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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

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.

cure.

LECTURE XX.

INSANITY OF MASTURBATION.

Ætiology-Effects of Sexual Derangement upon the Mind—Anxiety- Seminal

Emissions— Neurotic and Sanguine Temperaments-Hereditv-In Cases of Adolescent Insanity Masturbation is Ofien a Consequence Rather than a Cause-Symptoms-Debility-The Circulation-Appetite--SeclusionDepression-Irritability—Casos—Diagno.is, Religiosity-Dislike of the Opposite Sex — Tendency to Seek Isolation - Short Periods of Selfimportance—Prognosis — Treatment-Importance of Labor in the Open Air, etc.

Ætiology.—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, especially if it is one of lessened or irregular activity, which may be due to some unusual experience, when long protracted, or an undesired excitement of the organs, may prove quite sufficient to arouse this anxiety and render the individual miserable for the time being. Hence almost every practitioner of medicine has had numerous visits from young persons who nearly all come with a similar story, which runs somewhat as follows: that when young boys they had learned from older ones the wretched habit of self-abuse; that they occasionally practiced it for years, or until they learned in some manner that it was wrong, or became convinced of it by its effects upon themselves; that since such discovery they have abandoned the habit, but have been subject to seminal discharges; that these experiences, which have occurred as often as every two or three weeks or oftener, they feel confident, are producing a very bad effect upon their general health, are, in fact, sapping its very foundation.

When asked for the reason on which they base such conclusions, they can only reply, in a general way, that they feel languid and fatigued after wakening in the morning; that they frequently do not sleep so soundly as in former times; that they are subject to occasional headaches and unpleasant dreams, and constantly harassed with fears as to their future health and manhood.

When questioned more definitely as to any actual change which has already taken place, whether they are disabled from labor, or have lost flesh or strength, or have any actual pain or debility which disqualifies them from performing their usual duties, they are forced to admit that no such results have already occurred. They, however, are constantly haunted with the expectation that they will soon come, and hence they beg you to prescribe such remedial and preventive measures and medicines as will be sure to save them from such experiences.

Another class, less numerous than that already referred to, come with a similar story, except that they did not learn of the evil effects of the habit until after long years and an excessive indulgence in it.

Many of them have attained this knowledge at last only by the debility which has occurred in the sexual organs, or from some stray quack advertisement of a newspaper, the full meaning of which they have hardly comprehended. When finally they have determined to abandon the habit, they find themselves greatly annoyed and weakened by frequent seminal discharges. These have continued so long that the subjects experience a debility of both mind and body; they lose flesh, have occasional night-sweats, and wretched dreams; have lost interest in their usual avocations and the society of friends, and think they are unable to become interested in either study or labor, however much they may endeavor to do so. They have become timorous, emotional, easily excited, and often restless, and have frequent foreboding as to their future, and, in short, are in a state of mind to believe almost anything, however bad and hopeless it may be, in reference to the probabilities of their case. Indeed, generally the more unfavorable the prognosis of any physician may be in reference to their future, the more serious and alarming the statements he makes in reference to the necessity for immediate and skillful treatment, the more ready are they to place confidence in his statements, and regard that physician as the one who fully understands their case.

These are the unfortunate ones who are preyed upon by medical sharks who prowl about through almost all large

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