was willful, secretive, deceitful and imaginative. As a wife to her first husband, incompatible, devilish and finally divorced. To her second husband, jealous, insinuating and constantly menacing. He was lenient and kind, yielding to her every whim, encouraging every idea, no matter how ridiculous, until finally she lost all willful control and became a helpless dement.

Had this child's mental irregularity been given professional attention, had she been taught self restraint, had she been educated differently, had her environments been changed as a woman not only would her own life been spared this terrible calamity, but her husband and son would have been saved much discomfort and disgrace. Any subject being in question mentally should be examined carefully and what I mean by being careful is not only to take subjective symptoms in an indifferent way but to get all of the objective findings as well. The hardened artery, high blood pressure, albumen, indican or sugar in the urine, excessive or diminished amounts of red or white blood corpuscles, the tightened sphincter, the hypertrophied or atrophied organ, the hooded clitoris, the contracted prepuce, or the prolapsed viscera, must each and all be weighed for mental aberrations are not infrequently the consequence of some apparently slight physical defect.

The patient who comes and says she is sleepless, nervous and particularly susceptible to all noises, who has become petulant, irritable, fault finding and generally incompetent, may show no other need than help for some slight kidney incompetency, some form of auto-intoxication or some lack of nutrition. Thus it will be seen that our whole professional duty is not fulfilled until we have exhausted. every resource both mental and physical. Illustrating this fact the following case is cited: A music teacher, aged 45, had in the performance of her profession learned to listen hypercritically for disturbing notes and thus became an easy subject for extreme irritation of the auditory sense. About a year ago this patient became very nervous, every noise disturbed, every motion aggravated, every abnormal surrounding irritated until finally she became a marked monomaniac. During her first few days at the sanatorium she had her room changed seven different times to get away from the various noises which to her were greatly magnified. She would put cotton in her ears, shut herself in the closet, put pillows over her head and do many other things which bespoke a serious mental disturbance. On everything else she was quite herself, but on the subject of noise she was insane. This condition proved to be a very serious one for rapid loss of flesh, sleeplessness, constant worry and poor appetite. were making of her a physical as well as a mental wreck. Several previous doctors had regarded her as hysterical and so she had gone on from bad to worse. A careful review of her early history revealed luetic infection from a divorced husband, her bowels were extremely constipated, urine showed a trace of sugar and large quantities of indican. Her arteries were hard and inelastic, her red blood count high, while leucocytes were subnormal. Here was a case of syphilitic infection, auto-intoxication, incompetent elimination and

poor nutrition. Her mental manifestations were only symptoms of physical irregularity. A few weeks of physiological measures applied to meet these conditions set right the blood making functions, corrected the disturbed nutrition, overcame the mental infirmity and returned to active life one whose existence seemed to be irreparably disturbed. Had these conditions gone on unchecked this woman would have suicided or become a raving maniac. To take her subjective symptoms and pass to a drug prescription had meant only to add to her troubles, to find their causes by the process of careful observation and laboratory analyses meant to cure her. Had her condition gone on to brain degeneration help would have been impossible, early recognition and discovery of causes meant recovery and so one less human being was spared the custodial care of an asylum. I do not relate these cases for personal aggrandizement but simply to emphasize the necessity of careful investigation of all cases.

One of the greatest responsibilities the doctor has comes through his duty to mankind regarding the marriage of suspected subjects, not infrequently doctors are asked their opinion as the advisability of mentally disposed patients becoming married. The following case will serve to elucidate:

A young college student about 20 years of age, coming from a highly neurotic family began to show signs of mental disturbance in that he complained of his parents being unjust to him. Every action of his father or mother was regarded as unfavorable to his interests. He was petulant, irritable, and at times threatening. His reasons for his conclusions were given with a precision and exactness known only to the paranoic, his family and doctor both recognized in him the elements of mental derangement. He was known to be delusional and yet his marriage was encouraged and executed. by those who knew he was unquestionably insane, and the innocent young wife has to bear the imposition of an incompatible and miserable husband.

It is bad enough to have one life blighted but it is terrible to mortgage the existence of another and embargo future generations. Any doctor who will lend consent or co-operation to such things fails to realize the import of the red lights which flash back their danger signals and he should be held culpable not only for his lack of foresight in discovering the trouble but as well for his indifference and lack of interference with the obtaining of martial privilege.

Thus it will be seen that as the subject of insanity widens, professional duties increase, further that professional duty is not only to the patient but likewise, to all corrollary interests, so it is with family history. No disorder to which the human body is subject follows heredity more certainly than does insanity and so we should ever be on the lookout for broken links of this kind in the family chain. A recent experience shows how remote and yet how certain are inherited tendencies. A young man after having been for two years an inmate of one of our state institutions was brought to us for examination. He had all the indications of a dementia precox of about five years standing. Had he been the only case in his family

we would have had greater hopes of his recovery, for acquired conditions of this kind are much more amenable than in cases where the shadow of preceding generations is found falling upon those who follow. In this case first inquiry found no inherited clue but final evidence gave information of an aunt on the maternal side who had gone through much such an experience as the patient. Here was a line which helped us in our diagnosis and guarded our prognosis, this fact in itself should have served for the early recognition of this young man's trouble which might have anticipated complete dementia, had his condition only been recognized and treated early, neglect of which passed him to the degree of a dement without hope of recovery. So in making up the prognosis much of import attaches and great are the duties of the profession. In summarizing I would say that in all cases early recognition is the chief element of success in the treatment of mental disorders, further that the doctor's responsibility is not only that of recognition and treatment but it is also the education of the people up to the fact that insanity is neither a disgrace nor a dishonor and that frankness on the part of friends and relatives, not only helps in the recovery of the patient but likewise shortens the duration of even the severest types of mental infirmity and if co-operation and assistance may be elicitated in this regard, that the number of the insane will be greatly diminished.

