DISEASES OF THE NERVOUS SYSTEM. (continued 2)

(f) Toxic (poison) paralysis. Lead paralysis.—It is hard to extend the fingers. The lead line is shown on the gums.

PHYSICIANS' TREATMENT for Palsy.—Remove the cause. Give salts and iodide of potash. Paralysis from arsenic, mercury, zinc or copper:—The symptoms are those of neuritis and are greatly similar in each kind. The spongy gums show mercury; the puffy face and diarrhea show arsenic poison. Remove the cause.

CONGESTION OF THE BRAIN. (Diseases of the Cerebral (Brain) Circulation). (Hyperaemia).—The brain is too full of blood.

Causes. For Active Congestion.—Over-exertion in study, etc.; chronic pletbora (too much blood in the blood vessels); from constant use of alcohol, tobacco, amyl nitrite, and from the stomach.

For passive congestion.—Local obstruction to the return of blood from the brain. Prolonged mental and physical exertion with excesses and irregular living may cause it.

Symptoms of active kind.—Head feels warm, face is red, the arteries in the neck beat hard, violent headache, ears ringing, very restless and does not sleep well.

Symptoms of the passive form.—The headache is not so great; there may be stupor, drowsiness and dull intellect and very sleepy.

Recovery.—Favorable if the cause is removed.

Treatment for active congestion.—Keep the patient absolutely quiet in a dark, well aired room, with the head and shoulders raised, an ice bag or cold cloths to the head and warm applications to the hands and feet. A warm foot bath will aid in drawing the blood away from the head. Give salts (salines) to move the bowels. These take away a great deal of water from the blood and aid in relieving the congestion of the head.

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Treatment for passive congestion.—Remove the cause if possible. Give a light nutritious diet; prohibit alcohol in any form; keep the bowels regular.

CEREBRAL ANEMIA. (Too little blood in the brain). Causes.—Heart disease, general anemia, and mental excitement.

Symptoms.—"Fainting spells," dizziness, the ears ring and there are spots before the eyes; nausea and vomiting may go ahead of the fainting spells. The face is pale, the pupils are dilated, the pulse is small and feeble, and there may be cold sweating on the body. If you can remove the cause the result is favorable.

Treatment.—For the fainting fits:—Place the patient in the "lying down" position and this frequently restores consciousness; loosen any tight clothes, corset, waist, collar, etc. Give plenty of fresh air and do not crowd. Keep quiet yourself; do not get excited. In mild cases, mild stimulants may be necessary. Let the patient smell of camphor, put a cloth with camphor or ammonia near the nose. In other cases amylnitrite and strychnine may be necessary. Small doses of whisky or brandy frequently help. Remove the cause. Give tonics for general anemia.

TUMORS OF THE BRAIN AND INFLAMMATION, Abscess, etc. Abscess.

Causes.—This is always secondary and comes from some other part of the body. It comes often in young and middle life and is more common in males than in females. The most frequent cause is inflammation of the ear and the next is from fracture of the skull bones. It may be large or small.

Symptoms.—May come slowly or quickly. After an injury to the head the symptoms may come on suddenly such as intense headache, delirium, vomiting, chills, high fever, and sometimes convulsions, and a very deep seeming sleep (coma). In chronic cases the symptoms are not so severe.

Treatment.—An operation if the abscess can be reached. If not, an ice bag should be applied to the head; quiet the distress with narcotics.

TUMORS OF THE BRAIN.—Varieties in order of their frequency. Gumma, tuberculous tumors, glioma, sarcoma, cancer, etc.

Causes. Predisposing.—Men are about twice as often affected as women until fifty and then it is about equal. It is more frequent in early adult life. The exciting causes are blows and severe emotional shock.

Gumma (in third stage of Syphilis) appear as a round, yellow, cheesy mass, usually beginning in the membranes and are usually seen between thirty and fifty. They come from syphilis.

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Tuberculous tumors. These appear as hard masses and vary in size. They may be single or many, and are situated in any part of the brain. More than half of the tumors appearing in children are of this variety.

Glioma. "Glue-tumor." They come from tissue forming the basis of the supporting framework of the nervous tissue. This kind occurs often in the young.

Sarcoma and Cancer are rare.

Symptoms.—The most of the growths start in the membranes of the brain, and by compressing a certain part of the brain they produce their special symptoms such as headache, vomiting, inflammation of the nerves of the eye, double vision, blindness, the memory impaired, dullness and apathy, an irritable temper, and sometimes become demented. There is often vertigo or a sense of giddiness. There may be convulsions, and paralysis of some muscles. A general tuberculosis tendency or history of syphilis will help to make the diagnosis. In children it is more likely to be tuberculous. The result is more favorable in tuberculous growths in children and syphilitic tumors in adults. It may last from a few months to three years in a bad case.

Treatment.—For gumma, caused by syphilis, iodide of potash and mercury should be given. In both kinds, syphilitic and tuberculous, a nutritious diet and general tonic treatment, such as cod-liver oil, iron, arsenic, and quinine should be given. The bowels must be kept open and special attention given to the digestion.

For headache.—Ice bags, cold to the head, mustard to the nape of the neck.

For Vomiting.—Mustard over the stomach. Surgery is necessary for some tumors that can be reached. You will naturally depend upon your attending physician for advice and treatment.

