sis (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 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, and 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 preserving, 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 Holy 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 excited 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 already stated, 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 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-accusa

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 manner. 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 into an asylum, which he sub sequently 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.

tions 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 impression or conviction.

It is probable that many of those young men whose insanity has become developed through such revival meetings as have of late (1862) been held in various districts of Great Britain and Ireland, would, on searching inquiry, be found to be cases 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 I set on this acute observer's remarks on this disease. I must be pardoned, however, if I differ from him somewhat as to the prognosis and treatment. It may be that I have had unusual opportunities of treating the disease in its commencement, but I confess I am much more sanguine as to the success of treatment than is Dr. Ritchie.

When, however, 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, and I feel that kind care and domestic attentions are all that can be done to soothe the latter days of these victims of ignorance or vice.

CHAPT. IV.-PHTHISIS ARISING FROM MASTURBATION.

THE attention of physicians has been lately directed to this subject, and no doubt can exist that consumption is frequently closely connected with sexual excesses. 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

sure.

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 Delicate constitutions, with a consumptive tendency, are often very susceptible to sexual excitement. They are consequently peculiarly liable to nocturnal emissions, and to the temptation to commit excesses. 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 constitutions. It is well when the surgeon or physician is able, early in life, to impress on such a patient the imminent risk he incurs in allowing even the sexual feelings to run riot. I am 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.

PERIOD III.

THE FUNCTIONS AND DISORDERS OF THE REPRODUCTIVE ORGANS IN THE ADULT.

THE following pages will, for the purpose of greater clearness and conciseness, be divided into two parts. In the first I propose to describe the adult sexual condition as a whole, and, in the second, to examine rather more minutely the constituent parts and necessary requisites of the sexual act, viz., erection, ejaculation, and emitted semen.

FIRST DIVISION.

ADULT SEXUAL CONDITION AS A WHOLE.

The commencement of adult life is a period in human existence less marked, perhaps, but not less real, and hardly less critical, than that of puberty. The general growth of the body is complete. The immature limbs of childhood are hardened into the firm and elastic frame of man. The mental powers should be at their highest. The will and judgment should command, and yet be enlivened by the remains of youthful energy and enthusiasm. And, which is more to our present purpose, the virile powers, whose existence commenced at puberty, now at last matured, should be fit and ready to be exercised in obedience to the Creator's command to be fruitful and multiply.

At a period differing in every man's life—but occurring generally somewhere between twenty-five and thirty-he is conscious, if he had lived on the whole a chaste life, of a great change in those sexual tendencies of which he has been frequently conscious before. They are no longer the fitful fancies of a boy, but are capable, he feels, of ripening at once into the steady rational