I should like to discuss at this time some of the physiological measures which we find useful in the treatment of the various cases of mental aberration but as time limit debars elaborations in this matter I shall content myself with just a few suggestions indicating professional duty in this regard. I should like to discuss at this time some of the homeopathic remedies which experience has taught are of incalculable value but the limitations of the occasion only admit of my suggesting in a general way some whose characteristics would remind us of their usefulness in all cases of the mentally afflicted.

Agaricus, with its confused mind, its stupidity and feeling of intoxication has a special sphere of action in the paretic. Argentum Nitricum with its tendency to tetanic convulsions, coma and death, signifies its adaptability to the anemic, to the hypochondriac and in all cases of sclerosis of the brain and cord.

Baptisia, that great constitutional antiseptic which serves to antidote the various toxines is especially indicated in all cases of besotted appearance, stupor and especially where there is present the hallucination that one cannot get himself together again.

Belladonna, where there are spasmodic tendencies and where there is mental excitement in any form of insanity. When the patient is timid, lacks power of co-ordination, is sickly in appearance, apprehensive, despondent and distrustful, Causticum comes to the rescue. In violent delirium with purging and collapse when the patient is over-worked and exhausted. Cuprum plays an important part. Hyoscyamus, Nux Vomica, Phosphoric Acid and Platina, Rhus Tox, Stramonium and Veratrum Viride each have their special indication, their particular purpose and if their characteristics are studied with care and applied with diligence, much good will result.

I would remind you that as physiological measures for the treatment of the mentally afflicted there are none which are entitled to more credit than water and its proper application. Hydrotherapy when applied intelligently gives more promise than any other one single means of which we have knowledge. If you would try their efficacy try the following suggestions: For sleeplessness the cold trunk pack, for violent delirium the continued bath. For the subject of auto-intoxication the electric light bath at 200, 10 min. followed by a hot water bath at 100 degrees, for ten minutes, after which the temperature be reduced to 66 degrees. For the melancholic the needle bath and spinal compress. For the paretic the salt rub, Methyline Blue Enema, brisk rubbings and rest in bed.

HYPERTROPHY OF THE PROSTATE.*

BY ARTHUR E. GUE, M. D., OKLAHOMA CITY, LATE PROFESSOR SURGERY, DETROIT HOMEOPATHIC COLLEGE. LATE SURGEON GRACE

HOSPITAL, DETROIT, MICHIGAN. CHIEF SURGEON

AUSABLE AND NORTH-WESTERN R. R.

This serious affection may be looked upon as a senile disease, seldom occuring before the age of fifty-five, and commonly met with after this. It has been rightly denominated "the common inheritance of mankind." For, as Brodie observes, "when the hair becomes gray and scanty, when atheroma begins to be deposited on the coats of the arteries, and when the arcus senilis forms on the cornea, so also the prostate increases in size."

If we look upon the diseased enlargement of the prostate as such an amount of hypertrophy of this organ as interferes seriously with. the discharge of the urine, then we shall probably not find it so frequent even in old men as is generally supposed. But if we include (as we should) other changes that take place in the genito-urinary system, simultaneously with this unfortunate enlargement, then we will find it frequently among the aged. Guthrie states that it is not commonly found in the pensioners at Greenwich Hospital. Mr. Thompson found that an enlargement appreciable after death existed in 34 per cent. of men above the age of sixty; but that such a degree of enlargement as to give rise to symptoms during life was only met in 15 or 16 per cent. of the cases he examined.

Though age must be looked upon as the primary cause of this particular hypertrophy, there can be little doubt that it may be pre

*

Read at the last session of the Oklahoma Homeopathic Medical Institute.

disposed to by any continued source of irritation of the urinary organs, such as gonorrhea, stricture, excess or hard living of any kind. The first symptom of the disease is merely a diminution in the force of the urinary stream, which may exist without giving inconvenience or exciting particular attention. After a time, however, the desire to urinate increases, but the patient feels less ability to accomplish the act. During these periods there is a sense of weight, heaviness, and dull pain in the perineum. There exists a degree of irritation about the rectum, which may increase to such a degree that feces pass with the efforts to urinate. Then inflammation of the neck of the bladder develops, which adds to the discomfort and uneasiness of the patient. As the hypertrophy increases, the urethral canal becomes more and more closed, and consequently micturition is incomplete and painful. At this stage incontinence of urine takes place during the night. With the development of these symptoms, we find the constitutional symptoms on the increase, there are frequent attacks of fever, followed by sweats, emaciation due to loss of sleep and the constant irritation. Then there are times when we find complete retention which is not only painful to the patient bodily, but very distressing to him mentally. The obstruction thus offered to the natural outlet for the renal secretion, combined with the irritation of the urinary apparatus, are sufficient to cause changes in the chemical character of the urine. We find a large amount of glairy and slimy matter deposited; the reaction is alkaline, the odor is fetid, and often a blood color. These things will add to the torment of the patient, not only in pain but by absorption of this septic material and the general constitution becomes much weakened. Thus ends the picture of prostatic hypertrophy.

As we have already said, prostatic hypertrophy occurs mostly at the age of fifty or sixty years a few cases are recorded in younger men. The disease is very common; and to repeat Thompson's figures, 34 per cent of all men at the age of sixty have enlarged prostate, and of these almost half suffer from the symptoms already described.

We might dilate on the etiology outlined by adding that investigations have shown, that hypertrophy of the prostrate very frequently exists without arteriosclerosis of the prostatic or even of the other vessels. Others believe that the hypertrophy of the prostate is analogous to the formation of fibro-myoma in the uterus, but the formation of real fibroids in the prostate is the exceptional kind of prostatic enlargement.