SYPHILIS OF THE BRAIN. Causes.—The symptoms of syphilis of the brain, belong to the third stage of the disease, and are rarely ever observed until at least one year or longer from the time of the first lesion (chancre). It may be from ten to twenty years coming on. Both sexes are equally liable, and it may come at any age. Syphilis may produce a circumscribed tumor, a disease of the arteries or a general hardened infiltration of the brain. The tumors are small, yellowish, and cheesy in the center. They originate in the "Dura Mater" (covering) and spread to the brain structure proper. The disease of the arteries causes a thickening of these vessels, a narrowing of the blood channel in them, thus producing a clot.

Symptoms.—Of gumma (syphilis tumors) at the base of the brain, are persistent headache, worse at night; sleeplessness, depression of the mind, memory impaired, vertigo, sometimes vomiting and paralysis of some of the nerves (third and sixth pairs). Violent convulsions, like epilepsy, appear in some cases.

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Symptoms when arteries are diseased.—Temporary loss of speech, numbness or weakness in one limb, the sight is disturbed, or vertigo; and, when the clot (thrombus) appears, symptoms of apoplexy, This is a common variety of syphilis of the brain.

How to tell what the disease is.—The history of the patient will help. An apoplexy in a young person would suggest syphilis.

Recovery.—The chances are better when the disease forms gumma (tumors) than when the blood vessels are diseased.

Treatment.—Should be begun and properly carried on when the person has the primary sore (chancre), and then these after troubles may not follow. This is one of the diseases where the victim reaps a big harvest on account of the sexual sin, and in order to escape the bad results for himself, etc. he should go through a regular course of treatment when he first contracts the disease, perhaps for a year or more, This treatment should last as a rule for some years. It is late to begin when the brain symptoms show brain involvement. For this there must be radical and careful treatment with mercury and iodide of potash; with tonics and general building up treatment, and then even if the patient lives he may be a nuisance to himself and others.

GENERAL PARESIS. (Paretic dementia. General Paralysis of the Insane. Softening of the Brain).—This belongs under diseases of the mind, but there are so many cases that a description of this disease may be instructive and interesting. One author says: "General paresis is a chronic, progressive, diffuse, encephalitis (inflammation of the brain), resulting in structural changes in the cerebral (brain) tissue, with involvement of the cortical, and meningeal, (covering) blood and lymph vessels, presenting characteristic symptoms, with progressive course and fatal termination usually within three years." There are three stages:—1. The period of incubation (the prodromal stage). 2. A stage of pronounced mono-maniac activity with symptoms of paralysis. 3. Stage of extreme enfeeblement with diminution and final loss of power. These stages run into each other. First stage in a typical case:—There are tremblings and slight trouble in speech and expression of the face. The mind has exalted and excited spells, etc.

Symptoms.—The patient is irritable. The mental and moral character is unstable. His affairs are in confusion. He uses bad language, neglects his family, goes with drunkards and bad women, makes indecent proposals to respectable women of his acquaintance without realizing that it is improper. He cannot keep his mind on one thing. Speech is a little thick, indistinct and hesitating. Syllables are dropped or repeated, speech finally becomes undistinguishable. He is very excited; he thinks he is persecuted. He is a big fellow generally. He is a king, he is rich and mighty. This is the usual run. As the disease progresses he becomes feeble-minded more and more so continually. Persistent insomnia comes on early and frequently recurring, one-sided headache often goes with it. Sometimes there is an uncontrollable desire to sleep. Loss of consciousness is an early symptom. After severe attacks there may be one-sided paralysis (hemiplegia) which usually disappears in a few hours or days. Convulsions like epilepsy may appear early, but usually occur in the later stages. The pupils are mostly dilated, rarely contracted, and they are often unequal and react slowly to light. When the tongue is protruded it trembles and is put out in a jerky manner. The hands tremble, in the advanced stage. The speech is jerky and slow. Syllables are dropped and repeated. One early symptom is retention of the urine. There is another annoying symptom—a constant grinding of the teeth. The walk is very spasmodic, but in advanced stages it becomes slouching or dragging. The skin may be red or blue. When the feeble-mindedness is fully developed the mind does not perceive anything accurately. He sees imaginary things, and things that he does see do not appear to him as they are. Finally he has no mind.

Treatment.—The end is sure. You can relieve the distress partly. Personal attention by a physician is needed.

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INSOMNIA.—Insomnia is not a disease, but a symptom of disease. It may, however, become so active, prominent, and important a symptom as to constitute a condition which merits individual management and treatment.

Definition.—Insomnia is the term employed to denote actual or absolute sleeplessness, and also lack of fully restful sleep, which might be termed relative sleeplessness.

Causes.—Organic causes. Disease of the brain and spinal cord. Toxic causes due to poison circulating in the blood which by irritation of the brain and cord (axis) and especially of the brain, cause such diseases as nephritis (chronic), jaundice, typhoid fever and consumption.

Primary causes. Depend upon insanity.

Nervous or simplest causes.—These are present in nervous persons and comprise the two conditions of congestion and anemia of the brain. The brain congestion is typified by the nerve-tire of the student; over-study and anxiety bring too much blood to the brain and necessarily too much activity and then insomnia. Anemia of the brain acts in the opposite manner. The brain cells are not properly nourished and hence irritated, and sleeplessness follows.

SLEEPLESSNESS. Mothers' Remedies. 1. Hop Pillow Stops.—"People affected in this way will be very much benefited by the use of a pillow composed of hops, or cup of warm hop tea on retiring. The hops have a very soothing effect upon the nerves."

2. Sleeplessness, Easy and Simple Remedy for.—"On going to bed, take some sound, as a clock-tick or the breathing of some one within hearing, and breathe long breaths, keeping time to the sound. In a very short time you will fall asleep, without any of the painful anxieties attending insomnia."

