Every individual should know how to care for the sexual organs as well

as those of any other part of the body, providing that the instruction

be given by the proper person and at the proper time and place. Such

information should be imparted to children by parents, guardians, or

physicians at an early age and, if this is neglected through ignorance

or false modesty, erroneous ideas of the nature and purpose of the

sexual function will very surely be supplied later by ignorant and

probably evil-minded persons with correspondingly bad results. There

is no other responsibility in the whole range of parental duties which

is so commonly shirked and with such deplorable consequences. When the

subject is shorn of the morbid and seductive mystery with which custom

has foolishly surrounded it in the past, and considered in the same

spirit with which we study the hygiene of the digestion and other

natural functions, it will be found possible to give instruction about

the sexual function in a natural way and without exciting unhealthy

and morbid curiosity.

A word in the beginning as to the harm produced by abuse of the sexual

function. The injury thus received is purposely magnified tenfold for

reasons of gain by quacks who work upon the fears of their victims for

their own selfish purposes. The voluntary exercise of the sexual

function--unlike that of any other important organs--is not necessary

to health until maturity has been reached; on the contrary, continence

is conducive to health, both physical and mental. Even after maturity,

unless marriage occurs, or by improper living the sexual desires are

unnaturally stimulated, it is quite possible to maintain perfect

health through life without exercising the sexual function at all.

Undue irritation of the sexual organs causes disorder of the nervous

system, and if continued it will result ultimately in overfatigue and

failure of the nervous activities which control the normal functions

of every organ in the body. In other words, it will result in nervous

exhaustion.

Damage is also wrought by exciting local irritation, congestion, and

inflammation of the sexual organs which result in impairment of the

proper functions of these parts and in local disorders and distress.

It is unnecessary further to particularize other than to state that

abuse of the sexual organs in the young is usually owing to the almost

criminal neglect or ignorance of the child's parents. But so far from

increasing alarm in the patient it is almost always possible to enable

the child to be rid of the habit by kindly instruction and judicious

oversight in the future, and no serious permanent local damage to the

sexual organs or general injury to the nervous system will be likely

to persist. The opposite teaching is that peculiar to the quack who

prophesies every imaginable evil, from complete loss of sexual

function to insanity. Any real or fancied disorder of the sexual

function is extremely apt to lead to much mental anxiety and

depression, so that a cheerful outlook is essential in inspiring

effort to correct bad habits and is wholly warranted in view of the

entire recovery in most cases of the young who have abused their

sexual organs. Insanity or imbecility are seldom the result but more

often the cause of such habits. It is a sad fact, however, that, under

the prevailing custom of failure of the parents to exercise proper

supervision over the sexual function of their children, self-abuse is

generally practiced in youth, at least by boys.

This often leads to temporary physical and mental suffering and is

very prejudicial to the morals, but does not commonly result in

permanent injury except in the degenerate. Children at an early

age--three to four years--should be taught not to touch, handle, rub,

or irritate their sexual organs in any way whatsoever except so far as

is necessary in urination or in the course of the daily cleansing. If

there seems to be any inclination to do so it will usually be found

that it is due to some local trouble to which a physician's attention

should be called and which may generally be readily remedied by him.

It is always advisable to ask the medical adviser to examine babies

for any existing trouble and abnormality of the sexual organs, as a

tight, adherent, or elongated foreskin in boys--and rarely a

corresponding condition in girls--may give rise to much local

irritation and remote nervous disturbances. The presence of worms may

lead to irritation in the bowel, which excites masturbation in

children. Girl babies should be watched to prevent them from

irritating the external sexual parts by rubbing them between the inner

surfaces of the thighs. As the child begins to play with other

children he or she should be cautioned to avoid those who in any way

try to thwart the parents' advice, and be instructed to report all

such occurrences. It is wise also to try and gratify the child's

natural curiosity about the sexual function so far as may be judicious

by explanations as to the purpose of the sexual organs, when the child

is old enough to comprehend such matters.

The reticence and disinclination of parents to instruct their children

in matters relating to sex cannot be too strongly condemned. It is

perfectly natural that the youth should wish to know something of the

origin of life and how human beings come into the world. The mystery

and concealment thrown around these matters only serve to stimulate

his curiosity. It is a habit of most parents to rebuke any questions

relating to this subject as improper and immodest, and the first

lesson the child learns is to associate the idea of shame with the

sexual organs; and, since he is not enlightened by his natural

instructors, he picks up his knowledge of the sex function in a

haphazard way from older and often depraved companions.

Evasive replies with the intent of staving off the dreaded explanation

do no good and may result in unexpected evil. By securing the child's

confidence at the start, one may not only keep informed of his actions

but protect him from seeking or even listening to bad counsels. At the

age of ten or twelve it is well that the family physician or parent

should give instruction as to the special harm which results from

unnaturally exciting the sexual nature by handling and stimulating the

sexual organs and also warning the child against filthy literature and

improper companions. At the age of puberty he should be warned against

the moral and physical dangers of sexual intercourse with lewd women.

The physical dangers refer to the great possibility of infection with

one or both of the common diseases--syphilis and gonorrhea--acquired

by sexual contact with one suffering from these terrible disorders (p.

199). It is usually quite impossible for a layman to detect the

presence of these diseases in others, or rather, to be sure of their

absence, and the permanent damage which may be wrought to the sufferer

and to others with whom he may have sexual relations is incalculable.

It is generally known that syphilis is a disease to be dreaded, but

not perhaps that it not only endangers the life and happiness of the

patient, but the future generation of his descendants. Gonorrhea--the

much more common disease--while often treated lightly by youth,

frequently leads to long, chronic, local disease and may even result

fatally in death; later in life it may cause infection of a wife

resulting in chronic invalidism and necessitating surgical removal of

her maternal organs. These possibilities often occur long after the

patient thinks he is wholly free from the disease. Gonorrhea in women

is the most frequent cause of their sterility, and also is a common

source of abortion and premature birth. It is the cause in most cases

of blindness in infants (p. 205) and also of vulvo-vaginitis in girl

babies. Furthermore, gonorrhea is so alarmingly prevalent that it is

stated on good authority that the disease occurs in eighty per cent of

all males some time during their lives. The disease is not confined to

prostitutes, but is common, much more frequently than is suspected, in

all walks and classes of life and at all ages. Even among boys

attending boarding schools and similar institutions the disease is

only too frequent. It is particularly important that the true

situation be explained to boys about to enter college or a business

career, for it is at this period of life that their temptations become

greatest. Alcohol is the most dangerous foe--next to bad

companions--with which they must contend in this matter, for, weakened

by its influence and associated with persuasive friends, their will

gives way and the advice and warning, which they may have received,

are forgotten. Idleness is also another influential factor in

indirectly causing sexual disease; hard physical and mental work are

powerful correctives of the passions.

It may be of interest to readers to know that but recently an

association of American physicians, alarmed by the fearful prevalence

of sexual diseases in this country, has been taking measures to inform

youths and adults and the general public, through special instruction

in schools, and by means of pamphlets and lectures to teachers and

others, of the prevalence and great danger of this evil.

When young adult life has been attained it is also desirable for the

parent, or the family physician, to inform the young man or

woman--especially if either is about to enter a marriage

engagement--that close and frequent personal contact with the opposite

sex, especially when the affections are involved, will necessarily,

though involuntarily, excite local stimulation of the sexual organs

and general irritability and exhaustion of the entire nervous system.

Long engagements--when the participants are frequent companions--are

thus peculiarly unfortunate. It is only when the sexual functions are

normally exercised in adult life, as in sexual intercourse, that

sexual excitement is not harmful.

Young women about to marry should receive instruction from their

mothers as to the sexual relations which will exist after marriage.

Most girls are allowed to grow up ignorant of such matters and in

consequence may become greatly shocked and even disgusted by the

sexual relations in marriage--fancying that there must be something

unnatural and wrong about them because the subject was avoided by

those responsible for their welfare.

Any excess in frequency of sexual intercourse after marriage is

followed by feelings of depression and debility of some sort which may

be readily attributed to the cause and so corrected. Any deviation

from the natural mode of intercourse is pretty certain to lead to

physical disaster; thus, unnatural prolongation of the act, or

withdrawal on the part of the man before the natural completion of the

act in order to prevent conception, often results in deplorable

nervous disorders.

In conclusion, it may be said that parents must take upon themselves

the burden of instructing their children in sexual hygiene or shift it

upon the shoulders of the family physician, who can undertake it with

much less mental perturbation and with more intelligence. Otherwise

they subject their offspring to the possibility of incalculable

suffering, disease, and even death--largely through their own

inexcusable neglect.

CHAPTER II

=Genito-Urinary Diseases=

_Contagious Disorders--Common Troubles of Children--Inflammation of

the Bladder--Stoppage and Suppression of Urine--Causes and Treatment

of Bright's Disease._

=GONORRHEA.=--Gonorrhea is a contagious inflammation of the urethra,

accompanied by a white or yellowish discharge. It is caused by a

specific germ, the _gonococcus_, and is acquired through sexual

intercourse with a person suffering from this disease. Exceptionally

the disease may be conveyed by objects soiled with the discharge, as

basins, towels, and, in children, diapers, so that in institutions for

infants it may be thus transferred from one to the other, causing an

epidemic. The mucous membrane of the lower part of the bowel and the

eyes are also subject to the disease through contamination with the

discharge. The disease begins usually three to seven days after sexual

intercourse, with symptoms of burning, smarting, and pain on

urination, and a watery discharge from the passage, soon followed by a

yellowish or white secretion. Swelling of the penis, frequent

urination, and painful erections are also common symptoms. The

disease, if uncomplicated and running a favorable course, may end in

recovery within six weeks or earlier, with proper treatment. On the

other hand, complications are exceedingly frequent, and the disorder

often terminates in a chronic inflammation which may persist for

years--even without the knowledge of the patient--and may result in

the infection of others after all visible signs have ceased to appear.

=Treatment.=--Rest is the most important requisite; at first, best in

bed; if not, the patient should keep as quiet as possible for several

days. The diet should consist of large quantities of water or

milk, or milk and vichy, with bread, cereals, potatoes, and

vegetables--absolutely avoiding alcohol in any form. Sexual

intercourse is harmful at any stage in the disease and will

communicate the infection. Aperient salts should be taken to keep the

bowels loose. The penis should be soaked in hot water three times

daily to reduce the inflammation and cleanse the organ. A small wad of

absorbent cotton may be held in place by drawing the foreskin over it

to absorb the discharge, or may be held in place by means of a bag

fitting over the penis. All cloths, cotton, etc., which have become

soiled with the discharge, should be burned, and the hands should be

washed after contact with the discharge; otherwise the contagion may

be conveyed to the eyes, producing blindness. It is advisable for the

patient to take one-half teaspoonful of baking soda in water three

times daily between meals for the first four or five days, or, better,

fifteen grains of potassium citrate and fifteen drops of sweet spirit

of nitre in the same way. Painful erections may be relieved by bathing

the penis in cold water, urinating every three hours, and taking

twenty grains of sodium bromide at night in water. After all swelling

and pain have subsided, local treatment may be begun.

