scrupled to attribute the occasional loss of matches to this cause. The diet of convalescents taking gymnastic exercise should be attended to pretty carefully. Thus, for breakfast, I prescribe cocoa and milk, and I recommend the cocoa nibs stewed down for several hours as preferable to the cocoa sold ready prepared in the shops. Tea, coffee, and tobacco I look on as so many poisons for persons suffering under the nervous depression such as we are here speaking of. It is in vain to recommend weak tea, so I prohibit tea or coffee for breakfast, and substitute in summer seltzerwater, soda-water, or lime-water with cream or milk; those who prefer it may take claret and water, made by diluting one glass of good claret with a tumbler of water. The taking of warm fluids for breakfast is a habit that may be soon got over. I am convinced that deluging the stomach of invalids with hot strong fluid is injudicious, but at first it is somewhat difficult to induce patients to become singular and take cold fluids for breakfast. Stale bread and a moderate quantity of lean meat are advisable if the patient has a fair digestion, and if he does not feel oppressed after eating. I order luncheon for those who dine late, which may consist of a small portion of meat and stale bread, with a glass of sherry or a little bitter beer. This midday meal is absolutely necessary, for I find that if a man in exercise does not take nourishment in the middle of the day, he eats voraciously at dinner, and his digestion becomes impaired. I forbid late dinners, and counsel plain but wholesome diet. I forbid fried fish, cheese, pastry, or suet-puddings, and advise only moderate quantities of meat, vegetables, and bread, with a pint of bitter beer or three moderate-sized glasses of wine (claret or sherry). Both (beer and wine) should not be taken at the same meal.1 1 The rules of diet that are followed in training may be interesting, though I would not recommend an invalid to attend to them strictly, except under medical advice. One of the most successful pedestrians of the day thus described his mode of living to me. He rose early, walked one mile and a half out and back, then had a sponge-bath and took his breakfast, consisting of a cup of weak tea, or of eggs beaten up instead of milk, and a small quantity of meat. FALSE SPERMATORRHOEA-DISEASES SIMULATING SPERMA TORRHOEA-QUACKS. In the first edition of my work on "Diseases of the Urinary and Generative Organs," I wrote a chapter entitled SyphiliphoThen his exercise again, change of flannels, a rub down; as regards flannels he told me he preferred wearing a tight flannel waistcoat, not merino or flannel shirts, as they felt cold if not changed. At half-past 12 he took a moderate dinner of meat, with vegetables, rice, sago, or light pudding, and a small quantity of bottled stout. In the afternoon his exercise again; eat at five, no meat, but a little lettuce or watercress, and at eight or nine a little arrowroot or light supper, and then to bed in blankets. I may add that this man was, although in very vigorous health, most moderate in sexual indulgence. To this account I may add a description of the training that boating men go through: "The training of university oarsmen consists of early hours, running, rowing, and a temperate use of the most nourishing food and drink. The same treatment cannot be prescribed for all constitutions; but the following seems to be about an average specimen of the way in which the month preceding the match is spent. All meet at seven a.m., and run a couple of miles at first, gently, afterwards at a sharp burst; this is essential, as it is the only improver of the wind. After a tub and rub, they breakfast together in turn at one another's rooms, and have broiled steaks and chops, bread and butter, watercresses, and tea in moderation. A little reading fills up the morning capitally, and keeps the mind quietly occupied; indeed, high classical attainments and good rowing often go hand in hand. At 12.30 a biscuit and a glass of wine, and at two p.m. down to the river to row the course. This over, they have a comfortable wash, and then dine together upon beef or mutton sufficiently roasted, broiled, or boiled, wholesome vegetables, plain jelly, watercresses, lettuces, and a pint of sound home-brewed ale. Pork, veal, salted meats, made dishes, pastry, cheese, condiments, and smoking* are forbidden. Those who are used to wine are allowed a glass or two after dinner. All ought to be in bed shortly after ten o'clock; and, for those with whom it agrees, the best thing to take as supper is a basin of carefully made plain oatmeal water-gruel. But training is very ticklish work with many men; they are apt to get feverish, and nearly the same round of food day after day often palls. Again, about ten days after the system of training has been begun, a period of depression sometimes occurs; this, however, is a turning-point, and once passed, the patients feel brighter and harder. The mentor and the coxswain strive to keep the crew cheerful and good-tempered one with another, free from all sensations of staleness and overtraining. If the cast of character includes a good low-comedy man, so much the better." -Once a Week. * This rule has been a little relaxed of late years, and a very moderate indulgence in tobacco has been allowed, and indeed considered beneficial. bia in which I collected together a variety of complaints that presented many of the characteristics of true disease. Since then, a wider knowledge of these subjects has sprung up. Hypochondriacs and a large class of patients who have leisure to dwell on their morbid thoughts and feelings have, by reading the books so freely advertised in the quacks' corner of the newspapers, come to the conclusion that they are suffering under spermatorrhoea—a word with which they are now familiar. In this corner formerly five or six such advertisements directed public attention to the so-called disease; the headings of "Manly Vigor" and "Secret Diseases" have disappeared, and are replaced by the term "Spermatorrhoea,' "1 the form of sexual disease now in