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3. Sleeplessness, Ginger at Bedtime for.—"Ginger tea taken at bedtime soothes one to sleep," This is a very good remedy when the stomach is at fault. It stimulates this organ and produces a greater circulation, thereby drawing the blood from the head. This will make the patient feel easier and sleep will soon follow.

4. Sleeplessness, Milk Will Stop.—"Sip a glass of hot milk just before retiring. This is very soothing to the nerves, and a good stimulant for the stomach,"

PHYSICIANS' TREATMENT.—Remove the cause and be careful in using drugs. In the organic kind the treatment is not very successful. In the toxic kind drugs must be given to correct other diseases and also tonics given. For brain congestion and anemia kind other means must be used first, and the drugs as the last resort. Treatment of the congestive insomnia.—1. Hot or warm general body-baths are very advantageous to stimulate the circulation and restore its balance alike in congestion and anemic cases. After such baths the patient must go to bed at once and not get chilled in cold rooms or by drafts. They must be properly covered and kept warm.

2. Cold spongings, cold shower baths, or cold plunge baths are given when the hot or warm bath does not produce the correct result. If this does not depress it is better than the warm bath. The person should be rubbed with warm rough towels until the skin is aglow. If he feels rested and quieted, the reaction is proper; if depressed, the treatment is too vigorous and not suitable.

3. The patient should stand ankle deep in a tub of hot water and a "drip sheet," from water at 75 to 80 degrees temperature, thrown over him. Then rub the patient's back and abdomen hard and a general brisk rub-down immediately after leaving the tub. This treatment should quiet, not excite or depress.

4. The cold abdominal pack is valuable. Flannel is wrung out in water, 75 to 80 degrees temperature and laid in several thicknesses upon the abdomen; place a dry towel over this, cover all with oiled silk, overlapping widely in order to protect the bed. Tie or bandage all this firmly. The effect of this work is first that of a cold then of a warm poultice.

5. Exercise. This should be in the open air when possible. A fast walk, horseback ride or ride on bicycle for a half hour before bedtime, followed by a rub-down will frequently give a good sleep. Dumb-bell, Indian club exercise, chest weight, are good in some cases.

Diet.—A light easily digested supper is often better than a heavy meal. Sometimes a little eaten before bed-time will give sleep. A piece of toast, for instance. It draws the blood from the brain and more to the stomach.

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Medicines. If you must use them.—The bromides are the best. Sodium and strontium bromide are first choice. Twenty to thirty grains in water one-half hour before retiring. Chloral hydrate should not be used often. Sulphonal, trional, etc., should always be given with a little food-never alone. Sometimes bread pills do just as well.

ANEMIC CONGESTION. Diet.—A light supper before retiring, like hot milk, broths, milk punch, etc., will very frequently promote sleep by removing the cause and quickening the circulation. Give nutritious, easy food to digest. The baths are not so valuable for this kind of insomnia. A cold sponge bath or plunge may be of service.

Medicines.—Tonics are needed here as in regular anemia. The patient must be carefully treated, and very many of these cases can be cured. The patient must render all the aid he can give, and the physician should gain his confidence. If he does he will not need to give much medicine to put the patient to sleep, and if he does give it he can frequently use a Placebo with the same effect. Mind has an influence over mind. By "Placebo" is meant any harmless substance, as bread-pills, given to soothe the patient's anxiety rather than as a remedy.

SLEEP WALKING.—There is a tendency to sleep walking in some families, often more than one child will do this to a greater or less extent. It is very extreme in some cases, and the next morning they do not know anything about it. The person is very seldom hurt and he can do some dizzy things. Many persons walk about in their sleeping room or simply get out of bed. Fatigue, worry, poor sleep, restlessness, nervousness, a hearty late dinner are aggravating causes. As age advances and the person becomes stronger, the patient will do less of it.

Treatment.—Avoid over-eating, worry, over-study. The evening should be spent quietly. Such persons had better drop parties, late hours or anything that tends to cause worry, fatigue or nervousness.

STAMMERING.—This may be inherited to some extent; excitement, nervousness, bodily fatigue, want of rest, etc., make it worse.

MOTHER'S REMEDY. 1. Stammering, Easy Cure for.—"Read aloud in a room an hour each day. Repeat each word slowly and distinctly."

PHYSICIANS' TREATMENT.—The person should be taught early to talk slowly, and to do everything to control himself and not get nervous. There are schools for this trouble, and they seem to do good work. They teach the patients how to speak slowly, distinctly and to keep their minds off of themselves.

HICCOUGH.—This is caused by intermittent, sudden contraction of the diaphragm; obstinate hiccough is a very distressing symptom and sometimes it is hard to control.

302 MOTHERS' REMEDIES

Causes.—Inflammatory causes. It is seen in gastritis, peritonitis, hernia, appendicitis, and in severe forms of typhoid fever. Irritative causes. Swallowing hot substances, local disease of the gullet near the diaphragm, and in many cases of stomach trouble and bowel disorder, especially when associated with gas (flatus). Specific causes: Gout, diabetes or chronic Bright's disease. Nervous (Neurotic) causes. Hysteria, epilepsy, shock, or brain tumors.

MOTHERS' REMEDIES. 1. Hiccough. Vinegar for.—"One teaspoonful vinegar sipped carefully (so it will not strangle the patient) will stop them almost instantly."

2. Hiccough, Sugar and Vinegar Stops.—"A few drops of strong vinegar dropped on a lump of sugar and held in the mouth until dissolved, will stop most cases of hiccoughs."