Injections or irrigations with various medicated fluids constitute the

best and most efficient measures of local treatment. They should be

used only under the advice and management of the physician. No greater

mistake can be made than to resort to the advertising quack, the

druggist's clerk, or the prescription furnished by an obliging friend.

Skillful treatment, resulting in a complete radical cure, may save him

much suffering from avoidable complications and months or years of

chronic trouble.

At the same time the first medicines advised are stopped and oleoresin

of cubebs, five grains, or copaiba balsam, ten grains--or both

together--are to be taken three times daily after meals, in capsules,

for several weeks, unless they disturb the digestion too much. A

suspensory bandage should be worn throughout the continuance of the

disease. The approach of the cure of the disease is marked by a

diminution in the quantity and a change in the character of the

discharge, which becomes thinner and less purulent and reduced to

merely a drop in the passage in the early morning, but this may

continue for a great while. Chronic discharge of this kind and the

complications cannot be treated properly by the patient, but require

skilled medical care.

In this connection it may be said that most patients have an idea that

the subsidence or disappearance of the discharge is an evidence of the

cure of the disease. Experience shows that the disease may lapse into

a latent or chronic form and remain quiescent, without visible

symptoms, during a prolonged period, while susceptible of being

revived under the influence of alcoholic drinks or sexual intercourse.

It is important that treatment should be continued until all disease

germs are destroyed, which can only be determined by an examination of

the secretions from the urethra under the microscope.

The more common complications of gonorrhea are inflammation of the

glands in the groin (bubo), acute inflammation of the prostate glands

and bladder, of the seminal vesicles, or of the testicles. The latter

complication is a most common cause of sterility in men. Formerly it

was thought that gonorrhea was a local inflammation confined to the

urinary canal and neighboring parts, but advances in our knowledge

have shown that the germs may be taken up into the general circulation

and affect any part of the body, such as the muscles, joints, heart,

lungs, liver, spleen, kidneys, etc., with results always serious and

often fatal to life. One of the most common complications is

gonorrheal arthritis, which may affect one or several joints and

result in stiffness or complete loss of movement of the affected

joint, with more or less deformity and permanent disability. Another

complication is gonorrheal inflammation of the eye, from direct

transference of the pus by the fingers or otherwise, and resulting in

partial or complete blindness.

=GONORRHEA IN WOMEN.=--Gonorrhea in women is a much more frequent and

serious disease than was formerly supposed. The general impression

among the laity is that gonorrhea in women is limited to the

prostitute and vicious classes who indulge in licentious relations.

Unfortunately, this is not the case. There is perhaps more gonorrhea,

in the aggregate, among virtuous and respectable wives than among

professional prostitutes, and the explanation is the following: A

large proportion of men contract the disease at or before the marrying

age. The great majority are not cured, and the disease simply lapses

into a latent form. Many of them marry, believing themselves cured,

and ignorant of the fact that they are bearers of contagion. They

transmit the disease to the women they marry, many of whom, from

motives of modesty and an unwillingness to undergo an examination do

not consult a physician, and they remain ignorant of the existence of

the disease until the health is seriously involved. In women,

gonorrhea is not usually so acute and painful as in men, unless it

involves the urethra. It usually begins with smarting and painful

urination, with frequent desire to urinate and with a more or less

abundant discharge from the front passage. In the majority of cases

the infection takes place in the deeper parts, that is, in the neck or

body of the womb. In this location it may not give rise at first to

painful symptoms, and the patient often attributes the increased

discharge to an aggravation of leucorrhea from which she may have

suffered. The special danger to women from gonorrhea is that the

inflammation is apt to be aggravated during the menstrual period and

the germs of the disease ascend to the cavity of the womb, the tubes,

and ovaries, and invade the peritoneal covering, causing peritonitis.

Pregnancy and childbirth afford favorable opportunities for the upward

ascension of the germs to the peritoneal cavity. The changes caused by

gonorrheal inflammation in the maternal organs are the most common

cause of sterility in women. It is estimated that about fifty per cent

of all sterility in women proceeds from this cause. In addition to its

effects upon the child-bearing function, the danger to the health of

such women is always serious. In the large proportion of cases they

are made permanent invalids, no longer able to walk freely, but

compelled to pass their lives in a reclining position until worn out

by suffering, which can only be relieved by the surgical removal of

their maternal organs. It is estimated that from fifty to sixty per

cent of all operations performed on the maternal organs of women are

due to disease caused by gonorrheal inflammation.

=Treatment.=--Rest in bed, the use of injections of hot water,

medicated with various astringents, by means of a fountain syringe in

the front passage three times daily, and the same remedies and bath

recommended above, with hot sitz baths, will usually relieve the

distress. In view of the serious character of this affection in women

and its unfortunate results when not properly treated, it is important

that they should have the benefit of prompt and skillful treatment by

a physician. Otherwise, the health and life of the patient may be

seriously compromised.

The social danger of gonorrhea introduced after marriage is not

limited to the risks to the health of the woman. When a woman thus

infected bears a child the contagion of the disease may be conveyed to

the eyes of the child in the process of birth. Gonorrheal pus is the

most virulent of all poisons. A single drop of the pus transferred to

the eye may destroy this organ in from twenty-four to forty-eight

hours. It is estimated that from seventy-five to eighty per cent of

all babies blinded at birth have suffered from this cause, while from

twenty to thirty per cent of blindness from all causes is due to

gonorrhea. While the horrors of this disease in the newborn have been

mitigated by what is called the Crede method (instillation of nitrate

of silver solution in the eye immediately after birth), it still

remains one of the most common factors in the causation of blindness.

Another social danger is caused by the pus being conveyed to the

genital parts of female children, either at birth or by some object

upon which it has been accidentally deposited, such as clothes,

sponges, diapers, etc. These cases are very common in babies'

hospitals and institutions for the care of children. Quite a number of

epidemics have been traced to this cause. The disease occurring in

children is exceedingly difficult of cure and is often followed by

impairment in the development of their maternal organs. Much of the

ill health of young girls from disordered menstruation and other

uterine diseases may be traced to this cause. Another serious

infection in babies and young children is gonorrheal inflammation of

the joints, with more or less permanent crippling.

=SYPHILIS; THE POX; LUES.=--Syphilis is a contagious germ disease

affecting the entire system. While commonly acquired through sexual

intercourse with a person affected with the disorder, it may be

inherited from the parents, one or both. It is often acquired through

accidental contact with sources of contagion. Syphilis and

tuberculosis are the two great destroyers of health and happiness, but

syphilis is the more common.

=Symptoms.=--Acquired syphilis may be divided into three stages: the

primary, secondary, and tertiary. The first stage is characterized by

the appearance of a pimple or sore on the surface of the sexual organ

not usually earlier than two, nor later than five to seven, weeks

after sexual intercourse. The appearance of this first sore is subject

to such variations that it is not always possible for even the most

skillful physician to determine positively the presence of syphilis

in any individual until the symptoms characteristic of the second

stage develop. Following the pimple on the surface of the penis comes

a raw sore with hard deposit beneath, as of a coin under the skin. It

may be so slight as to pass unnoticed or become a large ulcer, and may

last from a few weeks to several months. There are several other kinds

of sores which have no connection with syphilis and yet may resemble

the syphilitic sore so closely that it becomes impossible to

distinguish between them except by the later symptoms to be described.

Along with this sore, lumps usually occur in one or both groins, due

to enlarged glands.

The second stage appears in six to seven weeks after the initial sore,

and is characterized by the occurrence of a copper-colored rash over

the body, but not often on the face, which resembles measles

considerably. Sometimes a pimply or scaly eruption is seen following

this or in place of the red rash. At about, or preceding, this period

other symptoms may develop, as fever, headache, nausea, loss of

appetite, and sleeplessness, but these may not be prominent. Moist

patches may appear on the skin, in the armpits, between the toes, and

about the rectum; or warty outgrowths in the latter region. There is

sore throat, with frequently grayish patches on the inside of the

cheeks, lips, and tongue. The hair falls out in patches or, less

often, is all lost. Inflammation of the eye is sometimes a symptom.

These symptoms do not always occur at the same time, and some may be

absent or less noticeable than others.

The third stage comes on after months or years, or in those subjected

to treatment may not occur at all. This stage is characterized by

sores and ulcerations on the skin and deeper tissues, and the

occurrence of disease of different organs of the body, including the

muscles, bones, nervous system, and blood vessels; every internal

organ is susceptible to syphilitic change.

A great many affections of the internal organs--the heart, lungs,

liver, kidneys, brain, and cord--which were formerly attributed to

other causes, are now recognized as the product of syphilis. The

central nervous system is peculiarly susceptible to the action of the

syphilitic poison, and when affected may show the fact through

paralysis, crippling, disabling, and disfiguring disorders.

Years after cure has apparently resulted, patients are more liable to

certain nervous disorders, as locomotor ataxia, which attacks

practically only syphilitics; and general paresis, of which

seventy-five per cent of the cases occur in those who have had

syphilis.

=Inherited Syphilis.=--Children born with syphilis of syphilitic

parents show the disease at birth or usually within one or two months.

They present a gaunt, wasted appearance, suffer continually from

snuffles or nasal catarrh, have sores and cracks about the lips, loss

of hair, and troublesome skin eruptions. The syphilitic child has been

described as a "little old man with a cold in his head." The internal

organs are almost invariably diseased, and sixty to eighty per cent of

the cases fortunately die. Those who live to grow up are puny and

poorly developed, so that at twenty they look not older than twelve,

and are always delicate.

It is to be noted that syphilis is not necessarily a venereal disease,

that is, acquired through sexual relations. It may be communicated by

kissing, by accidental contact with a sore on a patient's body, by the

use of pipes, cups, spoons, or other eating or drinking utensils, or

contact with any object upon which the virus of the disease has been

deposited.

Any part of the surface of the body or mucous membrane is susceptible

of being inoculated with the virus of syphilis, followed by a sore

similar to what has been described as occurring upon the genital parts

and later the development of constitutional symptoms. The

contagiousness of the disease is supposed to last during the first

three years of its existence, but there are many authentic cases of

contagion occurring after four or five years of syphilis.

=Diagnosis.=--The positive determination of the existence of syphilis

at the earliest moment is of the utmost importance in order to set at

rest doubt and that treatment may be begun. It is necessary to wait,

however, until the appearance of the eruption, sore throat,

enlargement of glands, falling out of hair, etc., before it is safe to

be positive.

