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cause acting during the night. In the absence of excitement or a fit, the probability of this cause ought not to be forgotten.”
TERMINATION OF CASES.—"In the acute or recent dementia, the condition of the patient is most pitiable. His existence is, for a time, merely vegetative, and in well-marked cases the obstinacy of disposition is almost the only indication of a mental action, and the mental origin of this may even be doubted. The sufferer becomes quite silent, and is lost and unable to take care of himself. He becomes statuesque, and extremely obstinate. He resists passively, and occasionally actively. If he be in bed, he will not rise to be washed or dressed. If up, he will not retire at proper time to bed, or allow himself to be undressed. Everything requires to be done for him. Cleanliness is neglected, and his dress unattended to. He makes no effort to speak, arid when addressed, although conscious, does not appear to comprehend what is said. He will not feed himself.
"How earnestly do those who know what the future will bring to such a one repeat these feeling words of Ellis-Would that I could take its melancholy victims with me in my daily rounds (at Hanwell Asylum), and could point out to them the awful consequences which they do but little suspect to be the result of its indulgence. I could show them those gifted by nature with high talents, and fitted to be an ornament and a benefit to society, sunk into such a state of physical and moral degradation as wrings the heart to witness, and still perservering, with the last remnant of a mind gradually sinking into fatuity, the consciousness that their hopeless wretchedness is the just reward of their own misconduct.'
TENDENCY TO COMMIT SUICIDE.—On this point Dr. Ritchie says: “As regards suicide, the greater frequency of this occurs in those whose cases assume a melancholic character with the excitement.
“Although it will be found that various supposed causes may be alleged, still I believe that in the greater proportion of such cases the immediate exciting cause is the feeling of disgust at, combined with alarm for, the consequences of, the patient's criminal conduct. Hence it is that feelings of their own unworthiness arise in such patients, and, under the impression that they have committed the unpardonable sin—have sinned against the IIoly Ghost—and that a future world presents no hope of joy or happiness for them, as they are excluded from it by their past conduct, they frequently make attempts to terminate their own existence. Such an act is occasionally incited by hallucination of the aural organ; but I have not found that suicide is so frequently to be traced to this, as in other cases of mental aberration depending on other causes.”
SELF-MUTILATION.—“Another peculiarity of these cases is the tendency frequently exhibited to self-mutilation, and, as reports show, the attempts are not unfrequently successful. Thus is indicated an unsound reasoning power, the visiting on the supposed offending organs the faults of the ill-regulated mind.”
As Dr. Ritchie states, the delusions in many instances assume a religious character, and hence it is that it is repeatedly found that the cause of the sufferer's condition is supposed to be religion. The delusions of this class generally are of the melancholic character stated above : fears that eternal happiness is lost—that they have no hope beyond the grave—that they have committed an unpardonable sin-or that they are unworthy to live.
From the true cause of the mental condition of these cases
1 I was recently called upon to sign a certificate, for a gentleman of high standing in his profession, who was himself willing to enter an asylum. His case was a very sad one, and exemplifies the ideas a patient, in this state, forms of his own ailments. His history, which, however, I gleaned from him with some difficulty, was as follows:-Early in life he contracted the habit of masturbation, nevertheless he married, and lived tolerably happily with his wife; and his marital duties were performed, he assured me, in a satisfactory
He became, however, depressed, his conscience told him that he had done wrong in abusing himself early in life, and he determined as a punishment, that he would cut away the testes. This he effected,—the parts healed, and the patient entered an asylum, which he subsequently left. At the period I saw him, he was in what, I suppose, I may call a lucid interval. He still regretted most bitterly his early sins, and was satisfied that he had not been justified in mutilating himself. He was conscious that he was again losing his self-will, and felt that he ought to be watched, lest he should further injure himself (I was told he had attempted his life).—W. A.
not being understood, the meaning of these reproaches for past conduct cannot be comprehended; and it is easily explained why a young man of apparently blameless life making these self-accusations, is regarded by his friends as suffering from acute religious feelings, whereas remorse or fear has generally more to do with his condition than true religious impressions or conviction.
It is probable that many of those young men whose insanity has become developed through revival meetings, of which there have been several instances, would, on close inquiry, be found to be of the class now occupying our attention.
In some patients, rash and even criminal acts are the result of the idea that an atonement may thereby be made for the sin committed. The attempt to injure the genitals and similar extravagances often, I believe, arise from such insane fancy. While, on the other hand, extravagant masturbation or the tendency to commit rapes or unnatural crimes may be in some cases traced to the not less insane desire the sufferer feels to test, and prove to himself, or others, that he is not impotent.