3. Hiccough, Sugar Will Relieve Patient of.—"Place a little dry sugar on the end of the tongue and hold the breath. I have tried this remedy after others have failed and obtained instant relief."

4. Hiccough, Simple Remedy for.—"Have patient hold both ears closed with the fingers, then give them three swallows cold water while they hold their breath."

5. Hiccough, Home Remedy to Stop.—"Take nine swallows of cold water while holding the breath."

6. Hiccough. Vinegar Stops.—"One teaspoonful of vinegar thickened with sugar and eaten slowly."

7. Hiccough, Cinchona Bark in Peppermint Stops.—"Put about one-fourth teaspoonful of cinchona bark, powdered in two ounces of peppermint water, and give one teaspoonful every five or ten minutes until relieved, or three drops of camphor and aqua ammonia in wineglassful of water," These remedies are very good when the stomach is at fault, as they have a stimulating effect.

PHYSICIANS' TREATMENT.—Sudden start may check it in the light forms. Ice, a teaspoonful of salt and lemon juice may be tried. Inhalations of chloroform often relieve. Strong retraction of the tongue may give immediate relief. Spirits of camphor, one teaspoonful. Tincture of cayenne pepper one to two drops in water. Ten grains of musk by the rectum. Hoffman's anodyne one teaspoonful in ice water is very good.

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INJURIES TO THE HEAD. Concussion or Laceration of the Brain.—The brain may be injured by a blow on the head, or indirectly by falling fully upon the feet or sitting down hard upon the buttocks.

Symptoms.—The person who is injured may lose his balance and fall, become pale, confused, and giddy, may have nausea and vomiting and recover. If the injury is more severe and there is a tear of the membranes of the brain or the brain itself, the patient will fall and lie quietly with a feeble and fluttering heart, cold, clammy skin, and apparent unconsciousness; he can be roused by shouting but will not reply intelligently. He will be able to move his limbs. The urine and contents of the bowels will be passed involuntarily. As he gets better he may vomit. He may soon return to entire consciousness, but still suffer from some headache, feel wearied, and tired, and not feel like exerting himself. This may continue for some time. Occasionally the results are more serious even after a long time has passed, and an abscess of the brain should be watched for, sometimes epilepsy or insanity follows. If the patient grows worse instead of recovering, either deep seeming sleep sets in or symptoms of inflammation of the covering (meninges) or the brain itself follows. Such injuries must be carefully watched, for you can not tell at first how severe they may prove to be.

TREATMENT. What to do First.—Put the patient to bed without any pillow, and put around his body hot water bottles or bags, suitably covered. He should be kept quiet and free from excitement, and sleep should be encouraged. Hot water or ice water, when awake, as is most agreeable to the patient, may be given. Aromatic spirit of ammonia, during the shock is better for the patient to take than alcohol, for alcohol excites the brain; dose, one-half to two drams; the former can be given every ten minutes in a little water for about three doses. Surgical treatment may be necessary at any time.

INJURIES OF THE SPINAL CORD. Concussion of the Spine.—A severe jarring of the body followed by a group of spinal symptoms supposed to be due to some minute changes in the cord, of an unknown nature.

Causes.—Severe concussion may result from railway accidents or violent bending of the body, fall from a house, blow on the back, jumping, etc.

Symptoms.—May come on suddenly, when it is due to a jar of the brain as well as the cord. Loss of consciousness, complete paralysis, small pulse, collapse, and within a few hours death may follow. In other cases improvement, though very slow, follows. Walking is difficult and the upper extremities are weak in these cases. There are pain and tenderness along the spine. Brain symptoms, such as headache, dizziness and fainting, may be present or absent.

Treatment.—Absolute rest from the beginning, stimulants if necessary, electricity is useful.

TRAUMATISM OF THE CORD. (Blows, etc.).—(Fractures and dislocations, gunshot and stab wounds, etc.).

Symptoms.—They differ according to the place where the cord is injured. The motion and feeling power may be disturbed. There may be sudden complete paralysis of the upper and lower extremities depending on how severely the cord is injured, and how high up the injury is. The bladder and rectum may not act properly. The contents may be retained or "run-away." Death follows sooner or later if the injury is extensive. In some cases the symptoms are slight in the beginning, but increase in a few days, or they may suddenly increase a few months afterwards. In other cases, bad symptoms at first may gradually abate which is due to the blood clot having been absorbed.

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Recovery depends upon the extent of the injury and the constitution of the patient. It is always well to be careful about expressing an opinion about this injury.

Treatment. Immediate.—Surgical treatment is necessary. Absolute rest is a necessity, and must be had for weeks according to the severity of the case. It may seem long and become tedious, but the case must have rest for a long time.

ORGANIC DISEASES OF THE SPINAL CORD. Caisson Disease; Divers' Paralysis. Causes.—This affection occurs in divers, bridge builders, and others who are subject to increased atmospheric pressure. The symptoms develop on coming suddenly to the surface when the atmospheric pressure is greatly lessened.

Symptoms.—They usually occur on the return to the surface of the water, or after a few hours have passed. There are pains in the ears and joints and nose-bleed. The pulse is slow and strong. Neuralgia of the stomach and vomiting often occur. Paralysis of one side, or of the lower extremities may occur. Brain symptoms may develop and death may follow in a few hours. In most cases recovery takes place in a few days or weeks.

Treatment.—Persons who are engaged in such work should change very gradually from a great depth to the surface, and should not go into the outer air suddenly.

MYELITIS.—Myelitis is an inflammation of the spinal cord.