=Treatment.=--The treatment should be begun as soon as the diagnosis

is made, and must be continuously and conscientiously pursued for

three years or longer. If treatment is instituted before the secondary

symptoms, it may prevent their appearance so that the patient may

remain in doubt whether he had the disease or not, for it is

impossible for the most skilled specialist absolutely to distinguish

the disease before the eruption, no matter how probable its existence

may seem. This happens because there are several kinds of sores which

attack the sexual organs and which may closely simulate syphilis. The

treatment is chiefly carried out with various forms of mercury and

iodides, but so much knowledge and experience are required in adapting

these to the individual needs and peculiarities of the patient that it

is impossible to describe their use. Patients should not marry until

four or five years have elapsed since the appearance of syphilis in

their persons, and at least twelve months after all manifestations of

the disease have ceased. If these conditions have been complied with,

there is little danger of communicating the disease to their wives or

transmitting it to their offspring. They must moreover, have been

under the treatment during all this period. Abstinence from alcohol,

tobacco, dissipation, and especial care of the teeth are necessary

during treatment.

=Results.=--The majority of syphilitics recover wholly under treatment

and neither have a return of the disease nor communicate it to their

wives or children. It is, however, possible for a man, who has

apparently wholly recovered for five or six years or more, to impart

the disease. Without proper treatment or without treatment for the

proper time, recurrence of the disease is frequent with the occurrence

of the destructive and often serious symptoms characteristic of the

third stage of the disease. While syphilis is not so fatal to life as

tuberculosis, it is capable of causing more suffering and unhappiness,

and is directly transmitted from father to child, which is not the

case with consumption. Syphilis is also wholly preventable, which is

not true of tuberculosis at present. It is not probable that syphilis

is ever transmitted to the third generation directly, but deformities,

general debility, small and poor teeth, thin, scanty growth of hair,

nervous disorders, and a general miserable physique are seen in

children whose parents were the victims of inherited syphilis. In

married life syphilis may be communicated to the wife directly from

the primary sore on the penis of the husband during sexual

intercourse, but contamination of the wife more often happens from the

later manifestations of the disease in the husband, as from secretion

from open sores on the body or from the mouth, when the moist patches

exist there.

It is possible for a child to inherit syphilis from the father--when

the germs of syphilis are transmitted through the semen of the father

at the time of conception--and yet the mother escape the disease. On

the other hand, it is not uncommon for the child to become thus

infected and infect its mother while in her womb; or the mother may

receive syphilis from the husband after conception, and the child

become infected in the womb.

The chief social danger of syphilis comes from its introduction into

marriage and its morbid radiations through family and social life.

Probably one in every five cases of syphilis in women is communicated

by the husband in the marriage relation. There are so many sources and

modes of its contagion that it is spread from one person to another in

the ordinary relations of family and social life--from husband to wife

and child, from child to nurse, and to other members of the family, so

that small epidemics of syphilis may be traced to its introduction

into a family. Syphilis is the only disease which is transmitted in

full virulence to the offspring, and its effect is simply murderous.

As seen above, from sixty to eighty per cent of all children die

before or soon after birth. One-third of those born alive die within

the next six months, and those that finally survive are blighted in

their development, both physical and mental, and affected with various

organic defects and deformities which unfit them for the battle of

life. Syphilis has come to be recognized as one of the most powerful

factors in the depopulation and degeneration of the race.

=INVOLUNTARY PASSAGE OF URINE--BED-WETTING IN

CHILDREN.=--(_Incontinence of Urine_).--This refers to an escape of

urine from the bladder uncontrolled by the will. It naturally occurs

in infants under thirty months, or thereabouts, and in the very old,

and in connection with various diseases. It may be due to disease of

the brain, as in idiocy or insanity, apoplexy, or unconscious states.

Injuries or disorders of the spinal cord, which controls the action of

the bladder (subject to the brain), also cause incontinence. Local

disorders of the urinary organs are more frequent causes of the

trouble, as inflammation of any part of the urinary tract, diabetes,

nephritis, stone in the bladder, tumors, and malformations. The

involuntary passage of urine may arise from irritability of

bladder--the most frequent cause--or from weakness of the muscles

which restrain the escape of urine, or from obstruction to flow of

urine from the bladder, with overflow when it becomes distended.

It is a very common disorder of children and young persons, and in

some cases no cause can be found; but in many instances it is due to

masturbation (p. 193), to a narrow foreskin and small aperture at the

exit of the urinary passage, to worms in the bowels or disease of the

lower end of the bowels, such as fissure or eczema, to digestive

disorders, to retaining the urine overlong, to fright, to dream

impressions (dreaming of the act of urination), and to great weakness

brought on by fevers or other diseases. In old men it is often due to

an enlargement of a gland at the neck of the bladder which prevents

the bladder from closing properly. A concentrated and irritating

urine, from excessive acidity or alkalinity, may induce incontinence.

Children may recover from it as they approach adult life, but they

should not be punished, as it is a disease and not a fault. Exception

should be made in case children wet their clothing during play,

through failure to take the time and trouble to pass water naturally.

It is more common among children at night, leading to wetting of the

bed, but may occur in the day, and often improves in the spring and

summer, only to return with the cold weather. Children who sleep very

soundly are more apt to be subject to this disorder.

=Treatment.=--In the case of a disorder depending upon one of so many

conditions it will be realized that it would be folly for the layman

to attempt to treat it. Children who are weak need building up in

every possible way, as by an outdoor life, cold sponging daily, etc.

If there is in boys a long foreskin, or tight foreskin, hindering the

escape of urine and natural secretions of this part, circumcision may

be performed to advantage by the surgeon, even in the infant a few

months old. Sometimes a simpler operation, consisting of stretching or

overdistending the foreskin, can be done.

A somewhat corresponding condition in girls occasionally causes

bed-wetting and other troubles. It can be discovered by a physician.

Children who wet their beds, or clothes, should not drink liquid

after five in the afternoon, and should be taken up frequently during

the night to pass water. The bed covering must be light, and they

should be prevented from lying on the back while asleep by wearing a

towel knotted in the small part of the back. Elevation of the foot of

the bed a few inches is recommended as having a corrective influence.

Masturbation, if present, must be corrected.

It is a very difficult disorder to treat, and physicians must be

excused for failures even after every attempt has been made to

discover and remove the cause. Even when cure seems assured, the

disorder may recur.

=INFLAMMATION OF THE BLADDER= (_Cystitis_).--The condition which we

describe under this head commonly causes frequent painful urination.

Primarily there is usually some agency which mechanically or

chemically irritates the bladder, and if the irritation does not

subside, inflammation follows owing to the entrance of germs in some

manner. The introduction into the bladder of unboiled, and therefore

unclean, instruments is a cause; another cause is failure to pass

urine for a long period, from a feeling of delicacy in some persons

when in unfavorable surroundings. Nervous spasm of the urinary passage

from pain, injuries, and surgical operations constitutes another

cause. Inflammation may extend from neighboring parts and attack the

bladder, as in gonorrhea, and in various inflammations of the sexual

organs of women, as in childbed infection. Certain foods, waters, and

drinks, as alcohol in large amounts, and drugs, as turpentine or

cantharides applied externally or given internally, may lead to

irritation of the bladder. Exposure to cold in susceptible persons is

frequently a source of cystitis, as well as external blows and

injuries. The foregoing causes are apt to bring on sudden or acute

attacks of bladder trouble, but often the disease comes on slowly and

is continuous or chronic.

Among the causes of chronic cystitis, in men over fifty, is

obstruction to the outflow of urine from enlargement of the prostate

gland, which blocks the exit from the bladder. In young men, narrowing

of the urethra, a sequel to gonorrhea, may also cause cystitis; also

stone in the bladder or foreign bodies, tumors growing in the bladder,

tuberculosis of the organ. Paralysis of the bladder, which renders the

organ incapable of emptying itself, thus retaining some fermenting

urine, is another cause of bladder inflammation.

=Symptoms.=--The combination of frequency of and pain during

urination, with the appearance of blood or white cloudiness and

sediment in the urine, are evidences of the existence of inflammation

of the bladder. The trouble is aggravated by standing, jolting, or

active exercise. The pain may be felt either at the beginning or end

of urination. There is also generally a feeling of weight and

heaviness low down in the belly, or about the lower part of the bowel.

Blood is not frequently present, but the urine is not clear, if there

is much inflammation, but deposits a white and often slimy sediment

on standing. In chronic inflammation of the bladder the urine often

has a foul odor and smells of ammonia.

=Treatment.=--The treatment of acute cystitis consists in

rest--preferably on the back, with the legs drawn up, in bed. The diet

should be chiefly fluid, as milk and pure water, flaxseed tea, or

mineral waters. Potassium citrate, fifteen grains, and sweet spirit of

nitre, fifteen drops, may be given in water to advantage three times

daily. Hot full baths or sitz baths two or three times a day, and in

women hot vaginal douches (that is, injections into the front

passage), with hot poultices or the hot-water bag over the lower part

of the abdomen, will serve to relieve the suffering. If, however, the

pain and frequency attending urination is considerable, nothing is so

efficient as a suppository containing one-quarter grain each of

morphine sulphate and belladonna extract, which should be introduced

into the bowel and repeated once in three hours if necessary. This

treatment should be employed only under the advice of a physician. In

chronic cystitis, urotropin in five-grain doses dissolved in a glass

of water and taken four times daily often affords great relief, but

these cases demand careful study by a physician to determine their

cause, and often local treatment. Avoidance of all source of

irritation is also essential in these cases, as sexual excitement and

the use of alcohol and spices. The diet should consist chiefly of

cereals and vegetables, with an abundance of milk and water. The

bowels should be kept loose by means of hot rectal injections in acute

cystitis.

=RETENTION, STOPPAGE, OR SUPPRESSION OF URINE.=--Retention refers to

that condition where the urine has been accumulating in the bladder

for a considerable time--over twelve hours--and cannot be passed. It

may follow an obstruction from disease, to which is added temporary

swelling and nervous contraction of some part of the urinary passage;

or it may be due to spasm and closure of the outlet from nervous

irritation, as in the cases of injuries and surgical operations in the

vicinity of the sexual organs, the rectum, or in other parts of the

body. Overdistention of the bladder from failure to pass water for a

long time may lead to a condition where urination becomes an

impossibility. Various general diseases, as severe fevers, and

conditions of unconsciousness, and other disorders of the nervous

system, are frequently accompanied by retention of urine. In retention

of urine there is often an escape of a little urine from time to time,

and not necessarily entire absence of outflow.

