vidualizing families and individuals. Thus at present our scope is limited (1) to a few people; (2) to those of them who are in good circumstances.

Considerations relating to the organs outside the nervous system.—All the organs are presided over to a certain extent by the central nervous system. But the nervous system has also one function-intellectuality - which is accomplished without the direct aid of an end apparatus, but which is, nevertheless, influenced by the condition of the organs. The central nervous system is the regulator of all vegetative and animal functions; consequently, disease in it must produce disturbances in the latter. Nature has provided that this influence should be somewhat limited. The organs possess in themselves ganglion cells which can regulate their functions and which are outside the brain and spinal cord, although it is an undoubted fact that diseases of the brain and spinal cord often influence very much the vegetative workings of the other organs.

The condition of every organ reacts upon the nervous system; after hard labor we feel tired. When something When something interferes with the respiration we are conscious that we are out of breath. When the organs are in such condition that the right amounts and the right kinds of stimuli are sent up to the central nervous system, we feel well; failing this, we feel badly.

The central nervous system regulates, registers and reflects what is going on, whether known or unknown to us, the organs.

in

Nervous diseases, however, do not all begin in the other organs, but can originate in the nervous apparatus itself. But it must not be forgotten that in treating a disease of the nervous system the condition of the other organs must never be neglected. The family history must be known, the manner of life, social and hygienic, and the disposition must all be enquired into. To deal with nervous diseases the physician must not only be a specialist in this one branch; his special knowledge and skill must be built up on a foundation

of a thorough acquaintance with general pathology. The neuropathic diathesis may cause certain nervous diseases, or, if any are present, it will always intensify them.

Nature of the neuropathic diathesis.— We say vaguely that the neuropathic diathesis consists in an undue irritability or excitability, in diminished power of function of the nervous system, in disturbance of association, in exaggeration or loss of inhibition, or in a lessened resistance of the nerve cells. When we have said this, we know, practically, about as much of the subject as we do of molecular disturbance. Until we have facts to go upon as to the nature of nervousness we must be content with conjecture, but happily even with the few data at our command our hypotheses may become of some value in formulating a prophylaxis.

Does the neuropathic diathesis possess any unity, or, in other words, do we always find the same substratum underlying the complex phenomena manifested in this condition? It seems impossible that such a common foundation should exist. Why, in some families, does the neuropathic diathesis tend to the occurrence of organic diseases, such as tabes and Friedreich's ataxia, and, in other cases, seem to lead to functional nervous diseases and to diseases of the mind?

Many authors have endeavored to answer the first part of this question by presupposing the existence of anomalies in the germ plasm. Experience is not in favor of this theory, though, for certain diseases, tabes, for example, it cannot be disproved. In the familiar types of diseases of the central nervous system the same effect is noticed in many of the members of the same family.

It seems, therefore, that the neuropathic diathesis cannot be considered as a unity. Nevertheless the assumption of the existence of anomalies in the germ plasm is of some use for prophylaxis in leading us to seek for causes which might produce such anomalies in the germ and for measures by which they might be influenced.

In view of the fact that we cannot show that parents of neuropathic offspring have any one common germ-predestinating pathological characteristic, we come to the question: Is the diathesis always primary in the nervous system or in other organs?

Quantitative changes in the specific activity of cells or groups of cells can occur without material alteration in the cells. Qualitative changes must always depend upon anatomical modifications. Quantitative changes (and these are what we have to deal with in the neuropathic diathesis), if they depended upon alteration in structure, would show some constancy. But we have only to consider neurasthenia and hysteria to see that exactly the reverse obtains. The symptoms change very rapidly while the main functions of the body, motion, secretion, excretion, etc., may remain practically normal. We know that faulty metabolism is the cause of many pathological conditions. Now in many cases we can refer nervous disturbances to the improper constitution of the nutrient fluids of the body or the production of certain unknown substances, acting as poisons upon the nervous system, which circulate in the body and produce either exaggeration or diminution in the proper functions of the nerves and bring about a "nervous condition." It is to be remembered that the nervous system being very susceptible, may react first, and before we get loss of weight, anemia or other symptoms, we may not be able to refer the injurious effects to any particular organ of the body, but are only conscious that we are "nervous."