Causes.—It may occur at any age, and is more common in male than in female. The exciting causes are prolonged exposure to severe colds, too great mental and physical exertion, sexual excess, blows, bleeding into the cord, alcoholic excess, acute infectious diseases, syphilis, etc.

Symptoms.—These depend upon the location of the inflammation and the severity. The onset may be sudden or gradual—when it is sudden, there may be a chill followed by a fever of 101 to 103 degrees—general feeling of illness, loss of appetite, with coated tongue and constipation. There may be over-sensitiveness to pain and touch. Pain may radiate from the back into the limbs, with numbing and tingling of the limbs. The urine may be retained or may dribble away. Usually there is obstinate constipation. There is frequently the feeling of a band around the body. Paralysis may follow in the lower extremities and higher up, sometimes, depending upon how high up in the cord the inflammation exists. This paralysis may cause no motion of the limbs or produce an exaggerated contracting of the affected muscles, the knees being drawn up on the abdomen and the heels touching the buttocks.

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Recovery.—Chances for recovery depend upon the cause. Most cases are chronic and may last for years.

Treatment.—Treatment depends also upon the cause. Rest in bed; counter-irritation, wet cupping, with care on account of bed sores. A water-bed from the first may prevent bed-sores. The urine must be drawn if it is retained. The medical treatment must be carefully given and a physician of experience should be obtained.

LOCOMOTOR ATAXIA. Tabes dorsalis. Posterior Spinal Sclerosis).—A hardening (sclerosis) affecting the posterior parts of the spinal cord and characterized by incoordination, which means a condition where a person is unable to produce voluntary muscular movements; for instance, of the legs, etc., loss of deep reflexes to bend them back; disturbances of nutrition and sensation, and various affections of sight.

Causes.—This is a disease of adult life, persons under twenty-five being rarely affected, and is more common in men than women (ten to one). Sometimes children suffering from hereditary syphilis have it. The chief predisposing cause is syphilis which precedes it in from seventy to eighty-five of the cases according to various authorities. Exposure to cold and wet, sexual and alcoholic excesses, mineral poisoning, and great physical exertion also exciting causes.

Symptoms.—These are numerous. They appear in succession and with the same regularity.

Stages.—Stages of pain; the stage of ataxia, peculiar gait; and the state of paralysis.

1. Prodromal or forerunning; the stage of pain.—This consists of lightning-like pains in the lower extremities, numbness, formication (feeling of ants, etc., crawling), sensation of dead extremities; pins and needles in the soles of the feet and fingers, coldness, itching of arms and scrotum or other parts, a sensation of constriction around the chest, headache, pain in the small of the back and loins of an aching character may occur. These symptoms may constitute the only evidence of locomotor ataxia and last for years; but sooner or later there are added absence of knee cap bone reflex (knee jerk), and immobility of the pupil. The loss of the knee jerk is always observed in time. The pupil fails to respond to light while it still accommodates for distance, called Argyll Roberston pupil. There may be imperfect control of the bladder with slow, dripping or hasty urination. Later the control is not imperfect, but it may be painful. Inflammation of the bladder may occur which is dangerous. There is usually obstinate constipation and loss of sexual power. These symptoms may last for several months and years, and then the second stage symptoms appear.

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2. Stage of Ataxia (Disturbance of motion).—The disturbance of motion (ataxia) is very marked, especially in the lower extremities; the walking becomes difficult and uncertain; there is difficulty in rising or rapid turning; the legs are wide apart; feet lifted too high and come down too forcibly; the length of the steps is irregular, and the body is imperfectly balanced. If the patient stands with his feet together and eyes closed he begins to sway, (Romberg's symptom), which is due to a defect in controlling the muscles from impairment of sensation. There may be imperfect use of the hands in dressing, writing, etc.; lancinating pains are marked in all cases and come on in paroxysms. The pains are mostly in the legs, but also occur in the arms, head, loins, back, and trunk. Then the sense of touch is partially lost. The prick of a pin may not be felt until a few seconds after being applied. This stage may last for years and remain at a "standstill;" but it is usually progressive, and advances to the third stage.

3. The stage of paralysis is marked by a gradual change to the worse, and the patient must remain in bed, because he cannot get out. The lower and sometimes the upper extremities have lost a great deal of their power of sensation: The joints, mostly the knee and hip joints show on both sides of the body a painless swelling, owing to the great quantities of watery liquid there. Dislocations and fractures occur simultaneously. Bed-sores and peculiar ulcers on the sole of the foot also occur. The urine dribbles away constantly, for all control of the bladder is lost. Death occurs from exhaustion; bedsores, inflammation of the bladder, or pneumonia coming on as a complication.

Treatment;—The only thing to do when the patient has this disease is to make him comfortable and arrest the progress of it, if possible. It is incurable, but treatment sometimes arrests the progress and at least lessens the suffering and prolongs life as long as it is worth living to them. I have given a longer description than was necessary, for I wanted men who live such fast lives to understand what it brings them for most cases are caused by syphilis. The description could have been made longer and other symptoms and complications put in. I think enough has been given and perhaps this description may deter some one from going the same road.

The Diagnosis is made at first by the fatigue, peculiar pains, loss of the knee jerk, the peculiar pupil and history of syphilis. Later it is made from the ataxia; the peculiar walk, etc., and the bladder disturbances.

HEREDITARY ATAXIA. Friedrich's Disease.—This peculiar disease is due to a degenerative disease of the posterior and lateral columns (parts) of the spinal cord, occurring in childhood, and often in several children of the same family.

Causes.—More in boys than in girls and oftener in the country districts. Heredity is frequently a cause and it is traced to syphilis, epilepsy, alcoholism, and insanity in the ancestors. Several children of the same family may have it.