=Treatment.=--Retention of urine is a serious condition. If not

relieved, it may end in death from toxaemia, caused by back pressure on

the kidneys, or from rupture of the bladder. Therefore surgical

assistance is demanded as soon as it can be obtained. Failing this,

begin with the simpler methods. A hot sitz bath, or, if the patient

cannot move, hot applications, as a hot poultice or hot cloths

applied over the lower part of the belly, may afford relief.

Injections of hot water into the bowel are often more efficient still.

A single full dose of opium in some form, as fifteen drops of

laudanum[10] or two teaspoonfuls of paregoric[10] or one-quarter grain

of morphine,[10] will frequently allow of a free passage of urine. The

introduction of a suppository into the bowel, containing one-quarter

grain each of morphine sulphate,[10] and belladonna extract, is often

preferable to giving the drug by the mouth. These measures proving of

no avail, the next endeavor should be to pass a catheter. If a soft

rubber or elastic catheter is used with reasonable care, little damage

can be done, even by a novice. The catheter should be boiled in water

for ten minutes, and after washing his hands thoroughly the attendant

should anoint the catheter with sweet oil (which has been boiled) or

clean vaseline and proceed to introduce the catheter slowly into the

urinary passage until the urine begins to flow out through the

instrument.

A medium-sized catheter is most generally suitable, as a No. 16 of the

French scale, or a No. 8-1/2 of the English scale.

=BRIGHTS DISEASE OF THE KIDNEYS.=--Bright's disease of the kidneys is

acute or chronic, and its presence can be definitely determined only

by chemical and microscopical examination of the urine. Acute Bright's

disease coming on in persons previously well may often, however,

present certain symptoms by which its existence may be suspected even

by the layman.

=ACUTE BRIGHT'S DISEASE; ACUTE INFLAMMATION OF THE KIDNEYS.=--Acute

Bright's disease is often the result of exposure to cold and wet.

Inflammation of the kidneys may be produced by swallowing turpentine,

many of the cheap flavoring extracts in large amounts, carbolic acid,

and Spanish flies; the external use of large quantities of turpentine,

carbolic acid, or Spanish flies may also lead to acute inflammation of

the kidneys. It occurs occasionally in pregnant women. The contagious

germ diseases are very frequently the source of acute Bright's disease

either as a complication or sequel. Thus scarlet fever is the most

frequent cause, but measles, smallpox, chickenpox, yellow fever,

typhoid fever, erysipelas, diphtheria, cholera, and malaria are also

causative factors.

=Symptoms.=--Acute Bright's disease may develop suddenly with pallor

and puffiness of the face owing to dropsy. The eyelids, ankles, legs,

and lower part of the belly are apt to show the dropsy most. There may

be nausea, vomiting, pain and lameness in the small part of the back,

chills and fever, loss of appetite, and often constipation. In

children convulsions sometimes appear. The urine is small in amount,

perhaps not more than a cupful in twenty-four hours, instead of the

normal daily excretion of three pints. Occasionally complete

suppression of urine occurs. It is high-colored, either smoky or of a

porter color, or sometimes a dark or even bright red, from the

pressure of blood. Stupor and unconsciousness may supervene in severe

cases. Recovery usually occurs, in favorable cases, within a few

weeks, with gradually diminishing dropsy and increasing secretion of

urine, or the disease may end in a chronic disorder of the kidneys. If

acute Bright's disease is caused by, or complicated with, other

diseases, the probable result becomes much more difficult to predict.

=Treatment.=--The failure of the kidneys to perform their usual

function of eliminating waste matter from the blood makes it necessary

for the skin and bowels to do double duty. The patient should remain

in bed and be kept very warm with flannel night clothes and blankets

next the body. The diet should consist wholly of milk, a glass every

two hours, in those with whom it agrees, and in others gruels may be

substituted to some extent. The addition to milk of mineral waters,

limewater, small amounts of tea, coffee, or salt often makes it more

palatable to those otherwise disliking it. As the patient improves,

bread and butter, green and juicy vegetables, and fruits may be

permitted. An abundance of pure water is always desirable. The bowels

should be kept loose from the outset by salts given in as little water

as possible and immediately followed by a glass of pure water. A

teaspoonful may be given hourly till the bowels move. Epsom or

Glauber's salts are efficient, but the compound jalap powder is the

best purgative. Children, or those to whom these remedies are

repugnant, may take the solution of citrate of magnesia, of which the

dose is one-half to a whole bottle for adults. The skin is stimulated

by the patient's lying in a hot bath for twenty minutes each day or,

if this is not possible, by wrapping the patient in a blanket wrung

out of hot water and covered by a dry blanket, and then by a rubber or

waterproof sheet, and he is allowed to remain in it for an hour with a

cold cloth to the head. If the patient takes the hot bath he should be

immediately wrapped in warmed blankets on leaving it, and receive a

hot drink of lemonade to stimulate sweating.

For treatment of convulsions, see Vol. I, p. 188.

Vomiting is allayed by swallowing cracked ice, single doses of bismuth

subnitrate (one-quarter teaspoonful) once in three hours, and by heat

applied externally over the stomach. Recovery is hastened by avoiding

cold and damp, and persisting with a liquid diet for a considerable

period. A course of iron is usually desirable after a few weeks have

elapsed to improve the quality of the blood; ten drops of the tincture

of the chloride of iron taken in water through a glass tube by adults;

for children five to ten drops of the syrup of the iodide of iron. In

either case the medicine should be taken three times daily after

meals.

=CHRONIC BRIGHT'S DISEASE.=--This includes several forms of kidney

disease. The symptoms are often very obscure, and the condition may

not be discovered or suspected by the physician until an examination

of the urine is made, which should always be done in any case of

serious or obscure disorder. Accidental discovery of Bright's disease

during examination for life insurance is not rare. The disease may

exist for years without serious impairment resulting.

=Causes.=--Chronic Bright's disease often follows and is the result of

fevers and acute inflammation of the kidneys. It is more common in

adults. Overeating, more especially of meat, and overdrinking of

alcohol are frequent causes. Gout is a frequent factor in its

causation. The disease has in the past been regarded as a local

disease of the kidneys, but recent research makes it probable that

there is a general disorder of the system due to some faulty

assimilation of food--especially when the diet itself is faulty--with

the production of chemical products which damage various organs in the

body as well as the kidneys, notably the heart and blood vessels.

=Symptoms.=--The symptoms are most diverse and varied and it is not

possible to be sure of the existence of the disease without a careful

physical examination, together with a complete examination of the

urine, both made by a competent physician. Patients may be afflicted

with the disease for long periods without any symptoms until some

sudden complication calls attention to the underlying trouble.

Symptoms suggesting chronic Bright's disease are among the following:

indigestion, diarrhea and vomiting, frequent headache, shortness of

breath, weakness, paleness, puffiness of the eyelids, swelling of the

feet in the morning, dropsy, failure of eyesight, and nosebleed, and

sometimes apoplexy. As the disease comes on slowly the patient has

usually time to apply for medical aid, and attention is called to the

foregoing symptoms merely to emphasize the importance of attending to

such in due season.

=Outcome.=--While the outlook as to complete recovery is very

discouraging, yet persons may live and be able to work for years in

comparative comfort in many cases. When a physician pronounces the

verdict of chronic Bright's disease, it is not by any means equivalent

to a death warrant, but the condition is often compatible with many

years of usefulness and freedom from serious suffering.

=Treatment.=--Medicines will no more cure Bright's disease than old

age. Out-of-door life in a dry, warm, and equable climate has the most

favorable influence upon the cause of chronic Bright's disease, and

should always be recommended as a remedial agent when available.

Proper diet is of great importance. Cereals, vegetables, an abundance

of fat in the form of butter and cream--to the amount of a pint or so

a day of the latter, and the avoidance of alcohol and meat, fish and

eggs constitute the ideal regimen when this can be carried out. Tea

and coffee in much moderation are usually allowable and water in

abundance. The underclothing should be of wool the year round, and

especial care is essential to avoid chilling of the surface. Medicines

have their usefulness to relieve special conditions, but should only

be taken at the advice of a physician, whose services should always be

secured when available.

Part IV

DISEASE AND DISORDER OF THE

MIND

BY

ALBERT WARREN FERRIS

CHAPTER I

=Insanity=

Insanity is the name given to a collection of symptoms of disease of

the brain or disorder of brain nutrition or circulation. The principal

test of insanity lies in the adjustment of the patient to his

surroundings, as evidenced in conduct and speech. Yet one must not

include within the field of insanity the improper conduct and speech

of the vicious, nor of the mentally defective. Crime is not insanity,

though there are undoubtedly some insane people confined in prisons

who have been arrested because of the commission of crime.

Then, too, while mental defect may exist in the insane, there is a

certain class of mental defectives whose condition is due not to

disease of the brain, but to arrest of development of the brain during

childhood or youth, and these we call idiots or imbeciles; but they

are not classed with the insane.

_Mental Disorder Not Insanity_

We frequently hear repeated the assertion, "Everybody is a little

insane," and the quotation is reported as coming from an expert in

insanity. This quotation is untrue. The fact is that anyone is liable

to mental disorder; but mental disorder is not insanity. To

illustrate: a green glove is shown to a certain man and he asserts

that its color is brown, and you cannot prove to him that he is wrong,

because he is color-blind. Green and brown appear alike to him. This

is mental disorder, but not insanity. Again, a friend will explain to

you how he can make a large profit by investing his money in a certain

way. He does so invest it and loses it, because he has overlooked

certain factors, has not given proper weight to certain influences,

and has ignored probable occurrences, all of which were apparent to

you. He was a victim of his mental disorder, his judgment, reason, and

conception being faulty; yet he was not insane. Again, you answer a

letter from a correspondent, copying on the envelope the address you

read at the head of his letter. A few days later your answer is

returned to you undelivered. In astonishment, you refer to his letter

and find that you have misread the address he gave, mistaking the

number of his house. This was an instance of mental disorder in your

not reading the figure aright; but it was not insanity.

_What Autopsies of the Brain Reveal_

The changes in the brain accompanying or resulting from disease, as

found in some chronic cases of insanity in which autopsies are made,

consist largely in alteration of the nerve cells of the brain. The

cells are smaller and fewer than they should be, they are altered in

shape, and their threads of communication with other cells are

broken. Nerve cells and often large areas of gray matter are replaced

by connective tissue (resembling scar tissue), which grows and

increases in what would otherwise be vacant spaces. All areas which

contain this connective tissue, this filling which has no function, of

course, cease to join with other parts of the brain in concerted

action, and so the power of the brain is diminished, and certain of

its activities are restricted or abolished.

