morbid feeling, it is the duty of the surgeon to assure his patient of sympathy and cordial help, and to do all in his power to remove these delusions.

Treatment. In the earlier stages of this mental and bodily debility the services of the surgeon may be of great benefit. If a bougie be introduced into the urethra, and the treatment alluded to at p. 47 be employed, the patient will find it much easier to exercise self-control (which is what is wanted). If he will aid the surgical treatment, by taking gymnastic exercise and following the other rules laid down above, pp. 66, 74, a favorable result may be expected. It is in the earlier stages that relief should be sought, not when dementia has occurred, or when the brain has become disorganized. Those who treat mental diseases are not consulted sufficiently early to recommend this treatment; they see the effects when too often the mischief is irremediable; and it may be from the impression thus produced that sufficient weight has not been as yet given to surgical treatment in the incipient forms of insanity, brought on by this malady.

If, however, a patient will not attempt self-control, mental as well as physical, and if, instead of consulting a qualified medical man, hearing from him a statement of the consequences of the practice, strictly following out the treatment recommended, and giving up the vile habit, he should abandon himself to humiliation and despair, the downward course may be very rapid and fatal. When this frame of mind has completely got hold of a man, the step to insanity in its worst and most hopeless form is alarmingly short.

CHAPT. III.—INSANITY ARISING FROM MASTURBATION.

That insanity is a consequence of this habit, is now beyond a doubt. The subject has recently been thoroughly investigated

1 The connection between insanity and extravagant sexual desire is alarmingly close, as appears from many modern investigations, especially with regard to the central portion of the cerebellum.

Deslandes has remarked that, "in proportion as the intellect becomes enfeebled the generative sensibility is augmented."

by Dr. Ritchie, from whose able treatise, entitled, "An inquiry into a frequent cause of insanity in young men," I have condensed the following particulars :

THE CAUSE.-Dr. Ritchie thus quotes from a work by Esquirol, entitled "Des Maladies Mentales:"-"La masturbation, ce fléau de l'espèce humaine, est, plus souvent qu'on ne pense, cause de folie, surtout chez les riches." And again-"La masturbation, dont nous avons parlé sous un autre rapport, est signalée, dans tous les pays, comme une des causes fréquentes de folie; quelque fois c'est le prélude de la manie, de la deménce, et même de la démence sénile; elle jette dans la melancholie, conduit au suicide. Elle est plus funeste aux hommes qu'aux femmes," etc.

CLASS OF PERSONS AFFECTED. "It might be expected," says Dr. Ritchie, "that these cases would chiefly occur in members of families of strict religious education. Experience supports this expectation; and facts also show that those who from this cause. become insane have generally, to all appearance, been of strictly moral life, and recognized as persons who paid much attention to the forms of religion. As will be afterwards more fully stated, it is frequently observed, especially in the acute attack resulting from this cause, that religion forms a noted subject of conversation or delusion."

PREMONITORY SYMPTOMS.-"The parent, after her son (the only child it may be) is taken to an asylum, will tell you that his insanity cannot be accounted for. He has been so well conducted, so quiet and studious, not seeking the company of the gay, the idle, and the thoughtless, but remaining quietly at home rather than joining the social amusements of those of his own age. Further inquiry may elicit that he has been of good abilities, and it may be, clever in his occupation; that he had few friends, and rather shunned the society of those of the other sex. Had he been other than he was, some cause might have been found in the irregularities of life to cause insanity in one scarcely beyond boyhood's years; but in such a quiet lad, and so carefully brought up, she is unable to suppose a cause. Then she may tell you that for some time past a gradual alteration has

been going on; he has changed not only in manner but in appearance; he has become so peevish and irritable, so reserved in his conversation, so apathetic in manner, so slovenly in dress, so contradictory and so uncertain in his actions, so hesitating, first determining on one thing, and before he could execute that changing to some other course, and has shown such a want of self-reliance. That quite recently he has grown more and more apathetic, more slovenly in dress, paying less attention to cleanliness, and become slower in his actions; that he is now not only irritable in his temper, but is at times violent; that he does things by "fits and starts," is impulsive, deliberating long, and then suddenly hastens apparently to carry out his intention; and has become so stupid-looking and lost, and incapable of taking care either of himself or his business; and all this has occurred without any apparent cause, except it may be his studious habits.' At last he can be borne with no longer; he is unmanageable in a private house, and is obliged to be removed from his home."