Symptoms.—In very young children it is noticed that they are slow in learning to walk; the child staggers in trying to stand or to walk; it uses its hands clumsily, and has difficulty in speaking. The movements of the hands are peculiar, the hands move like in chorea, the speech is slow and drawling.

Recovery.—Very doubtful, but they may last for years.

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INFANTILE PARALYSIS. (Acute Anterior Polio Myelitis).—This is an acute disease occurring almost exclusively in young children with paralysis, followed by rapid dwindling of the muscles of the parts affected by the paralysis.

Causes.—Found in children under three years old. It is more common in summer than in winter. It often follows scarlet fever, measles, and diphtheria.

Symptoms.—The onset is usually sudden; often the child is put to bed at night seemingly well and in the morning is found paralyzed in one or more limbs. High fever or chills, general feeling of illness, pain all over the body, decided brain symptoms, like delirium or convulsions and intermittent contractions of the muscles may usher in the disease. These forerunning symptoms may last a short time or for several weeks, after which the paralysis is noticed, being extensive as a rule, and affecting one, two, or all of the extremities and sometimes the muscles of the trunk. This general paralysis soon disappears being left permanently in only one extremity, chiefly in one leg. The other symptoms disappear. The paralyzed part atrophies (wastes) rapidly. The disease is very rare in adults. If the paralysis does not show a decided change within the first few months, full recovery is doubtful.

Treatment.—During the acute stage there must be absolute quiet and rest with a diet that is not stimulating, one that is easily digested; ice to the head or cold cloths, counter-irritation to the spine; electricity should be used after a few weeks. There is quite a good deal of this paralysis, and the case should receive careful attention from the start.

TASTE.—Taste-Buds.—There are three kinds of papillae or eminences on the human tongue,—the circumvallate, the fungiform and the filiform. The circumvallate are from seven to twelve in number and lie near the root of the tongue, arranged in the form of a V, with its open angle turned forward. Each one is an elevation of the mucous membrane, covered by epithelium and surrounded by a trench. On the sides of the papillae, embedded in the epithelium, are small oval bodies called taste-buds. These taste-buds consist of a sheath of flattened, fusiform cells, enclosing a number of spindle-like cells whose tapering ends are prolonged into a hair-like process. As the filaments of the gustatory nerves terminate between these rod-like cells, it is probable that they are the true sensory cells of taste.

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In the human tongue taste-buds are also found in the fungiform papillae, often seem as red dots scattered over its surface; and to an area just in front of the anterior pillar of the fauces. It is also possible that single taste-cells are scattered over the tongue, as the sense of taste exists where no taste-buds can be found.

[Illustration: Taste Buds.]

Many so-called tastes are really smells. This is easily proved by compressing the nostrils and attempting to distinguish by taste different articles of food.

The taste sensation is greatest when the exciting substance is at the temperature of the body. There is no perceptible sweetness to sugar when the tongue has been dipped for a half-minute in water either at the freezing temperature or warmed to 50 degrees C. Neither is there any sense of taste until the substance is dissolved by the natural fluids of the mouth, as will be seen by wiping the tongue dry and placing sugar upon it.

The four primary taste-sensations are bitter, sweet, sour and salt. These probably have separate centers and nerve fibers. Sweet and sour tastes are chiefly recognized at the front and bitter and alkaline tastes at the back of the tongue. The same substance will often excite a different sensation, according as it is placed at the front or back of the tongue.

There are also laws of contrast in taste sensations. Certain substances will enhance the flavor of another and others will destroy it. Again, certain tastes may disguise others without destroying them, as when an acid is covered with a sweet.

INSANITY. History.—The earliest reference to insanity is found in the book of Deuteronomy. Another reference is in Samuel where it speaks concerning David's cunning and successful feigning of insanity. "And he changed his behavior before them and feigned himself mad in their hands, and scrabbled on the door-posts of the gate, and let his spittle fall down upon his beard," Feigning insanity under distressing circumstances has been one of man's achievements throughout the centuries. It is spoken of in Ecclesiastes. Jeremiah says in regard to the wine cup: "And they shall drink and be moved and be mad." Nations also were poisoned by the wine cup, for Jeremiah says, "Babylon has been a golden cup in the Lord's hands, that made all the earth drunken. The nations have drunken of her wine, therefore the nations are mad." Greek writers speak of cases of mental unsoundness as occurring with some frequency in Greece. The inhabitants of the Roman Empire were afflicted with mental unsoundness and Nero was considered crazy. In ancient Egypt there were temples and priests for the care of the insane.

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Hippocrates, who lived four hundred years before Christ, was the first physician who seemed to have any true conception of the real nature of insanity. For many centuries later the masses believed that madness was simply a visitation of the devil. The insane, in the time of Christ, were permitted to wander at large among the woods and caves of Palestine. The monks built the first hospital or asylum for the insane six centuries after Christ.

A hospital for the insane was established at Valencia in Spain in 1409. In 1547 the hospital of St. Mary of Bethlehem was established near London and was known as "Bedlam" for a long time.

The first asylum to be run upon reform principles was St. Luke's of London, founded in 1751. About 1791 Samuel Hahnemann established an asylum for the insane at Georgenthal, near Gotha, and the law of kindness was the unvarying rule in the institution. Hahnemann says in his Lesser Writings: "I never allow any insane persons to be punished by blows or other corporeal inflictions." Pineli struck the chains from the incarcerated insane at the Bicetre, near Paris in 1792 or 1793.