TREATMENT.—The long extracts I have given from Dr. Ritchie's pamphlet may testify to the high value which I set on this acute observer's remarks on this disease; I differ from him, however, somewhat as to the prognosis and treatment, and am far more sanguine than he is of the success which may ticipated from appropriate management.
Still, when dementia has set in, I quite agree with Dr. Ritchie, that the case assumes a very serious form, and then it passes from the surgeon's care into the hands of those who attend to such cases. Kind care and domestic attentions are all that can be suggested to soothe the latter days of these victims of ignorance or vice.
In the last edition of this book diffidence on my part prevented my giving any positive opinion on this subject, and I preferred quoting the opinions of Dr. Ritchie, who had then recently published his pamphlet.
The experience I have gained during the last five years has induced me (while allowing the present chapter to remain) to give my personal opinion on this most important question, and I con
fidently assert that, at least in the earlier stages of dementia caused by self-abuse, the greatest service can be done to the patient. Even in the more confirmed cases of insanity arising from this cause, I should not be disposed to give up the hope of effecting a cure, instead of consigning them to confinement in a lunatic asylum, and I trust my persanal experience may induce those who specially devote their attention to mental diseases to give my plan of treatment, recommended at page 77, a fair trial. One thing I can confidently promise, that if my advice does not cure the confirmed case, it cannot do any harm. If it enable but one poor sufferer to be rescued from the madhouse, it deserves a trial, and I think my professional brethren will often find that it succeeds in what they have previously considered hopeless cases.
CHAPT. IV.-PHTHISIS ARISING FROM MASTURBATION.
The attention of physicians has been of late years directed to this subject. In the year 1862, Dr. Smith read a paper before the Med.-Chir. Society entitled “A Statistical Inquiry into the prevalence of numerous conditions affecting the constitution in one thousand phthisical persons when in health.” In this paper, he stated that 11.6 per cent. of the males had committed sexual excesses ; 18.2 per cent. had been addicted to masturbation, and 22 per cent. had suffered from involuntary emissions. I can, from my own observations, fully corroborate his statements, though whether the phthisical cachexia is to be regarded as a cause or an effect of sexual excess I am not sure.
Delicate constitutions, with a consumptive tendency, are often very susceptible of sexual excitement. They are consequently peculiarly liable to nocturnal emissions, and to the temptation to commit
Coupled with this special tendency, there is often in such persons a high spirit, and a carelessness of consequences, which will not yield to any slight indisposition. It may, perhaps, often be, in such instances, as much the constitution which predisposes to excesses, as the sexual excesses which induce the delicacy of constitution. There can be, however, no doubt that these
excesses are doubly fatal to such idiosyncrasies. It is well when the surgeon or physician is able, early in life, to impress on a patient with marked family predisposition to phthisis the imminent risk he incurs in allowing the sexual feelings to run riot. convinced that it is from such preventible causes as these that the hopeful career of many of our most promising youths and hard-working students comes to a sad and early end. It should be here noticed, and the fact will be more fully considered in the later portions of this volume, that a lavish expenditure of the vital fluid semen is most detrimental to a young man's constitution. Whether this arises from masturbation, sexual excesses, or very frequent nocturnal emissions, the effects will be very similar. If we here treat of masturbation, it is because this vice is one more readily and easily practised and repeated by young men, and to it, therefore, more frequently than the other causes, it is that the evil consequences which we are now considering are due.
THE PROGNOSIS is favourable if the patient is seen early and the treatment comformable to the causes of the complaint adopted. I have seen many young men in consultation with some of the leading authorities of London, and have rescued them from what has been considered a very dangerous condition. The ordinary remedies for phthisis are of no avail unless we at once check the cause of the complaint, namely, sexual excesses. When this has been done, everything that can improve the health, or enable the system to rally, will, of course, be beneficial, and the observations I have already made, page 116, on the treatment of insanity apply with equal force to phthisis. I shall, thereforo, not repeat them, but merely express my conviction that we can, in a large number of cases, afford relief and rescue the sufferers from imminent danger.
CHAPT. V.-AFFECTIONS OF THE HEART ARISING FROM
I have seldom met an instance of sexual excess in which complaints of the heart's action have not been made. Patients assert that they can make no exertion without suffering under palpita