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rhagia or other exhausting diseases which lessen the vital force and strength, there is greater danger of becoming insane at this time.

With these conditions present as predisposing causes, with this unstable and unsettled condition of mind-overwork, grief, or worry, of even anemia may be important factors in dethroning the reason.

Care should be exercised and this mental disease differentiated from simple melancholia and organic dementia.

A large percentage of uncomplicated cases of climacteric insanity are restored to health. Melancholia and mania in an acute form, are regarded as the most curable forms of mental disease, and when a climacteric case assumes either of these types, we may reasonably expect a favorable termination of the disease.

We sometimes, unfortunately, find patients who become addicted to the use of stimulants or narcotics in order to get relief from the pains, and many women regard gin as a universal cure-all. We occasionally see patients who have been injudiciously advised to use morphine or other narcotics. A few years ago, a patient came to me for treatment, and said that her family physician, an eminent professional man, had given her a hypodermic of morphine occasionally during the menstrual periods. After a time he regarded it as unnecessary for him to visit her, and gave her the syringe with instructions to use it for two or three days, when the pains were the most severe. The result was that she used it every day and had for years. She is a mental wreck now.

Probably seventy-five per cent. of the recoveries get well within a year. The earlier the patient is placed under systematic treatment, the greater the chances of recovery. In determining the time it will take to recover, it is well to take into consideration the age of the patient; the duration of the disease; the family history, and the tendency to use stimulants or drugs.

Clouston says, "Some of the cases take a long time to get well. I never give up hope in a climacteric case for five or six years, except there are symptoms of dementia or fixed delusions. The physiological period of life not being fixed nor always a short time, its nervous and mental accompaniments are often prolonged and irregular."

When the melancholia assumes the resistive type, the disease is likely to be of longer duration, and it is possible that terminal dementia may follow. There is no danger of a fatal termination if the patient is urged to take sufficient nourishment, and yet anemia, mal

nutrition, a weak heart, or some physical disease like pneumonia or phthisis, or even apoplexy, may end the patient's career.

Some of the symptoms observed are a furred tongue, dry, harsh, and muddy skin, lessening of all the secretions and obstinate constipation, especially when the mental disease assumes the form of melancholia.

The muscular system is lacking in tone, the muscles become thin and flabby, and there is general lassitude.

There is a gradual loss of strength, and in fact the entire form changes.

With a mild case of climacteric insanity, the melancholia may be unaccompanied with delusions or hallucinations. There is headache, abnormal sounds in the ears, dreamy and unrefreshing sleep, and an irritable manner and simple depression.

The vasomotor disturbances are frequently very marked. There is blurred and dim vision, vertigo, hot and cold flushes, and hyperemia of the brain, with a constant fear and dread that they are going to lose their mind.

Indifference to food, possibly as the result of nervous dyspepsia, is often apparent.

In the more severe cases, these symptoms are intensified. The depression is more marked. There are delusions and hallucinations; and often suicidal and homicidal tendencies. The patient is in the depths of despair, fears some impending danger, worries because things about them have not changed or that they are wicked, or have committed the unpardonable sin.

Occasionally the depression is so intense that there is refusal of food, and forced feeding is necessary.

Bevan Lewis says, “In over fifty-five per cent. of our cases, mental depression existed throughout the attack, a subacute delusional melancholia being the most frequent form. Out of a total of sixtyone deluded cases, sixteen were victims to the terrible delusion that the soul was eternally lost, and that the subject was to be consigned to the flames of Hell."

In the treatment of this type of mental disease, the first thing to do is to separate the patient from home and home influences. The treatment of such cases when surrounded by sympathetic relatives is usually unsuccessful. Persistent watchfulness especially with suicidal cases may prevent much sorrow and many regrets.

Time is essential, the readjustment or change cannot be stopped, but the patient can be benefitted in many ways, and many conditions modified

The dyspepsia, constipation and insomnia must receive attention. The skin should be kept in good condition. Nature's greatest restorer, fresh air, should be sought and a large portion of the time spent outdoors. Walks and drives, diversion and recreation of various forms should be utilized. Hot and cold baths, massage and electricity are useful, but above all things a good, generous, nourishing diet should be provided and watchful care and even forced feeding utilized if necessary.

Drugs which depress the nerve centers like bromides, chloral and hyoscine, and hypodermic injections of morphine should never be resorted to.

The sedative effect of a glass of hot milk at intervals is excellent with this as well as other mental conditions.

I have found in my experience that the following remedies, when indicated, were helpful and curative, and have been of material assistance in the treatment of many patients :

Aconite, bell., gels., pulsatilla, ignatia, sulphur, sepia, lilium tig., cimicifuga, coffea, glonoin, lachesis and sanguinaria.

BARLOW'S DISEASE.

By MILLIE J. CHAPMAN, M.D.,

Pittsburg, Pa.

