Volume 1

Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne.

Date:
1906-1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    sanity, which is the only one I admit to be a true primary dementia, in which there is no preliminary mania, or melancholia, or stupor, l)ut a gradual enfeeblement of the mental powers until true terminal dementia is reached. I have seen only about six typical cases of this form. It is the only form that is hopeless from the beginning. Treatment.—The treatment I have lately adopted for such cases is founded on physio- logical considerations. The normal completion of the period of adolescence is in both sexes accompanied by a considerable deposit of adipose tissue, by an overplus of strength and activity, and by a state of general good nourishment of the body. To attain to this normal condition of body should imdoulitedly be our aim in treat- ing all cases of mental disease at this period. It always seemed to me that there were two things that constantly worked the other way, and that I had to contend against in their ti'eat- nient. These were the general lirain excitability and the morbid strength, and often perversion, of the generative nisus, with the inhil)itory power over it gone. The one tended to mania, sleeplessness, purposeless motor action, thinness, and exhaustion ; the other to erotic trains of thought, sexual excitement, and masturbation. I found that inaction, reading, indoor life, and amusements increased the one, while novel- reading, solitariness, and long hours in bed aggravated the other, while animal food and alcoholic stimulants gave increased strength to both morbid tendencies. I therefore put my patients to active exercise in the open air for as many hours a day as possible, walking, digging in the garden, and wheeling barrows; I give them shower-baths in the morning when the weather is suitable and they are strong enough, and I encoiu'age active muscular exercise in every way. Athletic games of all sorts in the open air are certainly good as far as they go. I ])lace great reliance on the diet. Milk in large quantity, and as often in the day as possible, Ijread, porridge, and broth are the staple articles of food for such patients here. My friend Dr. Keith, of this city, was the first to direct my attention to the advantage of a light farinaceous and milk diet in an allied class of cases, and my experience is strongly in favour of his views. The patients may have some fish, or fowl, or eggs, but in reality milk is the most important means of treatment. I seldom give such cases alcoholic stimulants. I give to all such patients who can take and assimilate it easily an emul- sion of cod-liver oil, hypophosphite of lime, and pepsine, made and flavoured in such a way that it resembles cream or extract of malt. I find very few indeed who cannot take this. Beyond this, an occasional bitter tonic, with sometimes a chalybeate or some of the new compound syrups of the phosphates, are about all the medicines I give. The effect of this diet, regi- men, and treatment is very marked in the majority of cases. No doubt during the first part of the attack patients may lose weight while the excitement is in its most acute stage, luit they soon begin to gain weight, and my prognosis is always favourable when I find the patient beginning to gain weight within a reasonable time, say six months or so. I have had patients who, in spite of very sharp excite- ment indeed, and nuich sleeplessness, gained weight under this treatment. It seems to me that the process of fattening such a patient, and the conditions under which it takes place, are antagonistic to the disease and its results. I have known the stopjiing of the cod-liver oil to be followed at once l)y a loss or diminished gain in weight, and mental aggravation, and its resumption to be followed by improvement in both directions. If a young man or woman suffering under the insanity of adolescence is found to gain one or two pounds a week within the first three months, I look on him as pretty safe. It is connnon to gain a stone in a month. I have now pursued this plan of treatment long enough to yield results that can be relied on, and I believe that more of my patients recover than before I adopted it. They recover sooner, and their recoveries are more reliable and permanent. Even in the case of those who sink into dementia I think they do so more quietly and with less of the element of chronic mania than inider a flesh diet. It is, I think, certain that the habit of masturbation, which is so frequent and so deleterious in such cases, is less practised liy patients on this diet and regi- men, and, when practised, is less damaging to brain function, and takes less hold on them. Prophylaxis.—Lastly, in connection with this subject, I would say a word about prophylaxis in children with a strong neurotic inheritance. My experience is that the children who have the most nein'otic temperament and diathesis, and who show the greatest tendencies to instability of brain, are, as a rule, flesh-eaters, having a crav- ing for animal food too often and in too great quantities. I have found also that a large pi'o- portion of the adolescent insane had been flesh- eaters, consuming and having a craving for much animal food. It is in such boys that the habit of masturbation is most apt to be acquired, and, when acquired, to produce such a fascina- tion and a craving that it may ruin the bodily and mental powers. I have seen a change of diet to milk, fish, and farinaceous food produce a marked improvement in regard to the nervous irrital)ility of such children. And in sncli cliildren I thoroughly agree with Dr. Keitli, wlio in Edinbm-gh for many years has preachcfl an antiflesh crusade in the bringing up of children up to eight or ten years of age. I believe that by a proper diet and regimen, along with other means, we can fight against and counteract