delivery instrumental. She has been about as usual and nursed the child, though feeling weak and unable to make any exertion. Finally she was brought to the hospital for the purpose of building up her general health, and after admission there became affected with hallucinations of hearing, and thought persons were calling to her. She made efforts to reply to these voices, and after a few days became so much excited and noisy that she was transferred to the Retreat. On admission she was despondent and unable to sleep except with medicine, looked thin and anæmic, but was able to reply to all questions when her attention was secured. She continued to talk to herself or to imaginary persons in a rambling and incoherent manner, and was greatly despondent. She was at once put upon the use of the hypophosphites and an abundance of food, and took hydrobromate of hyoscine for sleeping at night. She continued for some two or three weeks to imagine that some calamity was impending, and that she was fast failing and should never recover; that she was liable to die at any moment. She was suspicious and would not believe what was said to her; but in spite of all her forebodings she slowly gained; the hallucinations became less and her strength improved until she was removed by her friends, and though she was still in a condition of debility and could not be regarded as fully recovered, yet I have no doubt she did recover at her own home. Prognosis. The prognosis in lactational insanity is generally favorable. By reference to the preceding tables it will be observed that of nine cases in the Retreat, four recovered, and three were so much improved within five months (i. e., were so nearly recovered) that they were removed by friends; as they did not return, they may be considered as recovered. The recoveries, therefore, amount to 77 per cent. One of the remaining two was discharged as improved. She had experienced one previous attack, had borne seven children, and was admitted once afterward. The remaining one is under treatment. Of the 13 in the Connecticut Hospital six recovered; those who were discharged as improved had experienced former attacks, and two more of them had subsequent attacks, while four are under treatment. Of 54 cases reported by Dr. J. Batty Tuke, 39 recovered. Dr. Clouston reports actual recoveries amounting to 77.5 per cent., and with a still higher percentage as probable, some of the patients having been removed before recovery was complete. In the analysis of results as reported by Dr. Bevan Lewis the percentage of recoveries is 65.6. Treatment.—The indications for treatment are readily suggested by the physical states which are present in the larger number of cases and can hardly be mistaken. Those cases which are affected with the milder form of mental derangement can be easily managed in their own homes if the conditions of living are favorable and good nurses can be secured. Indeed, no inconsiderable number are thus cared for as are indicated by the statistics of asylums. The aversion toward removing such cases from home is greater than exists in patients affected with some other forms of insanity. It is, however, better that the larger proportion of patients should be removed from the influences and responsibilities connected with home life and placed beyond continual reminders of them. They require to be relieved from the friction and irritation which comes from the care of young children and which has probably been a factor of causation. Freedom from care of self and others, regularity in the use of food in large variety, favorable conditions for securing an abundance of sleep, new scenes and skillful nursing, all tend to place the patient in the most favorable environment for recovery. The prospect of recovery, which can be stated to friends, will act as a strong inducement toward leading them to place the patient in the care of some institution. As preliminary to this, however, it is desirable to wean the child if this has not already been done. The first point of importance in the treatment after admission to an institution or at home is the administration of an abundance of highly nutritious food. This should be given as often as every four hours, or at least five or six times in the course of 24 hours. It should consist of milk and eggs, beef extract or strong broths, fish, and easily digested meats. Uncooked eggs beaten up with wine or cider are generally relished and will take the place of solid food if this is refused. A glass of milk taken before retiring, or when awake during the night, will often be of service and tend to allay restlessness. In cases of insomnia, hyoscine, sulfonal, chloralamid, or, in case any one of these should not produce sleep, chloral, may be used for a few nights. If an abundance of food is taken the use of the above hypnotics at bedtime for a short period will generally be sufficient to prepare the system for sleep without the use of any hypnotic afterward. Opium should not be used unless in those cases in which depression is present, and then should be combined with the bromide of sodium or bromide of ammonium. Bitter infusions, quinine, wine or malt liquors, cream or cod-liver oil, and the free use of eggs, with gentle exercise in the open air by riding or walking, will tend rapidly toward a cure. Fowler's solution will sometimes be of essential service. It should be given in small doses at first, three- or four-minim doses three times a day, and may be increased from week to week according to indications. Rubbing and warm salt baths are also important in some cases; but it should be remembered that, after all, an abundance of easily digested food of good quality, in small quantities and frequently used, is a prime necessity and will conduce toward recovery more than any other one thing. LECTURE XX. INSANITY OF MASTURBATION. Etiology-Effects of Sexual Derangement upon the Mind-Anxiety-Seminal Emissions Neurotic and Sanguine Temperaments-Heredity-In Cases of Adolescent Insanity Masturbation is Often a Consequence Rather than a Cause Symptoms--Debility—The Circulation—Appetite-Seclusion— Depression-Irritability-Cases-Diagno-is-Religiosity-Dislike of the Etiology. The connection and sympathy existing between the intellectual and sexual centres of the brain and their reciprocal influence have long been recognized as most intimate. A lack of development in the sexual organs, at that period of life when they usually come into normal activity, is nearly always attended with a corresponding weakness and childishness of the mind; and it is only when the sexual organs become fully developed that the mind passes into the freedom and courage of manhood. Further, this influence continues to old age, and a derangement of no function or system sooner manifests itself on the mind than that of the sexual organs. Indeed, it is not always necessary that the change in functional activity be an actual disorder to raise anxiety and forebodings. Often a mere change in sexual feeling, |