_Curious Illusions of the Insane_

In the normal brain certain impressions are received from the special

senses: impressions of sight or of hearing, for example. These

impressions are called conscious perceptions, and the healthy brain

groups them together and forms concepts. For instance, you see

something which is flat and shiny with square-cut edges. You touch it,

and learn that it is cold, smooth, and hard. Lift it and you find it

heavy. Grouping together your sense perceptions you form the concept,

and decide that the object is a piece of marble. Again, you enter a

dimly lighted room and see a figure in a corner the height of a woman,

with a gown like a woman's. You approach it, speak to it and get no

reply, and you find you can walk directly through it, for it is a

shadow. Perhaps you were frightened. Perhaps you imagined she was a

thief. Your first judgment was wrong and you correct it. The insane

person, however, has defective mental processes. He cannot group

together his perceptions and form proper conceptions. His imagination

runs riot. His emotions of fear or anger are not easily limited. He

has to some extent lost the control over his mental actions that you

and other people possess if your brains are normal. The insane man

will insist that there is a woman there, and not a shadow, and to his

mind it is not absurd to walk directly through this person. He cannot

correct the wrong idea. Such a wrongly interpreted sense perception is

called an illusion. Another example of illusion is the mistaking the

whistle of a locomotive for the shriek of a pursuing assassin.

_What Hallucinations Are_

The insane man may also suffer from hallucinations. A hallucination is

a false perception arising without external sensory experience. In a

hallucination of sight, the disease in the brain causes irritation to

be carried to the sight-centers of the brain, with a result that is

similar to the impression carried to the same centers by the optic

nerves when light is reflected into the eyes from some object. An

insane man may be deluded with the belief that he sees a face against

the wall where there is nothing at all. When the air is pure and sweet

and no odor is discoverable, he may smell feathers burning, and thus

reveal his hallucination of smell.

_Delusions Common to Insanity_

The insane man may have wrong ideas without logical reason for them.

Thus, an insane man may declare that a beautiful actress is in love

with him, when there is absolutely no foundation for such an idea. Or,

he may believe that he can lift 500 pounds and run faster than a

locomotive can go, while in reality he is so feeble as scarcely to be

able to walk, and unable to dress himself. Such ideas are delusions.

Sane people may be mistaken; they may have hallucinations, illusions

and delusions; but they abandon their mistaken notions and correct

their judgment at once, on being shown their errors. Sane people see

the force of logical argument, and act upon it, abandoning all

irrational ideas. The insane person, on the other hand, cannot see the

force of logical argument; cannot realize the absurdity or

impossibility of error. He clings to his own beliefs, for the evidence

of his perverted senses or the deductions from his disease-irritation

are very real to him. When we find this to be the fact we know he is

insane.

Yet we must not confound delirium of fever with insanity. A patient

suffering from typhoid fever may have a delusion that there is a pail

by his bed into which he persists in throwing articles. Or he may have

the hallucination that he is being called into the next room, and try

to obey the supposed voice.

Certain delusions are commonly found in certain types of insanity.

Depressed patients frequently manifest the delusion that they have

committed a great sin, and are unfit to associate with anyone.

Excited and maniacal patients often believe they are important

personages--kings or queens, old historical celebrities, etc.

Paranoiacs commonly have delusions of persecution and of a conspiracy

among their relatives or their associates or rivals. Victims of

alcoholic insanity have delusions regarding sexual matters, and

generally charge with infidelity those to whom they are married.

General paretics in most cases have delusions of grandeur; that is,

false ideas of great strength, wealth, political power, beauty, etc.

The emotion which accompanies mental activity is generally exaggerated

in all insane people except the demented. One sees extreme depression,

or undue elation and exaltation, or silly glee and absurd joy.

Intensity of emotion is frequent.

_Crimes Impulsively Committed by the Insane_

An interesting mental feature of many insane patients is the

imperative conception, or imperative impulse. This is a strong urging

felt by the patient to commit a certain act. He may know the act is

wrong and dread the punishment which he expects will follow its

commission. But so constantly and strongly is he impelled that he

finally yields and commits the act. Crimes are thus perpetrated by the

insane, with a full knowledge of their enormity. The fact that such

impulses undoubtedly exist should modify the common test, as to an

insane person's responsibility before the law. The statute in many

countries regards an insane criminal as responsible for his act, if he

knows the difference between right and wrong. This decision is unjust

and the basis is wrong; for an impulse may be overwhelming, and the

patient utterly helpless during its continuance. However, a patient

who has committed a crime under stress of such an irresistible impulse

should be put under permanent custodial care.

_Physical Signs of Insanity_

The physician who is skilled in psychiatry finds in very many insane

patients marked physical signs. There are pains, insensitive areas,

hypersensitive areas, changes in the pupils of the eyes, unrestrained

reflex action, and partial loss of muscular control, as shown in

talking, walking, and writing. Constipation and insomnia are very

early symptoms of disease in a very large proportion of the insane.

It is productive of no good result for a layman to try to classify the

insane. The matter of classification will be for several years in a

condition of developmental change. It is enough to speak of the

patient as depressed or excited, agitated or stupid, talkative or

mute, homicidal, suicidal, neglectful, uncleanly in personal habits,

etc.

_Illustrations of Various Types_

There are very interesting features connected with typical instances

of several varieties of insanity, as they were noted in certain cases

under the writer's care. A depressed patient with suicidal tendencies

cherished the delusion that war with Great Britain was imminent, and

that in such an event British troops would be landed on Long Island

between New York City and the spot where he conceived the cattle to be

kept. This, he argued, would cut off the beef and milk supply from the

city. He therefore decided to do his part toward husbanding the

present supply of food by refusing to eat; an act which necessitated

feeding him through a rubber tube for many weeks. He also attempted

suicide by drowning, throwing himself face downward in a shallow

swamp, whence he was rescued. This young man was an expert chess

player even during his attack.

A maniacal patient wore on her head a tent of newspaper to keep the

devil from coming through the ceiling and attacking her. She

frequently heard her husband running about the upper floor with the

devil on his back. As a further precaution she stained her gray hair

red with pickled beet juice, and would occasionally hurl loose

furniture at the walls and ceilings of her rooms and assault all who

approached her.

A man who presented a case of dementia pulled the hairs from his beard

and planted them in rows in the garden, watering them daily, and

showing much astonishment that they did not grow. He spent hours each

day in spelling words backward and forward, and also by repeating

their letters in the order in which they appear in the alphabet. When

he wanted funds he signed yellow fallen leaves with a needle, and they

turned into money.

A case of general paresis (commonly though improperly called

"softening of the brain") passed into the second stage as a delusion

was uppermost to the effect that there was opium everywhere; opium in

his hat, opium in his newspaper, opium in his bath sponge, opium in

his food. He thereupon refused to eat, and was fed with a tube for two

years, at the end of which time he resumed natural methods of

nutrition and ate voraciously. Another general paretic promised to his

physician such gifts as an ivory vest with diamond buttons, boasted of

his great strength while scarcely able to walk alone, and declared he

was a celebrated vocalist, while his lips and tongue were so tremulous

he could scarcely articulate.

_Fixed Delusions of Paranoia_

Paranoia is an infrequent variety of insanity in which the patient is

dominated by certain fixed delusions, while for a long time his

intellect is but slightly impaired. The delusions are usually

persecutory, and the patient alleges a conspiracy. He is generally

deluded with the belief that he is a prominent person in history, or

an Old Testament worthy, and there is usually a religious tinge to his

delusions. A patient of the writer believed himself to be the

reincarnation of Christ, appearing as "the Christ of the Jews and the

Christ of the Christians" in one. Over the head of his landlord, who

requested overdue rent, the patient fired a revolver, "to show that

the reign of peace had begun in the world." He wrote a new bible for

his followers, and arranged for a triumphal procession headed by his

brother and himself on horseback, wearing white stars.

_How the Physician Should Be Aided_

When there is a suspicion of irrationality in a person's conduct, and

certain acts or speeches suggest insanity, the whole surroundings and

the past life must be considered. Frequently when the eyes are once

opened to the fact of insanity, a whole chapter of corroborating

peculiarities can be recalled. It is wise to recall as many of these

circumstances as possible and note them in order as they occurred, for

the use of the physician. Strikingly eccentric letters should be

saved. Odd arrangement of clothes, or the collecting of useless

articles, should be noted in writing. Changes in character, alteration

in ideas of propriety, changes in disposition, business or social

habits, and great variation in the bodily health should be noted in

writing. Delusions, hallucinations, and illusions should be reported

in full. It conveys nothing to anyone's mind to say that the patient

is queer; tell what he does or says that leads you to think he is

queer, and let the physician draw his own inferences from the deeds or

speeches. Write down, for example, that the patient talks as if

answering voices that are imaginary; or that the patient brought an ax

into the dining room and stood it against the table during the meal;

or that he paraded up and down the lawn with a wreath of willow

branches about his neck; in each case stating the actual fact. It is

important to ascertain exactly what the patient's habits are, as to

the use of alcoholic beverages, tobacco, and drugs (such as opium),

and also as to sexual matters. To secure such information is extremely

difficult, and the help of a close friend or companion will be

necessary. After the mind begins to waver many a patient plunges into

dissipation, though formerly a model of propriety.

_The Causes of Insanity_

The two great causes of insanity are heredity and stress or strain.

Lunacy is not infrequent in children of epileptic, alcoholic, or

insane parents, and those born of parents suffering from nervous

disease frequently are in such condition that shock, intense emotion,

dissipation, or exhausting diseases render them insane. Drinking

alcoholic beverages is the most potent factor in the production of

insanity. Mental strain, overwork, and worry come next. Adverse

conditions, bereavement, business troubles, etc., rank third, equally

with heredity. The arterial diseases of old age, epilepsy, childbirth

(generally in the neurotic), change of life, fright and nervous shock,

venereal diseases, sexual excesses or irregularities follow in the

order named.

_A Temperate, Virtuous Life the Best Preventive_

To avoid insanity, therefore, one should lead a righteous,

industrious, sensible life, preserve as much equanimity as possible,

and be content with moderate pleasure and moderate success. In many

cases, people who are neurotic from early youth are so placed that

unusual demands are made upon them. Adversity brings necessity for

overwork, duties are manifold, and responsibilities are heavy. In

ignorance of the fact that they are on dangerous ground and driven by

circumstances, they overwork, cut short their sleep, and,

conscientiously pressing on, finally lose their mental balance and

insanity is the result, a great calamity which is really no fault of

theirs. Undoubtedly such is frequently the sad history; and for this

reason, as well as for the general reason that the insane are simply

ill, all insane should be cared for sympathetically. To consider the

insane as constantly malevolent is a relic of the old-time, absurd

belief that insane people were "possessed of the devil." It is no

disgrace to be insane, and the feeling of chagrin at discovering

disease of the brain in a relative is another absurdity. Avoidance of

insanity should be studied with as much devotion as avoidance of

tuberculosis. Yet there should be no detraction from the fact that the

heredity is strong. No one should be allowed to marry who has been

insane, for the offspring of the insane are defective.