There has been a gradual tendency during the last century toward better things in the behalf of the insane. A hundred years ago they were treated with prison surroundings and prison fare. Then asylum treatment began to prevail. This means close confinement, good food, sufficient clothing and comfortable beds. Asylum care means the humane custody of dangerous prisoners. "From the asylum we move on to the hospital system of caring for the insane and this system recognizes the fact that the lunatic is a sick man and needs nursing and medical treatment in order to be cured. Hospital treatment has been gradually introduced during the past thirty years or more," and in time it will eventually supercede asylum treatment and prison or workhouse methods in the management of the insane everywhere.

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Causes of Insanity.—There are many and various causes. One author states: "Mental abnormality is always due to either imperfect or eccentric physical development, or to the effects of inborn or acquired physical disease, or to injurious impressions, either ante-natal or post natal, upon the delicate and intricate physical structure known as the human brain." Some physical imperfections, more than others, give rise to mental derangements, and some persons, more than others, when affected by any bodily ailment, tend to aberrated conditions of the mind. Some impressions more than others, are peculiarly unfortunate by reason of their crowding effects upon the brain tablets of a sensitive mind. To these natural defects and unnatural tendencies, we apply, in the general way, the term "Insane Diathesis." This diathesis may be inherited or acquired. Those who are born to become insane do not necessarily spring from insane parents or from an ancestry having any apparent taint of lunacy in the blood. But they do receive from their progenitors oftentimes certain impressions upon their mental and moral, as well as upon their physical being, which impressions, like iron molds, fix and shape their subsequent destinies."

The insane diathesis in the child may come from hysteria in the mother. A drunken father may impel epilepsy, madness or idiocy in the child. Ungoverned passions, from love to hate, from hope to fear, when indulged in overmuch by the parents, may unloose the furies of unrestrained madness in the minds of the children. "The insane may often trace their sad humiliation and utter unfitness for life's duties back through a tedious line of unrestrained passion, of prejudice, bigotry, and superstition unbridled, of lust unchecked, of intemperance uncontrolled, of avarice unmastered, and of nerve resources wasted, exhausted, and made bankrupt before its time. Timely warnings by the physician and appeals to his clients of today, may save them for his own treatment, instead of consigning them to an asylum where his fees cease from doubling, and the crazed ones are at rest." The causes of the insane diathesis (constitution) are frequently traceable to the methods of life of those who produce children under such circumstances and conditions that the offspring bear the indelible birthmark of mental weakness. Early dissipations of the father produce an exhausted and enfeebled body; and a demoralized mind and an unholy and unhealthy existence in the mother, are causes. Fast living of parents in society is a fruitful cause of mental imperfections in their children. "The sons of royalty and the sons of the rich, are often weak in brain force because of the high living of their ancestry."

The fast high livers of today are developing rapidly and surely, strong tendencies to both mental and physical disorders. Elbert Hubbard says of those who live at a certain hotel and waste their substance there, that they are apt "to have gout at one end, general paresis at the other, and Bright's disease in the middle."

Drunkenness, lust, rage, fear, mental anxiety or incompatibility, "if admitted to participation in the act of impregnation will each, in turn or in combination, often set the seal of their presence in the shape of idiocy, imbecility, eccentricity, or absolute insanity."

Diogenes reproached a half-witted, cracked-brained unfortunate with this remark, "Surely, young man, thy father begat thee when he was drunk."

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Burton in his anatomy of melancholy states that: "If a drunken man begets a child it will never likely have a good brain," Michelet predicts: "Woe unto the children of darkness, the sons of drunkenness who were, nine months before their birth, an outrage on their mothers."

Children of drunkards are often "sad and hideous burlesques upon normal humanity." Business worry may cause unsoundness in the offspring generated under such conditions.

One father had two sons grow up strong and vigorous, mentally and physically, while a third son was weak, irresolute, fretful, suspicious and half demented. The father confessed to his physician that on account of business troubles he was half crazy and during this time the wife became pregnant and this half-crazy son was born and the father states that "he inherits just the state of mind I was then in." Many such cases could be mentioned. "A sound body and a cheerful mind can only be produced from healthy stock." Mental peculiarities are produced by unpleasant influences brought to bear upon the pregnant mother. The story is told of King James the Sixth of Scotland, that he was constitutionally timid and showed great terror at a drawn sword. His father was murdered in his mother's presence while she was pregnant. Children born under the influence of fear may be troubled with apprehensions of impending calamity, so intense that they may become insane at last. An instance is given of "an insane man who always manifested the greatest fear of being killed and constantly implored those around him not to hurt him." His mother lived with her drunken husband who often threatened to kill her with a knife.

Other Causes of Insanity. Imperfect Nutrition.—Whatever tends to weaken the brain or exhaust the central forces of life must favor the growth of insanity. The brain is not properly nourished.

Blows and Falls upon the Head.—Sometimes such injuries are forgotten, but they result infrequently in stealthily developed, but none the less dangerous, conditions, which may result in the derangement of all mental faculties. A child should not be struck on the head. Teachers or parents should not box a child's ears. One author says such a person "is guilty of slow murder of innocents."

Fright is Another Cause.—Punishing a child by locking it in a dark room or by "stories of greedy bears or grinning ghosts produces, oftentimes, a mental shock that makes a child wretched in early life, and drives him into insanity at a later date." Overtaxing the undeveloped physical powers is another cause.

