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READ MARCH 14th, 1843.

The cases I have ventured to lay before the Society occurred in a charitable institution for the maintenance and education of female children from the age of nine to fourteen, and may, perhaps, derive interest from their having been observed and treated with the strictness so difficult to accomplish, except within the walls of a public institution.

The cases, seventeen in number, occurred in two groups; the first commencing in February 1841, preceded by well-marked pyrexial symptoms; the second in October last, in which the hysterical and imitative character was evident from the first. The children attacked were from eleven to fourteen years of age.

In February 1841, one, and shortly afterwards seven of the children were attacked as follows

with a short and almost constant backing cough, with much pain and distress in breathing, but no expectoration ; quick pulse, hot skin, white tongue, and costive bowels. After two or three weeks, during which time these symptoms withstood all the remedies applied, the cough changed to sounds varying in the different patients; in some, resembling the double action of a large saw ; in two, a shrill screaming expiration, following a quick catching inspiratory effort, much resembled the cry of a peacock; in another, the sound was such as is produced by blowing into a small metallic tube. In fact, it is difficult to conceive the dissonance and constancy of these sounds.

Besides these, one girl, aged fourteen, became affected, at the same time, with symptoms exactly resembling those of laryngitis, and requiring the usual means for their removal; but they were followed after a week or two by the sounds above described.

In the commencement, sinapisms, blisters, combined with the administration of expectorants and sedatives, with and without the addition of antispasmodics, were tried without avail. A combination of extract of hemlock, sulphate of zinc and of quinine was given, as well as full doses of sesquioxide of iron, when the anomalous sounds were established, which produced no effect, although continued for a considerable period, until the children were separated one from the other, when with the exception of two, who were sent to their homes

in order to more perfect separation, they slowly recovered.

In the following October 1841, some indications of a return of the symptoms was manifested in three of the children, but the same remedies, combined with separation from each other, were shortly successful in arresting the attack.

No further occurrence of these symptoms took place till October 1842, when a considerable number were attacked. The symptoms, although commencing with the short hacking cough, and attended with some slight pyrexial symptoms, were almost immediately followed by the double sounds before described, and the hysterical and imitative character was well marked from the beginning. The uproar in the building now became alarming to the neighbourhood, and from the loudness of the sounds it became difficult to separate the patients effectively. No remedial means, including turpentine, spiritus ammoniæ succinatus, anti-spasmodics, tonics, mineral, as well as vegetable, combined with the regular use of the shower bath, being, after long continuance, found of any use, I determined to try the effect of a strong mental impression; and, following the plan adopted by the celebrated Boerhave, in the House of Charity, at Häarlem, I assembled the children, and informed them, that I must apply a red-hot iron to the throats of all who were not quite well on the following morning. This alarmed them so much that, with the exception of two of the elder girls, they ran away to their respective


homes on the following day, whence they returned on the day after quite well.

The two remaining, still made the same noise, in which they were again joined by the others in little more than a week. All other means failing, their throats were blistered by means of a spatula, covered with a silk handkerchief and heated in boiling water. This with some, succeeded in removing the symptoms; in two, who were carefully secluded from the rest, the affection gradually wore out; but two others were at last obliged to be sent to their homes, where, separated from their noisy companions, they soon recovered.

In reviewing these cases, it seems worthy of remark, that in two of them where illness of another kind supervened, the noise ceased.

This affection, like most of the hysterical family, although for the most part involuntary, still to a certain extent was controllable by a strong effort of the will; although such effort was extremely painful, giving rise to spasmodic catchings of the breath. Not that I believe these children were guilty of any trick, but that, on the contrary, they were very glad to be relieved.

The rapidity with which the cases succeeded each other, proves that imitation was their main cause, and the success of separation, and the comparative failure of other means, still further strengthen this supposition.

Although, doubtless, not absolutely novel, I have ventured to give the detail of the history and treat

ment of these cases to the Society, chiefly on account of their number, of their having occurred in one establishment, and as affording a means of judging of the varied treatment adopted with perfect strictness and perseverance.

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