In many cases, therefore, nervousness can be traced to defective nutrition and it may be said that a neuropathic diathesis implies a tendency to disease in general.

It is possible that quantitative changes may be due to temporary changes in structure. In healthy people degenerated nerve fibers have been found. Could not quantitative changes be due to a want of balance between degeneration and regeneration of nerve cells? This, again, might be traced to some

defect in the nutrient juices of the body. Thus some nervous people are anemic. Again, the effects upon the nervous system of the character of the fluids of the body are proven by the different phases of nervousness seen in patients who have lately had typhoid fever or some other of the infective diseases, as well as in those who are suffering from diabetes, gout and various other conditions. In many cases the origin of the neuropathic diathesis is to be referred to the improper constitution of the blood or lymph or to circulatory disturbances.

Certain poisons leave in the body substances which produce effects on the nervous system long after the poisons themselves have been eliminated from the body. We have post-syphilitic and post-diphtheritic nervous disturbances. and diseases of the central nervous system from ergotism, plumbism and lathyrism. Of course it is possible that in these cases there may be finer alterations in structure.

To sum up, the neuropathic diathesis may be regarded: (1) In a certain number of cases as nothing else than a tendency towards disease in general, from faulty metabolism, an improper blood supply and intoxications, which expend themselves principally upon the nervous system (acquired diathesis). (2). In other cases as consisting in a preponderating vulnerability of the nervous system to certain anomalies in the germ plasm (inherited diathesis). This condition is not understood but is supposed to rest upon a too speedy metabolism in the cells or an inequality between degeneration and regeneration of nerve tissue. Any injurious influence from outside (acquired) intensifies the hereditary diathesis.

Properly speaking, the neuropathic diathesis has to do only with functional disturbances, but where these are persistent and permanent we must suppose an anatomical change, though it may be too fine to be perceptible with our present methods. A want of balance between regeneration and degeneration produces functional nervous diseases, but suppose that regeneration ceases, we get organic disease.

The symptoms of the neuropathic diathesis consist in quantitative changes in function, while the specific energy is preserved. Persistent change-whether characterized by diminution or exaggeration is a sign of organic disease.

Thus far, then, we have the fundamental rule for prophylaxis which is to provide for proper nutrition and against disturbances in the composition of the blood and in the circulation.

The causes of the neuropathic diathesis are: (1) Those that an individual born sound encounters. (2) Those which he inherits. Enquiry must be made into the characteristics of the family not only about cases of insanity but about the general disposition of the various members for several generations.

Hereditary Diathesis.-Heredity in disease is either direct or indirect. One

or

more members of the family may have the same nervous disease or in later generations the same cause may lead to different affections. We may have a practical increase in the severity of the disease with every generation (degeneration). A man may be neurasthenic, the son epileptic and the grandson an idiot. Then we have atavismus where one generation is left out. Of course it is clear that not all the members of a family need be affected.

For prophylaxis the most radical way would be to prevent all persons suffering from nervous disease from marrying. But even were this possible it would not always be necessary. The inheritance of the malady is by no means necessary. The steadying influence of married life does much for some nervous people. Von Hoesslins says that half of his neurasthenics were unmarried. Sometimes a physician may have to recommend marriage if the conditions are favorable. But sometimes his duty points the other way. When earnest consideration has assured us that the progeny will be affected and that degenerates will be born, it is our duty to advise most strongly against marriage. Under the most favorable circumstances, if the other individual is sound, so that it is possible that all or most of the progeny may escape, it may not be wise to forbid mar

riage. In such cases special directions should be given to the persons con

cerned as to the care to be taken with a view to diminishing the danger.

In this connection it must be mentioned that statistics are unsatisfactory. They are incomplete, of course, and it must be remembered that we obtain reports of the cases in which the disease has been inherited more often than when the progeny has escaped. These last do not come before our notice.

The question is a broad one and each case must be decided upon its own merits. In many instances marriage may be permitted. But in the case of confirmed epileptics or of individuals having certain well established or recurring psychoses it must be absolutely forbidden. Too close intermarriage of blood relations should be prevented.