GENRRAL SYMPTOMS.-"On entering an asylum for the insane, especially if it be one receiving patients from the middle as well as from the lower class of society, there is one group of inmates which may arrest the attention of the visitor from the contrast presented to the excited persons around him, on the one hand, and to those who are convalescent on the other. Engaged in no social diversion, the patients of this group live alone in the midst of many. In their exercise they choose the quietest and most unfrequented parts of the airing-grounds. They join in no social conversation, nor enter with others into any amusement. They walk alone, or they sit alone. If engaged in reading, they talk not to others of what they may have read; their desire apparently is, in the midst of numbers, to be in solitude. They seek no social joys, nor is the wish for fellowship evinced.

"The pale complexion, the emaciated form, the slouching gait, the clammy palm, the glassy or leaden eye, and the averted gaze, indicate the lunatic victim to this vice.

"Apathy, loss of memory, abeyance of concentrative power and manifestation of mind generally, combined with loss of self

reliance, and indisposition for a repulsiveness of action, irritability of temper, and incoherence of language, are the most characteristic mental phenomena of chronic dementia resulting from masturbation in young men.

"As in diseases of an exhaustive nature we find that the cutaneous secretion is poured forth abundantly, so in the cases occupying our attention the perspiration breaks forth on the slightest exertion. This relaxed condition of the perspiratory system is especially marked in the palms, and the exception is to find these dry in the masturbator; for generally a damp, or cold, clammy perspiration is constantly present, and makes it particularly disagreeable to take the hand of one of these persons. The sub-integumentary layer is but sparingly supplied with fat, which is remarkable, considering the little exercise these patients, if left to their own guidance, would take.

"To conclude this description, it is only necessary to add that the gait is slovenly or slouching, that the gaze is downcast or averted, and when addressed, the masturbator does not look the speaker openly in the face whilst he replies, but looks to the ground or beyond the questioner."

DIAGNOSIS." The physical system is, as a rule, but indifferently developed. The muscles are small, soft and flabby; the body is generally emaciated, the adipose tissue being but feebly stored up; the complexion is variable, but, though occasionally flushed, is, as a rule, pale; the gaze is not constantly averted, but in all the cornea will be found dull and the expression inanimate.

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Excitement, with delusion of a melancholic cast, and frequently, if not in most cases, of a religious tendency, combined with a suicidal or a self-mutilating inclination, occurring in a thin or emaciated man, under the age of twenty-five (who does not present evidence of organic cerebral disease), of generally pale complexion and averted gaze, but always with the dull cornea and expressionless countenance, would lead to the diagnosis of the cause."

PROGNOSIS." This condition does not continue many days. The cause being discontinued, the stupor becomes less intense,

the inclination for repose more marked, and the sleep more natural and refreshing; the sensations of hunger and thirst are once more experienced; the secretions are more active; the cleanliness of habit is attended to; the dress is looked after; the obstinacy decreases, and gradually an inclination and the ability to converse, return, and at last, though slowly, the health of mind and body is restored. Such, in favourable cases, is the result, but it too often happens that convalescence is arrested, and that the condition of ordinary or chronic dementia becomes established, and with it the prospect of recovery diminishes."

RELAPSES." Remonstrate with these victims after they are received into an asylum, whilst reason is still not quite destroyed, and they will agree with your remarks. They will express their thankfulness that they have yet been spared some portions of reason; they will express their deep abhorence of their conduct; they will shed the tears of apparent penitence; and yet the old habit will be relapsed into; and when they think that they are removed beyond control, will once again indulge in their selfdestroying practice. The determination to conduct themselves in the pure course is wanting, and in this there is evidence of the pernicious energy-sapping cause.

"Few accidents are more capable of occasioning annoyance and disappointment to the physician, and none more calculated to excite his pity and regret, than to find the recovery he regarded as certain, marred and prevented, or delayed, by the preventible act of the patient himself. This cause of relapse is but little believed in, except by those who are intimately acquainted with the habits of the insane; but regarding it as possible, many an unexpected and unaccountable relapse can be readily explained. When any tendency to indulgence has been observed in the early stages of mania, the prognosis ought to be stated in well-weighed words. The fact of a patient, neither epileptic nor the subject of paralysis (although in young men the former is more probable), who when put to bed was progressing favorably, being in a lost or much confused state when he got up on the succeeding morning would be significant of some