The tendency of the times is toward nervous and mental disorder. In

the large cities the strain is too constant, the struggle is too keen,

the pace is too swift. Haste to be rich, desire to appear rich, or

ambition for social distinction has wrecked many a bright, strong

intellect. This is the age of the greatest luxury the world has ever

seen, and a large proportion of people in cities are living beyond

their means, in the gratification of luxurious desires or the effort

to appear as well as others. Stress and strain are voluntarily

invited. Children are pushed in their studies and overloaded with too

many subjects. Genius and insanity, worry and dementia, proceed among

us hand in hand; the overwrought brain finally totters.

_False Ideas Regarding Insanity_

Curious ideas regarding insanity are common, and are apparently

fostered by the reportorial writers of the daily papers. We read of

people who are "insane on a subject." This is an impossibility. Many

people can be drawn out and led into a betrayal of their mental

condition only when a certain topic or idea is discussed. But although

exhibiting their insane condition only when this topic is broached,

they are in no respect sane. Not every act of an insane man is an

insane act, we must remember. Forgetfulness of this fact leads to

errors in the superficial. You will hear people say that a certain

person must be sane, because during a half day's companionship nothing

astray was noticed. True, there may be a long period of self-control,

or of absence of test; but occasional conduct will establish the fact

of constant insanity. Again, we hear the expression: "He cannot be

insane; there is too much method in such madness." The answer to this

silly remark is that there is method in all madness except some

epileptic insanity and terminal dementia. Insane people prepare

careful plans, with all the details thoroughly considered, and perfect

methods to escape from hospitals with the greatest cunning. One must

never take it for granted that the insane person is so demented

mentally as to be unable to appreciate what is said and done. One

should never talk about the insane man in his presence, but should

include him in the conversation as if sane, as a general rule,

allaying his suspicions and avoiding antagonism. Do not agree with the

delusions of an insane person, except so far as may be necessary to

draw them out. Yet avoid argument over them. Simply do not agree, and

do not strengthen them by appearing to share them. His food should be

prepared for him, and his medicines administered to him as to any

other sick person. His baths should be regularly taken.

A depressed patient should be very carefully watched. If the slightest

suspicion of a suicidal impulse be present, the patient should never

be left alone. Many a valuable life has been saved through the moral

support of constant companionship; while we read very frequently of

the death of an insane patient who sprang from a window during a brief

period of relaxation of watchful care. Some people think it a

protection to one insane to elicit from him a promise not to be

depressed, and not to do anything wrong. One might as well secure a

promise not to have a rise of temperature. The gloom of despondency

and the suicidal impulse are as powerful as they are unwelcome and

unsought; and the wretchedly unhappy patient cannot alone meet the

issue and resist.

It is unreasonable to be offended by acts or speeches of an insane

patient, to bear a grudge or expect an apology. Very frequently such a

patient will turn savagely upon the nearest and dearest, and make

cutting remarks and accusations or exhibit baseless contempt. All this

conduct must be ignored and forgotten; for the unkind words of an

unaccountable and really ill person should not be taken at all

seriously.

Should a patient escape from home, it is the duty of the one in charge

without hesitation to overtake him, and then accompany him or at least

follow at a short distance. The nurse should go with and stay with the

patient, telephoning or telegraphing home when opportunity offers, and

finally securing aid; he should know where the patient is at all

times, foregoing sleep if necessary to protect his charge, and should

avoid as long as prudence permits the publicity of an arrest; though

the latter may finally be essential to safety, and to the prevention

of embarking on a voyage, or taking a train to a distance, or

purchasing weapons.

=Diversions.=--Music favorably affects many patients, so the pleasure

of listening to it should be afforded at frequent intervals. Patients

should be encouraged to absorb themselves in it. It is often possible

to take insane people to opera, musical comedy, or concert. Vocal and

instrumental practice at suitable intervals is of great value in

fixing the attention, filling the mind with desirable thoughts and

memories, and allaying irritability. Drawing and painting are of

service when within the number of the patient's accomplishments.

Intellectual pastimes, as authors, anagrams, billiards, chess, and

many games with playing cards, are generally helpful. Gardening,

croquet, and tennis are very desirable. Golf, rowing, swimming, and

skating are excellent, but are within the reach of very few insane

patients. All regular occupation that necessitates attention and

concentration is of supreme value; in fact, insane patients not

infrequently ask for occupation and find relief in the accomplishment

of something useful, as well as in the healthful sleep and increased

appetite that attend judicious physical fatigue.

_The Beneficial Atmosphere of Sanitariums_

After caring for an insane patient for a time at home, the question

arises as to the desirability of sending him away to a sanitarium.

Generally this is a wise course to pursue. The constant association

with an insane person is undermining; the responsibility is often too

heavy; children, often inheriting the same neurotic tendency and

always impressionable, should not be exposed to the perverting

influence; it may not be safe to keep a patient with suicidal or

homicidal impulses in his home; the surroundings amid which the insane

ideas first started may tend to continue a suggestion of these ideas.

Removal to strange locality and new scenes, the influence of

strangers, the abandonment of all responsibilities and duties, and the

atmosphere of obedience, routine, and discipline are all beneficial.

An insane person will generally make a greater effort for a stranger

than for a familiar relative. Discipline, in the form of orders of the

physicians, and exact obedience is very often very salutary. There is

a feeling with some that all discipline is cruel. This is not so, for

the conduct of an insane person is not all insane, but frequently

needs correction. Many cases of mental alienation improve promptly

under custodial care, many need it all their lives. A great many cases

of insanity are never obliged to go away from home, and there is a

considerable number who carry on a business while still insane, rear a

family, and take care of themselves. In general, a depressed patient

should be kept at home as long as there is absolute safety in so

doing. Most other forms of mental disease progress more rapidly toward

recovery in sanitariums or hospitals equipped for such patients.

Prospects of recovery are never jeopardized by confinement in a proper

institution. Mental and physical rest, quiet, regularity of eating,

exercising, and sleeping are the essentials which underlie all

successful treatment of these cases. Dietetics, diversion by means of

games, music, etc., regular occupation of any practicable sort,

together with the association with the hopeful, tactful, and reasoning

minds of physicians and nurses trained for this purpose are of great

value. It must be remembered that in wholly civilized localities

madhouses have been replaced by hospitals, keepers have been replaced

by nurses and attendants, and the old methods of punishment and

coercion have been long since abandoned, in the light of modern

compassionate custody.

Certain forms of insanity are hopeless from the start. Few recover

after two years of mental aberration. Omitting the hopeless cases,

over forty per cent of the cases of insanity recover. About sixty per

cent recover of the cases classed as melancholia and mania. Most

recoveries occur during the first year of the disease; but depressed

patients may emerge and recover after several years' treatment.

FOOTNOTES:

[10] Caution. Dangerous. Use only on physician's order.

APPENDIX

=Patent Medicines=[11]

The term "patent medicine" is loosely used to designate all remedies

of a secret, non-secret, or proprietary character, which are widely

advertised to the public. This use of the name is erroneous, and it is

better first to understand the exact difference between the different

classes of medicines generally comprised under this heading. Only in

this way can one comprehend their right and wrong use.

=A Patent Medicine= is a remedy which is patented. In order to secure

this patent, an exact statement of the ingredients and the mode of

manufacture must be filed with the government. These true "patent

medicines" are generally artificial products of chemical manufacture,

such as phenacetin. The very fact of their being patented makes them

non-secret, and if an intelligent idea is held of their nature and

mode of action, they may be properly used. Physicians with a full

knowledge of their uses, limitations, and dangers often, and

legitimately, prescribe them, and thus used they are the safest and

most useful of all drugs and compounds of this class.

=A Nostrum.=--The Century Dictionary defines a nostrum as "a medicine

the ingredients of which, and the methods of compounding them, are

kept secret for the purpose of restricting the profits of sale to the

inventor or proprietor." Some nostrums have stated, on their label,

the names of their ingredients, but not the amount. There has been no

restriction upon their manufacture or sale in this country, therefore

the user has only the manufacturer's statement as to the nature of the

medicine and its uses, and these statements, in many instances, have

been proved utterly false and unreliable.

=A Proprietary Medicine= is a non-secret compound which is marketed

under the maker's name. This is usually done because the manufacturer

claims some particular merit in his product and its mode of

preparation, and as these drugs are perfectly ethical and largely used

by physicians, it is to the maker's interest to maintain his

reputation for the purity and accuracy of the drug. Familiar instances

of this class are: Squibb's Ether and Chloroform, and Powers &

Weightman's Quinine.

From the above definition it may be seen that the only unreliable

medicines are those which are, in reality, nostrums. In regard to all

of these medicines the following rules should be observed:

_First._--Don't use any remedy that does not show its formula on the

label.

_Second._--No matter what your confidence in the medicine, or how

highly recommended it is, consult a physician before using very much

of it.

_Third._--Take no medicine internally without a physician's advice.

Throughout this chapter the word "patent medicine" will be used in its

widely accepted form, in the everyday sense, without regard to its

legal definition, and will be held to include any of the

above-mentioned classes, unless a direct statement is made to the

contrary.

In Germany the contents of patent medicines are commonly published,

and in this country, notably in Massachusetts, the State Boards of

Health are analyzing these preparations, and making public their

findings. In North Dakota a law has been passed which requires that a

proprietary medicine containing over five per cent of alcohol, or any

one of a number of specified drugs, be labeled accordingly.

=PURE FOOD BILL.=--A far-reaching and important step, in the movement

for reform of patent medicines and for the protection of the public,

has now been taken by the United States Government. On June 30, 1906,

an act was approved forbidding the manufacture, sale, or

transportation of adulterated, misbranded, or poisonous or deleterious

foods, drugs, medicines, or liquors. This act regulates interstate

commerce in these articles, and went into effect January 1, 1907.

Section 7 of this act states:

"That for the purposes of this Act an article shall be deemed to

be adulterated: in case of drugs:

"_First._ If, when a drug is sold under or by a name recognized in

the United States Pharmacopoeia or National Formulary, it differs

from the standard of strength, quality, or purity, as determined

by the test laid down in the United States Pharmacopoeia or

National Formulary official at the time of investigation;

_Provided_, that no drug defined in the United States

Pharmacopoeia or National Formulary shall be deemed to be

adulterated under this provision if the standard of strength,

quality, or purity be plainly stated upon the bottle, box or other

container thereof although the standard may differ from that

determined by the test laid down in the United States

Pharmacopoeia or National Formulary.