The relative frequency of nervous diseases in the offspring of first cousins and in the Jewish race is undoubtedly due to inbreeding. But it must be borne in mind that some individuals, while very closely connected by blood, have not inherited the same characteristics.

Prophylaxis in the Young.-It must be remembered that the earlier we begin in these cases, the greater the prospect for success. The physician has a great responsibility in the case of children of neuropathic tendencies. And first with respect to nutrition. Milk is the best food for children. When it does not agree with them, in most cases there is a fault somewhere which can be more or less easily rectified. Children should not be allowed coffee, tea or stimulants till they are twelve or fifteen years old, except when they are given as medicine. Even after the first dentition too albuminous a diet is hurtful. Children should have meat only once a day, the other meals consisting mostly of bread, butter, milk, sago, rice and the like. Relishes and sweets should be used with a most sparing hand. The quality and quantity of the food and regularity of the meal times are of the greatest importance.

Children should have light and air. But in this respect regulation is neces

sary. They act as stimuli, and excess is harmful. The new-born child comes into the world without being accustomed to stimuli. To allow him to be irritated by a sudden excess must be harmful. This applies equally to intellectual stimuli. After the child is a year old gentle hardening may be practiced. The water in which it is washed may be made cooler. Warmly clad it may be sent out in all but the rawest or very damp weather. Excesses in hardening must be avoided. The stimuli thus provoked are too severe.

clothing should be warm and fairly loose to admit of development. The peripheral nerves and the cutaneous vascular system must not be rendered over. susceptible by too heavy clothing. Nothing tight about the neck should be worn, otherwise passive hyperemia of the brain may result in headache and other manifold symptoms. Tight trousers and anything which might irritate the genitalia should be avoided. Sleep should be provided for, but a distinction should be made between night and day. The room should not be darkened by day or brilliantly lighted by night.

Bodily and Mental Training.-Careful regulated exercise in the open air is the best thing for creating a proper balance between the mental and bodily part of our nature. Bicycling is not to be recommended. Trauma is a factor in the production of nervous diseases. We cannot prevent children from falling, but we can see that in our nurseries there are no sharp angles which they would be likely to strike against. In case of any severe injury the most absolute rest and freedom from any nervous stimuli may do much to guard against further injury to the nervous system.

As far as regards mental education a volume might be written, but these brief directions may be useful: (1) For the first year simply allow the child to grow. Do not try to make him speak or run too early. The child should not be sent to school before its sixth year. The moral training may be undertaken earlier; the child should be taught obedience and self-control. If a child once

learns to obey somebody, later he will be more likely to obey his better Ego, to deny himself and to force himself to do things which he does not wish to do. Irresolution of character and inability to deny oneself favor the development of nervous diseases. Individuals who have always been in the habit of giving free rein to brain and nerve activity are more likely to succumb to the effects of a hereditary neuropathic diathesis. the other hand, too strict a regime is hurtful. Obedience must be obtained through conviction and not through fear. Occasionally punishment is, however, necessary and beneficial. Tears bring relief and often stop the storm of energy which is going on in the brain. Overwork at school and its injurious influences have been much exaggerated. Still there are a great many abuses which must be remedied. For the first three years of school, the child being from six to nine years old, not more than three hours of class work should be allowed. This should be supplemented by proper rest and bodily and mental exercise at home. We do not want to make of our children hot-house prodigies.

The pleasures of the young in gatherings belong to the open air. Parties in hot rooms, dancing, etc., just at a time. when children are arriving at the age of puberty, are very bad and lead to many evil results, such as chlorosis and hysteria in boys and girls. For many reasons large boarding schools are objectionable. In youth any excess, the pleasures of society, which besides include being shut up in hot rooms, loss of sleep, too high living, alcoholic or sexual excesses, are calculated to intensify a nervous disposition or to arouse it while yet sleeping in the protoplasm.

Choice of Profession.-For the laboring classes an out-door pursuit is the best one as opposed to working in factories, in which occupations there is at the same time usually great monotony. Employes on railroads are subjected to continuous shaking, which is not good for nervous people. Parents must not be too ambitious for their sons. Com