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became more turbulent on account of opposition which she received because of her fondness for male society. She would fall in love with every male who would pay her the least bit of attention. This grew worse until attraction for the male sex caused her to become lewd. She solicited men openly on the street. Her conduct otherwise became more degenerate. She would steal and lie, and on account of her stealing she was apprehended and then found to be insane. On admission to the hospital for the insane, she burst into maniacal fury, jumped, kicked, swore, destroyed her clothing, exposed her person by denuding herself of clothes. She offered stubborn resistance to everything, would bite, scratch, etc. She was sleepless and noisy. This outburst lasted for some time, but as her physical health improved through treatment, there resulted improvement first in conduct, then in reason and at last she recovered and is today well.

It is to be remarked that the prognosis in such a case is good, if treatment is begun early. To this end, the existence of mental disease might be recognized early and the capricious conduct, the mental aberrations be attributed rightly to disease and not to the whimsical conduct of girlhood.

It is too frequent, indeed, that physicians snap their fingers with disdain at such cases and say it is nothing; it will all pass away. My experience as a family physician (for I am in general practice as well as being interested in the special practice of mental and nervous diseases,) leads me to say that the diagnosis of mental disease will not be tolerated in a family as a rule, until some gross act of impropriety or criminal act impresses them with the fact that something is wrong. An early diagnosis in such mental disease and immediate treatment gives a favorable prognosis. Delayed treatment increases the danger of chronicity, alarmingly.

CASE II. This patient illustrates the sensory-motor symptoms as well as the intensity of mental abstraction. Male, aged 22, single, mother insane. He was a college student and while engrossed in his studies which, by the way, were carried without apparent effort, he became very much interested in a young lady. His devotion was peculiarly distressing to her because of its persistence. She liked the young man but his attention seemed so utterly at varience with the established customs that she thought him peculiar beyond reason. He developed jealousy, became somewhat demonstrative, harbored delusions of suspicion, and at last declared that he was confident she was immoral.

He became convinced that she was pregnant and that she had accused him of being the parent of the unborn child. His vagaries grew and all centered upon sexual thoughts. At last his friends declared he should be treated, especially were the young lady's friends emphatic in denouncing

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his ideas as purely delusional, which subsequent history found true. He was committed to the hospital, having previously become decidedly melancholy, introspective and inclined to suicide. On admission he presented catalyptic symptoms which became more pronounced and, ultimately, very profound. For seven months he was in the condition described by Kahlbaum as katatonia, He had to be fed with a tube, nursed in every way. His urine was drawn for weeks at a time, and then again it would involuntarily flow from him. The same condition of the bowels existed. Sensory changes, vaso-motor and trophic symptoms were present and, for a time, it looked as if death would result. However, he began to improve and in four months from the cessation of the catalyptic state he left the hospital recovered. Today he manages a large farm with success, and frequently calls in to see me.

Thus is shown the intensity of mental abstraction, how the whole cortical area, even the spinal cord was involved in the profound inhibitory disturbances.

CASE III.—It is not unusual to note a combination of the melancholy type with the maniacal, in fact, they merge one into the other. In such cases it has been my observation that masturbation is very frequently a factor, possibly in all these cases, if we could obtain full information regarding the case.

The following case is an illustration: Male, aged 20, a peculiar boy given to introspection, sedentary life and anti-social in his make-up. Loved solitude and sombre things, given to excessive piety. His condition finally became of such a nature as to attract attention. He seemed afraid, would cry easily and did peculiar things. Attempted suicide, feigned epilepsy and injured his brother. He became morose and would not eat, said that he had committed the unpardonable sin, would read his bible by the hour, could not get forgiveness, etc.; then imagined he lost his manhood, read quack literature, staid in his room and barricaded himself in it.

He was induced to come out but soon after became so dejected that he refused to speak and eat. He was placed under my care in a general hospital where for several weeks he improved. His parents thought best to remove him to his home, where he soon relapsed, I suspected that masturbation was a complication, for in my experience such relapses are usually due to this practice being resumed.

The delusions, too, are in line with the insanity of masturbation. This patient is no better today than he was six months ago, although a special attendant is with him constantly and every effort is made to keep him from the pernicious habit of self-abuse.

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The prognosis in such cases should be guarded for the reason that this practice not infrequently occurs as the result of the disease, and in such cases degeneration is a factor, and terminal dementia sooner or later occurs. CASE IV. This case is of interest because it illustrates that persist

ence in treatment is productive of good results.

A youth, aged 19, of the morose, introspective type, living in the country, without agreeable social or domestic surroundings, suddenly one day informed his father that he intended to leave home that night. His father questioned him closely why he had thus decided, and receiving no answer, said: "Well, if you must go, I will give fifty dollars to help you pay your expenses." The boy took the money, left home that evening, and was not heard of for seven months, when one night, he arrived at his home dirty, but none the worse for his trip, except a well-worn appearance. He said nothing about his trip, seemed happy, went direct to his room as if he had left it but the day before, bathed, came down to supper, and for several weeks engaged in the duties of the farm. He gave his father back the fifty dollars a few days after he returned, saying he did not need it nor had he used it.

One morning on arising he complained of headache, vomited and was troubled with nausea. In a few days he was quite ill; a physician, Dr. Barnes of Decatur, Ill., was consulted, who made the diagnosis of cerebral meningitis. He referred the case to me. He was admitted to "Our Savior's Hospital," Jacksonville, where it was noticed mental symptoms were quite in evidence. He was morose, had delusions of persecution regarding his father and others, intensely introspective and decidedly querulous.

I learned from him that he had received a severe brain injury while "on his tramp," having been knocked off of the blind end of a baggage car by tramps. He was detained for a week in a hotel in Arkansas, and under a physician's care. However, I did not give this accident as the cause of his mental abberration, but from some incomplete history and his father's account, I ascribed the whole condition to adolescent insanity, with a possible meningeal involvement, and masturbation as a factor.

He remained in the hospital several months, when I had him enter a business college, more for employment of his time and to systematize his mental efforts for improvement. He steadily gained both mentally and physically, but had one remission when he attempted suicide on the occasion of his father visiting him.

He is now pursuing a regular business course and, in my judgment, is well.

He is happy now, enters in the work with spirit and, according to