"_Second._ If its strength or purity fall below the professed

standard or quality under which it is sold."

Section 8 states that a drug shall be deemed misbranded:

"_First._ If it be an imitation of or offered for sale under the

name of another article.

"_Second._ If it (the package, bottle or box) fails to bear a

statement on the label of the quantity or proportion of any

alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine,

chloroform, cannabis indica, chloral hydrate, or acetanilid, or

any derivative or preparation of any such substances contained

therein."

What are the motives which impel persons to buy and use patent

medicines? The history of medicine offers a partial explanation. In

somewhat remote times we find that the medicines in use by regular

physicians were of the most vile, nauseating, and powerful nature. We

read of "purging gently" with a teaspoonful of calomel. Then during

the wonderful progress of scientific medicine, beginning a little more

than a half century ago, the most illustrious and useful workers were

so busily engaged in finding the causes of disease and the changes

wrought in the various organs, in observing the noticeable symptoms

and in classifying and diagnosticating them, that treatment was given

but scant attention. This was nowhere more noticeable than in Germany,

the birthplace, home, and world-center of scientific medicine, to

which all the medical profession flocked. Patients became simply

material which could be watched and studied. This was an exemplary

spirit, but did not suit the patients who wanted to be treated and

cured. This fact, together with the peculiar wording of the laws

regulating the practice of medicine, which allow anyone with the

exception of graduates to treat patients, but not to prescribe or

operate upon them, accounts for the number of quacks in Germany.

Dr. Jacobi states that "there is one quack doctor to every two regular

physicians in Saxony and Bavaria."[12]

Another cause for the use of patent medicines is mysticism. Ignorance

is the mother of credulity. It is reported[13] that Cato, the elder,

recommended cabbages as a panacea for all sorts of ills, that he

treated dislocations of the limbs by incantations, and ordered the

Greek physicians out of Rome. The ignorant are greatly influenced by

things that they cannot understand. Therefore, as the mass of people

are utterly ignorant of the changes in structure and function of the

body caused by disease, and also the limitations of medicines in their

power of healing such alterations, their belief in the mysterious

power said to attach to patent medicines is not surprising. When

testimonials of the efficacy of patent medicines purporting to come

from respectable divines, merchants, and statesmen are offered, the

proof of their power seems incontestable.

Economy and convenience are added incentives to the employment of

patent medicines. This method of saving the doctor's fee is engendered

by those physicians who themselves write prescriptions for nostrums.

"Why not, indeed, eliminate this middleman (the doctor) and buy the

nostrums direct?" So say the unthinking. But what doctor worthy of the

name would prescribe a medicine the composition of which he was

ignorant? Yet it is frequently done. As Dr. Cabot has so aptly put it,

what would be thought of a banker or financial adviser who recommended

his client to buy a security simply on the recommendation of the

exploiter of the security? Yet that is exactly the position of a

doctor who recommends a nostrum.

In view of the fact, therefore, that persons of undoubted intelligence

are in the habit of purchasing and using remedies of this character

and since many of the most widely advertised preparations are

extremely harmful, even poisonous, we have taken the liberty of

pointing out a few "danger signals," in the guise of extravagant

assertions and impossible claims, which are characteristic signs of

the patent medicines to be avoided.

=DANGER SIGNALS.=--There are many picturesque and easily grasped

features in the literature, labels, and advertising of patent

medicines that spell danger. When these features are seen, the

medicine should be abandoned immediately, no matter what your friends

tell you about it, or how highly recommended it may have been by

others than your physician.

=Claiming a Great Variety of Cures.=--Perhaps of all features of

patent medicine advertising, this is the most alluring. No one drug or

combination of drugs, with possibly one or two exceptions, can or does

"cure" any disease. Patients recover only when the resistance of the

body is greater than the strength of the disease. This body resistance

varies in different persons, and is never just alike in any two

individuals or illnesses. The patient must be treated and not the

disease, so it is the aim of every conscientious physician to conserve

and strengthen the vital forces and, at the same time, guard against

further encroachment of the disease. There is no cure-all, and even if

a drug or combination of drugs were helpful in any single case, they

might easily be totally unsuited, or even harmful, in another case,

with apparently similar symptoms. When a maker claims that his

particular concoction will cure a long list of diseases, the assertion

bears on its face evidence of its falsity.

One of the most widely advertised and largely sold catarrh remedies

claims to cure pneumonia, consumption, dyspepsia, enteritis,

appendicitis, Bright's disease, heart disease, canker sores, and

measles. _This is absolute fraud._ No matter what virtues this

medicine might have in the treatment of one or two ailments, no one

remedy could possibly be of service in such a varied list of diseases,

and it could not "cure" one of them.

Another remedy bases its assertion of "cures" on the fact that it

claims to be a germ killer, and assumes that all disease is caused by

germs. To quote from its advertising literature, it claims to cure

thirty-seven diseases which are mentioned by name, and then follows

the assertion that it cures "all diseases that begin with fever, all

inflammations, all catarrhal contagious diseases, all the results of

impure or poisoned blood. In nervous diseases--acts as a vitalizer,

accomplishing what no drugs can do." It would seem that an intellect

of any pretensions would recognize the fraudulent nature of this

claim, yet thousands of bottles of this stuff are annually sold to a

gullible public. These wide and unjustifiable claims are real danger

signals, and any medicine making them should be avoided. There are

many other remedies for which just as great claims are made; the two

instances cited are merely representative of a large class. It is a

waste of time, money, and health to buy them with any idea that they

can fulfill their pretensions.

=Claiming to Cure Headaches.=--The use of any "headache powders" or

"tablets" should be avoided, except on the advice of a physician. The

presence of pain in the head, or in any other part of the body, may be

a symptom of a serious and deep-seated disorder, and it may often be a

serious matter to temporize with it. At the best, these "pain

relievers" can give only temporary relief, and their use may prove to

be dangerous in the extreme. Their action is dependent upon one of the

modern coal-tar products, usually acetanilid, because it is the

cheapest. But, unfortunately, acetanilid is also the one with the most

depressant action on the heart. The danger of headache powders lies in

the habit which they induce, because of their quick pain-relieving

qualities and their easy procurability, and from overdosage. If a

person is otherwise in good health, the use of one headache powder

will in all probability do no harm, but the dose should not be

repeated without a doctor's authority. Many deaths have occurred from

their continued use, or because of an idiosyncrasy on the part of the

taker, but it is their abuse more than their use which has brought

upon them such almost universal condemnation. Therefore, while the

physician may advocate their use, do not take them without his advice

and specific directions as to kind and dosage.

=Claiming Exhilaration.=--These medicines, by their insidious

character, constitute a particularly dangerous variety. They depend,

for their effect, upon the amount of alcohol that they contain. Many

conscientious temperance workers have not only unsuspectingly taken

them, but have actually indorsed them. Recently the published analyses

of several State Boards of Health and the investigations made by

Samuel Hopkins Adams, and published in his series on "The Great

American Fraud" have shown that a majority of the "tonics,"

"vitalizers," and "reconstructors" depend for their exhilarating

effect upon the fact that they contain from seventeen to fifty per

cent of alcohol; while beer contains only five per cent, claret eight

per cent, and champagne nine per cent. Pure whisky contains only fifty

per cent of alcohol, yet few people would drink "three wineglassfuls

in forty-five minutes"[14] as a medicine pure and simple. The United

States Government has prohibited the sale of one of these medicines to

the Indians, simply on account of the fact that as an intoxicant it

was found too tempting and effective.[15]

If one must have a stimulant it is better to be assured of its purity.

These medicines are not only costly, but contain cheap, and often

adulterated, spirits.

Their worst feature is that they often induce the alcoholic habit in

otherwise upright people. Commencing with a small dose, the amount is

gradually increased until the user becomes a slave to drink. Could the

true history of these widely used medicines be written, it would

undoubtedly show that many drunkards were started on their downward

career by medicinal doses of these "tonics" and "bracers."

=Claiming Pain-relieving or Soothing Qualities.=--The properties of

this class of remedies depend generally upon the presence of cocaine,

opium, or some equally subtle and allied substance. It should be

needless to state that such powerful drugs should be taken only upon a

physician's prescription. Habit-forming and insidious in character,

they are an actual menace. When present in cough syrups, they give by

their soothing qualities a false sense of security, and when present

in "soothing syrups" or "colic cures" for babies, they may be given

with fatal result. Never take a medicine containing these drugs

without a full understanding of their dangerous character, and a

realization of the possible consequences.

=Testimonials.=--These may mean anything or nothing; generally the

latter. They are usually genuine, but, as Mr. Adams observes, "they

represent, not the average evidence, but the most glowing opinions

which the nostrum-vender can obtain, and generally they are the

expression of a low order of intelligence."[16] It is a sad commentary

on many men and women, prominent in public life, that they lend their

names and the weight of their "testimony" to further the ends of such

questionable ventures. Political and newspaper interests are

responsible for the collection of this class of testimonials. An

investigation of some men, who permitted the use of their names for

this purpose, revealed that many of them had never tasted the

compound, but that they were willing to sign the testimonials for the

joy of appearing in print as "prominent citizens."[17] "Prominent

ministers" and "distinguished temperance workers" are often cited as

bearing testimony to the virtues of some patent medicine. It has been

shown that, while the testimonials were real, the people who signed

them had little right of credence, and were possessed of characters

and attributes which would show their opinions to be of little value.

Money and energy can be productive of any number of testimonials for

any remedy. While some of them may be authentic, yet the fact that a

medicine "cured" any one of the signers is no evidence that it will

cure or even help anyone else. Many people recover from diseases with

no medicine at all, and isolated "cures" can never be taken as a

criterion of the value of any remedy or method.

=Offering "Money Back Unless Cured."=--Careful reading of this clause

in most advertising literature will show that there is "a string

attached." The manufacturers are usually safe in making this

proposition. In the first place, the average person will not put the

matter to a test. The second reason why this is a safe proposition for

the maker is, that if the medicine does not cure, the patient may die,

and dead men are hardly possible claimants.

=Claiming to Cure Diseases Incurable by Medicine Alone.=--Probably no

class of people are greater users of patent medicines than those

unfortunates afflicted with the so-called incurable diseases. The very

fact of the serious nature of their complaint, and the dread of

surgical intervention, makes them easy victims to the allurement of

"sure cures."

The committee on the prevention of tuberculosis of the Charity

Organization Society of New York City has announced in decided terms

that there is no specific medication for consumption. Cancer,

likewise, cannot be cured by the use of internal medicine alone.

Surgery holds out the greatest hope in this dread disease. The

medicines claiming to cure these diseases are, therefore, of the most

fraudulent nature. Their use is positively harmful, for in taking them

priceless time is lost.

