source from whence they can draw a supply as occasion may require; and often in urgent cases they are necessitated to use it of a quality not to be depended on. One physician procures it of another. It is often sent to different parts of the country. A spurious disease is thus frequently, and extensively circulated, and the evil becomes remediless. In my own practice this has been the case. I have observed a pustule rising, progressing and finishing its career, without satisfying my mind of its competency in protecting the system. A determination has been formed to revaccinate with pure lymph when obtained; but other avocations, removal of the children, and not unfrequently the unwillingness of parents, have prevented its accomplishment. I doubt not many physicians have experienced the like difficulties. An institution, then, founded by private association, and depending on individual support; or an institution established, conducted and supported by public patronage, is the only means by which this object can be accomplished. Several attempts on the former principle have, I believe, been made in many of the large cities of the Union, and but few have as yet been successful. This may be owing to a want of patronage from the profession generally, and often to a want of confidence in the conductors;-being individuals without responsibility to any authority for the faithfulness of their conduct in procuring, preserving and transmitting pure virus. They may be men of good characters, and fair standing in the community, but unless it can be made a source of emolument, neglect and inattention are most likely to ensue.

An institution under the patronage and control of the state, properly conducted, and established on a liberal plan, would be a public blessing. In this way an ample supply of pure virus could be perpetuated and transmitted with promptness and facility to every part of the state. By this means spurious disease would soon disappear; physicians could always depend on a supply of genuine infection, and by the aid thus rendered, a fair hope might be entertained that the horrors of small-pox would only be heard of, and not experienced.

Almost all the governments of Europe have institutions of this kind. Vaccination is under the direction, patronage and control of the states where they exist; and would not our legislature be consulting the vital interests of the state, of posterity, and of

mankind, by turning their attention to this important subject? The preservation of health, and the lives, not only of the present generation, but of unborn thousands, is certainly of as much importance as any subject that can engross their time or their attention.

ART. II.-Observations on Puerperal Mania. By J. MACDONALD, M. D. Physician to the Bloomingdale Asylum for the Insane.

THE mental disease to which lying-in women are subject, is commonly known by the name of "Puerperal Mania." This implies that all cases of insanity occurring at the puerperal period, are in character really maniacal. But as they are as variable in their forms, as those arising from other causes, it will be more correct to employ the generic term puerperal insanity. Dr. Burrows, in his late very able commentaries on insanity, has devoted a chapter to the investigation of this subject. "Puerperal mania," says this author, "is certainly inappropriate, since the symptoms developed are as often those of melancholia." As puerperal insanity, in the cases that have fallen under my observation, assumed the different characters of mania, monomania and dementia, I would go a step further, and add dementia as a species. As all instances of mental disorder of this kind, with a few exceptions, in which moral influences may have some weight, arise from similar causes, their variety of forms must be attributed to peculiarities of temperament. Each one of these may be said to have its individual trait, by which it may be distinguished from its like form, arising from other causes; thus, in puerperal mania there is a peculiar, wandering incoherency of mind, with obscenity of language, and indelicacy of conduct; in puerperal monomania, a singular propensity to suicide or infanticide; and in puerperal dementia, a sudden and extreme prostration of mental power, equal to that which follows months, or even years, of intense excitement.

The following cases of the different forms of puerperal insanity, are perhaps not so strongly marked as some others that might be selected. It is possible, that the latter might be recognised by the friends of the parties, and it is, therefore, improper to report them.

1st. A Case of Puerperal Mania.

B. G. ætat. 19.-No hereditary predisposition to insanity, and never insane before-married almost two years-first child either still-born, or died soon after birth-sanguine temperament:-entered the Asylum May 1st. Five weeks previously, after a natural labor, was delivered of a healthy child; for six days after confinement, "was doing well." was doing well." At the expiration of this time, she became suddenly maniacal. Her treat ment, adds the attending physician, was antiphlogistic without relief.

Symptoms when admitted.-General excitement; though unable to examine her pulse critically, we found it to be quick and full. Skin hot, as is common in this form of puerperal insanity-general disordered state of stomach and bowels-tongue coated in the centre, with red edges-bowels costive-no stool for several days-mind a perfect chaos, language obscene, and incoherent-conduct furious-entire absence of moral propriety.

The first and most pressing indication was to remove the morbid condition of the primæ viæ. This was answered by repeated purging, with sub. mur hyd. both in large and small doses. pulv. purg. and infus. sen. comp.; and when she refused these, ol. tiglii. During this course, however, typhoid symptoms manifested themselves, but subsided under its continuance. It may here be observed, that it is remarkable to what an extent it is necessary, in some cases of this kind, to pursue this method of treatment. Diet during this period-panada, gruel, arrow-root, light broths.

After the restoration of biliary and other secretions, the nervous excitement manifested by pervigilium, boisterous conduct, &c., next called the attention. From her aversion to medicine, our remedies were directed to the dermoid system alone. Tepid baths and firictions were used with the most tranquillizing effect, inducing quietude and sleep, after days of commotion and nights of pervegilium. Counter-irritation was now produced by ung. ant. tart. extensively applied to the hypochondria and extremities.

June 8th.-The bowels having resumed their natural action, cathartic medicines are no longer exhibited. The baths proving still soothing, continue them. Being still highly excitable, it is necessary to confine her to her room, (except when exercising with the nurse,) entirely secluded from every thing calculated to call forth excitement. Mind still very incoherent, and, as is common in this form of puerperal insanity, conduct indelicate, and language exceedingly obscene.

July 1st.-The digestive functions being now restored to a healthy condition, improvement in general health followed. This, however, being impaired by the heat of summer, a relapse of mental disorder ensued-inflammation of the mammæ, with symptomatic fever supervened. The subsidence of inflammation and fever, was succeeded by a tranquil mind-improvement in general health again took place, her mind daily and uninterruptedly gained strength, and she was discharged cured, October 5th, after five months residence in the Asylum.

2d. A Case of Puerperal Monomania.

S. B. admitted into the B. A., July 15th, ætat. 27, marriedtemperament melancholic-has always been subject to headache at the catamenial period-gave birth to her second child, four months since; and six weeks ago was observed to be palpably insane-ever since delivery, however, her conduct had been marked by many peculiarities, such as general torpor, loss of spirits, disinclination to mental and bodily exertion. She continued to nurse her child, until ten days previous to removal to this institution, when, in consequence of an attempt on his life, he was taken from her. She subsequently made several attempts at self-destruction. Before these occurrences, functional disorder was discovered in the mammæ, her milk had diminished in quantity, and had become watery. Two other circumstances point out the existence of some latent disorder long prior to the development of insanity, viz.: the entire absence of an erysipelatous inflammation, to which she had been long subject, particularly after her first confinement; and looseness of bowels, instead of habitual costiveness.

State when admitted.-Entire absence of mental excitement, mind apparently correct upon every subject, except that of her recent conduct. This she speaks of in the most dispassionate manner says that she is not, and has not been insane-that moral turpitude alone induced her to kill her child-that she deserves death; that she must be hung; that it was under such expectations she consented to come here; believing this to be the penitentiary, where she was to await her trial, which would result in capital punishment. When told that her child was still alive and well, she replied, it was her intention to commit murder, and that she was equally as culpable as if he were dead. As soon as she found herself in the Asylum, she begged to be taken to the strongest cell in the house, chained to the floor, and treated in the harshest manner. Her bodily functions were not materially disturbed, but her eye bore the impress of a disordered mind; it was clouded, fixed and unob