fashion; and as, in such hypochondriaco-misanthropic persons, the sexual feelings are generally more or less affected, the conclusion is arrived at that every one who, with a bad conscience, feels himself out of sorts, is suffering from spermatorrhoea. There is a fashion in diseases, just as there is in amusements or occupations. Patients, come to us, half persuaded that they suffer in the way described, but still in doubt whether what they complain of is fancy or the real disease. In such cases we have to deal with ignorance, irritability of temper, and sometimes with true symptoms, though magnified by great exaggeration, and no inconsiderable alarm about the consequences. Conscience tells many that their previous lives have been far from faultless, and these pseudo-medical books exaggerate their indiscretion and predict the most awful consequences, describing trains of symptoms enough to frighten the most courageous. It is not difficult for my readers to surmise what must be the effect on the ignorant, the weak-minded, and those already depressed by their fears, with no friend at hand to confide in or to calm their excited feelings. Too many throw themselves into the meshes of these harpies, and the consequence is that they are fleeced to an amount that is almost inconceivable, except to those familiar with the swindling transactions of the class. As I may 1 Since the former editions of this book were published, its title has been pirated by more than two persons in such advertisements. On inquiry I found that it was impossible for me to prevent them from so doing. not have another opportunity, I would just mention a few circumstances out of many that have come under my personal knowledge. A student at Cambridge sought my advice suffering from one of these sexual complaints, half real, half ideal. When cured, he mentioned that, before coming to me he had consulted one of the advertising firms, and after paying some £40 in fees, was told that he could be cured only after giving his note of hand for £300. Worn down by his alarms, fearful he should never get well without compliance, and being of a very delicate and susceptible disposition, he signed the agreement, and the purport of his visit was to show me a letter in which the £300 was demanded in a very peremptory manner. I advised him at once to put the case into a lawyer's hands; and after some hesitation on his part this was done. The interviews between the opposing solicitors were very characteristic, but to describe them would occupy too much space here; suffice it to say my patient's letters were only given up after a compromise had been effected by the payment of a sum of money. In another case, a nobleman was asked for and gave £1000 to one of these advertising firms; they had the impudence to ask another £1000 some time after, under the plea that his case was a particularly difficult one. This somewhat surprised his lordship, and the family solicitor was consulted. All attempts however, to induce the quack to refund the £1000 failed, probably in consequence of the threats of exposure used by the firm. The reports from the "Lancet" and the "Times," given in the Appendix B, p. 333, will fully show the system adopted by these pests of society. In the more recent cases in which appropriate legal proceedings have been threatened, a moiety of the money has been returned, without recourse to an open trial; but it too often happens that the dupe prefers losing his money to the chance of having his weakness exposed. This alternative, which is always threatened but never carried into effect, however, is no longer found necessary. I once thought that the exposure of such nefarious practices would do good, but I now feel convinced all that can be done is to secure a return of the money. The frequent recurrence of prosecutions for almost any disgracefully nefarious crime shows that the trial of one case does little, if anything, to prevent others from occurring with exactly the same features of rascality and credulity; and I am afraid that no medical bill will cure the evil under consideration, though it may possibly change the modus operandi. The only efficient remedy for this system of plunder is that the profession should no longer shun the treatment of this class of diseases. It should be clearly understood by sufferers, that surgeons of repute willingly undertake the treatment of these, as well as all the other ailments to which flesh is heir, and that it is by no means necessary to resort to quacks or advertising firms. If, however, medical men desire to obtain the confidence of this class of patients, they must listen patiently to their statements, and not pooh-pooh what at first may seem fanciful. 66 Sufferers from false spermatorrhoea are as fully convinced that they suffer from the real ailment, the symptoms of which they complain of, as do actual invalids, and I have too much reason to think that my profession does not always appreciate these ideal sufferings. Rather with Dr. Reid in his treatise on hypochondriasis we would say: Nothing surely can surpass the inhumanity, as well as the folly, with which patients of this class (sufferers from nervous diseases) are too frequently treated. We often act upon the ill-founded idea that such complaints are altogether dependent upon the power of the will; a notion which, in paradoxical extravagance, scarcely yields to the doctrine of a modern, though already obsolete writer on The Philosophy of . Morals,' who asserted that no one need die, if with a sufficient energy he determined to live. To command or to advise a person laboring under nervous depression to be cheerful and alert, is no less idle and absurd than it would be to command or advise a person, under the direct and most intense influence of the sun's rays, to shiver with cold, or one who is 'wallowing in December's snows' to perspire from a sensation of excessive heat. The practice of laughing at or scolding a patient of this class is equally cruel and ineffectual. No one was ever laughed or scolded out of hypochondriasis. It is scarcely likely that we should elevate 6 |