Never temporize if there is any suspicion of the existence of such

diseases as consumption or cancer. Self-treatment with patent

medicines in such cases is worse than useless--it is actually

dangerous to life itself. Consult a physician at the earliest possible

moment, and put no faith in patent medicines.

There are, however, as has been pointed out, certain patent and

proprietary medicines which may properly be employed by the physician.

These include the newly discovered, manufactured chemicals of known

composition and action; and single substances or combinations of known

drugs in known proportions, which can only be made to best advantage

by those having the adequate facilities. The habit of prescribing

proprietary mixtures of several substances for special diseases is,

however, generally a matter of laziness, carelessness, or ignorance on

the doctor's part. This follows because no disease is alike in any two

patients; because any one disease has many phases and stages; and

because a doctor should always treat the patient and not the disease.

Thus a doctor, after carefully questioning and examining the patient,

should adjust the remedy to the peculiarities of the patient and

disease. It is impossible to make a given combination of drugs fit all

patients with the same disease.

The quantity of patent medicine sold in the United States is enormous.

A series of articles by Samuel Hopkins Adams appeared in _Collier's

Weekly_ during 1905 and 1906, in which he not only showed the

fraudulent character of many of the best-known patent medicines,

giving their names and most minute details concerning them, but

furnished much reliable information in an interesting and convincing

manner. In the course of these articles he pointed out that about one

hundred millions of dollars are paid annually for patent medicines in

the United States. As explaining this, in part, he affirmed that as

many as five companies each expended over one million dollars annually

in advertising patent medicines.

_What Are the Good Ones Good For?_--In any great movement, when a

dormant public suddenly awakens to the fact that a fraud has been

perpetrated or a wrong committed, the instinctive and overwhelming

desire is for far-reaching reform. In efforts to obtain needed and

radical improvement, and with the impetus of a sense of wrong dealing,

the pendulum of public opinion is apt to swing too far in an opposite

direction. There are bad patent medicines--the proof of their

fraudulent character is clear and overwhelming; but there are good

ones whose merits have been obscured by the cloud of wholesale and

popular condemnation. It is true that the manufacturers of even some

of the valuable ones have an absurd habit of claiming the impossible.

This attitude is to be regretted, for the makers have thus often

caused us to lose faith in the really helpful uses to which their

products might be put.

However, it is well in condemning the bad not to overlook the good.

The mere fact that a medicine is patented, or that it is a so-called

proprietary remedy, does not mean that it is valueless or actually

harmful. The safety line is knowledge of the medicine's real nature,

its uses and its dangers; the rules given above should be rigorously

followed.

It is far easier to give general indications for the guidance of those

wishing to shun unworthy patent medicines than to enable the reader to

recognize the worthy article. It is safe to assume, however, that

there are certain simple remedies, particularly those for external

application, which have a definite use and are dependable. In justice

it must be said that great improvement has taken place, and is now

taking place in the ethical character of patent medicines, owing to

recent agitation, and what is true concerning them to-day may not be

true to-morrow.

The only proper, ethical patent medicine is the one showing its exact

composition, and refraining from promise of a cure in any disease.

Such a one might, nevertheless, advertise its purity, reliability,

advantageous mode of manufacture, and the excellence of its

ingredients with more modest and truthful claims as to its use.

The purchaser of a patent medicine pays not only for the ingredients,

the cost of combining them, and the maker's just profit, but he also

pays the exploiter's bills for advertising and distributing the

finished product. With such standard remedies as those mentioned

above, this added cost is usually a good investment for the purchaser,

because trade-marked remedies which have "made good" possess two

advantages over those less advertised, and over their prototypes in

crude form: procurability and integrity.

Even at remote cross-roads stores, it is possible to obtain a popular

remedy, one which has been well pushed commercially. And an article

sold in packages sealed by the makers gets to the consumer just as

pure as when it left the laboratory. This is not always true of

ingredients held in bulk by the retailer; witness the evidence

brought forward in recent prosecutions for drug adulteration.

It is not the purpose of this chapter, in any sense, to advertise or

place the seal of its unrestricted approval upon any one article of a

class. Its position in the matter is absolutely impartial. But in

order that it may be as helpful as possible, it definitely mentions

the most widely known, and therefore the most easily obtainable,

remedies. There are other equally good remedies in each case, but as

it would be almost impossible to mention each individual remedy with

similar virtues now on the market, the ones discussed must be taken as

representative of their class in each instance.

Do not forget that the use of these simple remedies does not justify

their abuse. They may make great claims while their use is really

limited. Do not rely upon them to do the impossible.

=Vaseline.=--This is pure and refined petroleum, and will be found of

much service in many forms of skin irritation. It is useful in the

prevention of "chapping," for softening rough skin, for preventing and

healing bleeding and cracked lips, as a protective dressing in burns,

cuts, or any acute inflammation of the skin where the cuticle has been

injured or destroyed, or where it is desirable that a wound should be

protected and kept closed from the air. Rubbed over the surface of the

body when a patient is desquamating or "peeling" after scarlet fever

or measles, it keeps the skin smooth, soothes the itching, and

prevents the scales from being carried about in the air and so

infecting others. Vaseline is a soothing, nonirritating, and bland

protective ointment for external use. It is perfectly harmless, but

should not be used for severe skin disease or for internal use, unless

recommended by a physician in conjunction with other means of healing.

=Pond's Extract.=--Although the makers have claimed special virtues

for this remedy, it is in reality an extract of hamamelis or

witch-hazel, and probably differs little in its application or results

from the ordinary marketed extract made by the average druggist. It is

mild and bland, harmless when used externally, but should not be used

internally unless ordered by a physician. It is soothing and healing

when applied to wounds, sprains, and bruises; diluted with water it is

a pleasant gargle for a sore throat, and may be applied externally on

the throat by means of a flannel wrung out in a solution of it in hot

water. For nosebleed it is often efficient when snuffed up the nose,

or when pledgets of cotton are soaked in it and placed in the

nostrils. It may be used as an application in ulcers or varicose

veins, and from two to four teaspoonfuls with an equal amount of water

injected into the rectum two or three times daily will often prove of

great help in piles, particularly if bleeding. It gives relief when

used for sore or inflamed eyes or eyelids, but in this, as in all

other serious inflammations, it is not a "cure all," and the physician

should be consulted if the relief is not prompt.

=Listerine.=--Of the many mild liquid antiseptics "Listerine" is

probably the best known. The remarks and recommendations concerning

it, however, are equally applicable to many other remedies of a

somewhat similar nature, such as glycothymoline, borolyptol, lythol,

alkalol, formalid, etc.

Listerine is a solution of antiseptic substances with the addition of

thymol and menthol in quantities sufficient to give it a pleasant odor

and taste. It has a very strong hold on the public, and is a

deservedly useful remedy.

Listerine has many helpful uses. It is potent enough to kill many

germs, and is excellent for this purpose when used as a mouth wash,

particularly during illness. In acute cold in the head it is soothing

to the mucous membrane of the nose, if used diluted with warm water as

a nasal douche. It serves a similar purpose when used as a gargle in

mild sore throat.

If there is any reason to suspect that dirt or other foreign matter

has come in contact with a sore or cut, the wound may be freely washed

with a solution of listerine in order to clean it and render it as

nearly aseptic as possible. When there are distinct signs of

inflammation it should not be relied upon. Do not use it internally

without a physician's advice.

=Scott's Emulsion.=--This is a good emulsion of cod-liver oil, widely

prescribed by physicians for the many patients who are too

delicate-stomached to retain the pure oil. For those who can take the

refined oil straight, Peter Moeller's brand is in a class by itself.

In certain conditions cod-liver oil is one of the most valuable

remedies known. As a concentrated and reconstructive food in many

wasting diseases it is of great service. Weak and puny children, and

all suffering from malnutrition may take it with benefit. It does help

produce flesh, increase strength, and add to the body's resisting

powers. It does not contain any medicinal properties, and its virtue

is largely in its fat or oil, but as an aid to other remedies, or

alone, when increased nutrition is desired, it is a reliable and

helpful remedy.

=Antiphlogistine.=--There are many clay poultices on the market:

antiphlogistine, antithermoline, cretamethyl, sedol, unguentum,

yorkelin, and the Emplastrum Kaolini of the U. S. Pharmacopoeia.

Antiphlogistine, being probably the most widely known, is here

discussed. It is of value when a poultice is indicated. It is

preferable to the homemade varieties in that it retains heat for a

longer period of time and is antiseptic.

It should never be used in deep-seated inflammations, such as

peritonitis, appendicitis, deep abscesses of any part of the body, or

other serious conditions, unless recommended by a physician; for such

ailments need more thorough treatment than can be afforded by any

poultice. It is perfectly harmless, and may be used with decided

benefit in aborting or preventing many inflammatory diseases. Applied

in the early stages of a boil, felon, or carbuncle it may either

abort the trouble or, if the disease has already progressed too far,

it will hasten suppuration and shorten the course of the disease. When

a poultice is indicated in bronchitis or pleurisy it is an excellent

one to use; it will afford much comfort, and often hasten recovery. In

nursing mothers, when the breasts become full and tender and signs of

beginning inflammation are present, antiphlogistine spread in a warm

and thick coat over the breasts will often afford relief.

=Platt's Chlorides.=--When it is desirable to use a liquid

disinfectant Platt's Chlorides will be found a useful article, as will

lysol and other marketed products. The source of a foul smell or

dangerous infection should never be overlooked. No disinfectant can

offer a safeguard if plumbing is defective, or other unsanitary

conditions exist; in fact, disinfectants are often deprecated, since

they afford a false sense of security. If a contagious disease exists

in a household, other means than the use of a disinfectant must be

taken in order to prevent the spread of the contagion. Disinfectants

do have their uses, however, and are often essential. In case of an

illness of a contagious or infectious nature, a solution of Platt's

Chlorides or a similar disinfectant should be kept in all vessels

containing or receiving discharges from the body. Pails containing

such a solution should be in readiness to receive all cloths, bedding,

or washable clothes which have come, in any way, in contact with the

patient.

FOOTNOTES:

[11] The publishers announce this chapter as prepared independent of

Dr. Winslow or any of the Advising Editors. Considered as an effort to

give helpful information, free of advertising on the one hand and

sensational exposures on the other, the article meets with the

approval of conservative physicians. But the problems dealt with are

too involved at present for discussion direct from the profession to

the public.

[12] Jacobi, Jour. Am. Med. Assn., Sept. 29, 1906.

[13] Ibid.

[14] S. H. Adams, "The Great American Fraud."

[15] Ibid.

[16] S. H. Adams, "The Great American Fraud."

[17] S. H. Adams, "The Great American Fraud."

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| The prescription symbol has been transcribed as [Rx]. |

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