T is now twenty years since Cheadle of London called attention

to cases of scurvy among infants and children, supervening on rickets. Barlow described the anatomical conditions, as determined by autopses, and a generous profession at once rewarded his scientific efforts by classing the partnership of scurvy and rickets as Barlow's Disease. England furnishes the greatest number of cases reported, and the most literature upon the subject of infantile scurvy. In 1894, Huebner stated that outside of England, only fifty cases had been observed in the past thirty years. Fifteen of these were American. Since then Rotch reports that he has treated seventy cases, and the author twenty, several others, three or four each. Doubtless the added list reported is due to a more careful observation rather than an increase of this form of disease.

It is supposed to be of chemical origin, and due to the persistent deprivation of fresh food. It is not surprising that many adults in the Klondike fields are to-day suffering from scurvy, the environ

ments contributing to this condition. But infants suffer from a similar disease, whether blessed with princely surroundings or dwelling in the haunts of poverty, if deprived of the natural food, and sustained for a prolonged term upon some of the many canned, condensed, baked, boiled, powdered, malted, or otherwise manufactured articles. Our zeal to combat microbes and bacilli by only administering milk after it has been pasteurized, sterilized, or diluted, has no doubt been an element in the development of this morbid state. Most cases occur between six months

and two years of age. The various authors agree upon the char· acteristics of the disease, viz., marked anemia, tendency to ecchy

moses about the eyes, edema of upper eyelids, swelling and sponginess of the gums when teeth are present, purpuric spots on limbs, hematura, and intestinal hemorrhage, a predominance of the lower limb affection, immobility, going on to pseudo paralysis, excessive tenderness, swelling, skin shiny and tense but seldom pitting, no undue local heat, thickening of the shafts of bones due to subperiosteal hemorrhage, liability to fracture near the epiphyses. A child that has seemed well gradually becomes pale, wasted, irritable, and manifests pain on handling, excessive tenderness of the lower limbs when moved at all. The child constantly moaning or screaming with agony. These symptoms have been mistaken for rheumatism, and in one case to injury of the spine, and was treated with a plaster jacket, and other accessories of the heroic school. The child had been fed on malted milk ten months, with pasteurized cream added, part of the time. It had been given and learned to call for the beverage of its nurse, green tea. In the reports of English authors, the use of tea is ascribed as an element causing scurvy. The reports of those treating the largest number prove that the most aggravated cases rapidly improve upon a change of diet, to a list which includes fresh milk, meat, vegetables, or fruit juices. No doubt all cases would be avoided if the diet was varied sooner. Since there are so large a number of children bottle-fed, and thus liable to this disease, which if not wisely treated, gradually proves fatal, it is of the greatest importance that all nurses and mothers be instructed that children deprived of natural food, should be given fruit or vegetable elements as a prophylactic of scurvy.

After the prepared foods have been given four months, a spoonful of grape juice added to the bottle once a day, Bovinine or freshly prepared meat-juice, will counteract this tendency; never forgetting the daily use of cold water to drink. The English prescribe sieved mashed potatoes. I prefer the baked potatoes, a spoonful made very

fine and put in the bottle of food for thin scrawny children, brings prompt relief. In winter when fruits are not always available, the following has been of great service: One potato, an onion, a turnip—all pared; put in two quarts of water, boiled until the potato falls apart, strain, salt, and add an ounce to each feeding. One well-developed case rapidly improved by use of ripe elderberry juice.

Children who have teeth and are able to chew, profit by use of celery and cabbage. The old school depend wholly upon corrected diet, and good nursing, but we are able to see health sooner and more permanently established by the administration of some of the following remedies –Carbo. veg., agave Americana, ars. alb., calcarea carb., calc. phos., phos. acid., merc. sil. In one case where the subperiosteal hemorrhage of the femur was considerable, the continued use of arnica produced the happiest result.

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Bromine in the Treatment of Endometritis. — Dr. Nitot believes that the prophylactic treatment of chronic disease of the uterus and adnexa consists in prompt attention to acute dometritis. To acomplish this it is necessary to resort to some diffusable medicament which can be applied to the entire mucous surface, so as to penetrate between the folds and into the uterine ends of the tubes. He has found in bromine vapor the most satisfactory agent. It is introduced into the uterine cavity through a double-current catheter attached to an atomizer, diffuses rapidly, and exerts a remarkable curative action in cases of acute endometritis and salpingitis.

Some Effects of Cannabis Indica in Large Dose.—Dr. Robert C. Bicknell regards as worthy of note the existence of muscular contractions, followed later by convulsive movements, evidently due to action of the drug on the spinal cord. Aside from acceleration of the pulse-rate and a feeling of fulness in the artery at the wrist, there was, just previous to the occurrence of unconsciousness, a sense of extreme tension in the abdominal blood-vessels; they felt distended almost to bursting. After some hours the urine was markedly increased in quantity. No constipation resulted. There was no foreboding nor fear of impending death.—Therapeutic Gazette, 1898, No. 1, page 13.

Somatose as a Galactagogue.- Dr. Richard Drews, from an extended experience, recommends this substance whenever the milk is checked from disease, mental or other disturbance, or when, although the glands are well developed, they do not secrete properly, in order to avoid the danger of the artificial feeding of children. Naturally, if the mother is suffering from a disease during which she should not nurse, this remedy should not be used -Therapeutische Wochenschrift, 1897, No. 45, S. 1157.

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