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Insanity is most Prevalent among the Working Classes.—Our factories, shops and stores frequently employ the young of both sexes and they are overtaxed by day and night and they become feeders of our hospitals for the insane. Another cause is forced education in the young. Our present school system tends to break down the body. The work may not be too hard, but the amount of anxiety and worry, which this work causes in the minds of sensitive children, tends to enfeeble them. Many children are sensitive, with nervous temperaments, and they are easily affected by the strain of mental toil. Delicate children should be kept in the open air and their physical condition should be considered more than their mental. Girls, especially, at the age of puberty, should be built up instead of rushed through a heavy routine of study. Herbert Spencer says: "On old and young the pressure of modern life puts a still increasing strain. Go where you will, and before long there comes under your notice cases of children, or youths of either sex, more or less injured by undue study." Here, to recover from a state of debility thus produced, a year's vacation has been found necessary. There you will find a chronic congestion of the brain that has already lasted many months and threatens to last much longer. Now you hear of a fever that has resulted from the over excitement, in some way, brought on at school. And, again, the instance is that of a youth who has already had to desist from his studies, and who, since he has returned to them is frequently taken out of his class in a fainting fit.

Social pleasure also tends to weaken the system of parents who produce nervous and weakened children. Another great cause of insanity is the unnatural, improper and excessive use of the sexual organs, and diseases that often come from indiscriminate sexual relations. General paresis is very often caused by specific disease. I might go on and enlarge upon these causes, but enough has been written to give warning to those who are breaking nature's laws.

Classification.—There are many classifications. I will mention only the leading names, such as Melancholia, Mania. Dementia, General Paresis.

MELANCHOLIA (Sad Mania).—Melancholia is a disease characterized by great mental depression.

Causes—Predisposition, physical disease, dissipation, work and worry, shock, brooding. In simple melancholia the mildest attack may be called the "blues."

ACUTE MELANCHOLIA.—Is generally the result of some mental shock.

CHRONIC MELANCHOLIA is the end of all other forms of mental depression. All these have their own peculiar manifestations and need a special line of treatment.

MANIA.—This type of insanity means a raving and furious madness. There are many cases of this kind. The causes are many and may be the same as those which produce melancholia. In melancholia the shock, etc., causes depression, while in the mania the causes of mental injury tend to produce irritation and excitement. In dementia, the causes of insanity tend to exhaust the body and to mental failure, while in general Paresis "the shock of disease comes after long and unwise contact with worry, wine and women." Insufficient sleep often causes mania. It often follows after exhausting and irritating fevers. Long continued ill health, together with worry, etc., may cause it.

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To sum up, "mania" may result from any unusual shock or strain upon the nervous system; or it may come after any unusual mental excitement in business, politics or in religion. Such are the exciting or stimulating causes, but we must go back of the presence of worldly misfortune and trace the tendency to mental disorder through channels of hereditary influence. "Infants are born every day whose inevitable goal is that of insanity." What is said in the Bible about sins of the parents is true.

DEMENTIA.—This term literally means "from mind," out of mind, and such a person is in a state of the most deplorable mental poverty. We all have seen such cases and some cases are not only very sad but disgusting.

PRIMARY DEMENTIA comes on independently of any other form of insanity.

SECONDARY DEMENTIA follows after some other form of insanity,—chiefly melancholia or mania. Dementia may be acute or chronic.

SENILE (OLD AGE) DEMENTIA may be Primary.—Acute dementia attacks both sexes, but it occurs most often in females, though in a milder degree. It is a disease of youth, being rarely seen beyond thirty years of age. It seems to depend often upon exhausting influences operating at a period of rapid growth. Monotony of thought and feeling or want of mental food can also induce it. Children who are sent at an early age into factories often pass into the condition of acute dementia. Prison life also tends to produce such a condition. Acute diseases such as typhoid and other fevers are sometimes followed by acute dementia. Persons frequently go "out of their mind" suddenly in this age, and upon recovering from acute dementia, the patient finds a great "vacancy of memory."

Chronic Dementia.—Shakespeare says, "Last scene of all, that ends this strange, eventful history, is second childishness and mere oblivion; sans teeth, sans eyes, sans taste, sans everything."

"The Sans Everything."—Is the sad and hopeless obscuration by time or disease of the once bright, vigorous, scintillating mental powers of exhuperant and lusty youth. Everyone has seen such people who are partially or hopelessly demented. It may come from diseases, such as epilepsy and syphilis; alcohol produces it.

Senile dementia is the result of old age and of acquired brain disease. It is different from simple old age or dotage. In old age the mind is weakened, but the patient is conscious of it, such a person forgets a name or date and gropes about in his memory to find it.

The demented person is not conscious of loss of memory, but applies wrong names to persons, and serenely thinks he is right.

The senile demented person does not realize his condition, and if there is any mental power left he cherishes delusions or false beliefs.

The victim of old age is unconscious of his weakness.

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GENERAL PARESIS.—Wine, worry and women produce a great many cases of this disease. The doctors claim a notorious criminal now committed to one asylum and about whom we have read so much, is a victim of this disease.

First stage.—There is worry, anxiety, sleeplessness and melancholy.

Second stage.—Stage of mania, wealth, power, and grandeur, alternating in some cases with attacks of temporary depressions.

Third stage.—Patient passes into a condition of subacute or chronic mania, with a slow tendency to decadence of all the powers, idiotic.

Fourth stage.—Stage of physical and mental failure and of death. Syphilis causes most cases. It usually develops between twenty-five and fifty years. The outlook for such cases is very unfavorable, as the patient usually dies from one to eight or ten years after the beginning of the disease.

TREATMENT.—There have been great advances made in recent years in the treatment of persons mentally unsound. They should be placed under proper treatment at an early stage. The causes have been given so that preventive measures may be taken.