patient home. A single case will illustrate my point. In November of last year there came under my care a young man who was having a mild attack of melancholia. From the moment of admission he was excessively homesick. He felt that if he were only at home among his friends he would get along much better than among strangers. He made fair progress, slept better, and, in general, gained steadily until December, when upon his pleading to be allowed to go home, his family yielded. He was taken home with an attendant and I heard nothing of him for a month. But one morning early in January I was called to the telephone and learned that he had been a disturbing factor in his home and that his family could endure his company no longer. He returned to my care in a worse condition than when he left. He remained until the middle of March, when his condition was so much improved that he appeared, to the inexperienced eye at least, in his normal state of health. His father visited him one day, thought him entirely recovered, and, against advice. once again took his son home, this time without an attendant. The home surroundings affected the patient so profoundly that he became exceedingly nervous, slept very little that night, and could not eat his breakfast the next morning. Convinced by these two experiments that he could not as yet bear the home environment, the patient, of his own accord, returned to us after an absence of less than twenty-four hours.

Letter-writing, absolutely prohibited in some cases, is always restricted; visitors are allowed at intervals, long or short according to the disease and the patient's condition; in fact, the minimum connection of the patient with former scenes and persons has proved to be best.

Rest, both of mind and body, is one of the essentials of the treatment. At times absolute rest in bed is required; but in most cases the modified rest treatment is all that is needed. To keep patients in bed too long-thus giving them time in which to revolve, in their too active minds, their ills, extending far into the past as well as into the future-is to do more harm than the absolute rest does good. A combination of rest in bed with gentle exercise which may be increased from time to time as the patient grows stronger has been very successful. It is far better, also, to combine "lying down" with walking or other exercise than to combine "lying down" with "sitting up."

Most patients who finally come to the sanatorium-I use the word "finally" advisedly, for many of them do everything else possible before thinking of the institutional treatment-have undergone many and varied courses of treatment according to their resources. Every nervous case, at some period, has been "toned up.” In attempting the tonic treatment of these disorders one is building a house upon the sand. It is building upon a false, abnormal, and unsound foundation. Our patients must first become relaxed before the "toning up" process can be profitably undertaken. They must

feel weak and good-for-nothing; they must lose that high tension that they have-that artificial feeling of capability and well-being which comes on as evening approaches. This relaxation is brought about in the sanatorium by rest, massage, baths, and other agents to be spoken of later. Once a patient is thoroughly relaxed we have a safe foundation upon which to build.

Exercise in proper amount and of the right sort is another important factor. Swedish and other light gymnastics, resistive movements, and massage, given in the evening for its helpful effect upon the insomnia found in most nervous cases, keep the saatorium patient in good condition while confined in bed. Walking, boating, bowling, clock golf, croquet, dumb-bell exercises, wood-sawing or other manual work have their place as the patient becomes stronger. These forms of exercise are prescribed by the physician in specified amounts to be taken at stated hours of the day according to the needs of the individual.

The diet of the nervous and mental case must be generous, varied, and richer in proteids than one would prescribe for the normal man. Many sanatorium patients show the bad effects of diets that contain insufficient amounts of proteids. They are the voluntary victims of one or another food fad. They have been living on patent preparations, liquids and vegetables, with very little or no meat. Such patients require meat two or three times a day, milk and eggs in abundance. They need to have impressed upon them the necessity of a thorough mastication of the food they eat and the harmfulness of drinking at meal time. The matter of a change of diet often requires the rarest judgment, for the digestive organs. of our patients are often in a very debilitated condition. One patient can not eat this food and another can not eat that, but before long both are eating the usual mixed diet.

Eating between meals is not to be recommended, except in comparatively rare instances. If patients can be persuaded to eat three full meals a day, as in most cases they can be, it is far better. After all has been said, however, it is not the amount of food that we eat that is of so great importance but how much we assimilate. A small amount of the right kind of food well assimilated is altogether preferable to a larger amount, poorly assimilated. The digestive organs require rest, as do the other organs of the body; and they rebel every time if the digestive process is made a continuous performance.

Regular hours for treatments, retiring, exercise and rest do much towards the patient's recovery. Accustomed as the patients are to all sorts of irregularities of living, the sanatorium regimen is, in most cases, a revelation and a relief.

Electricity in its many forms is an extremely useful adjunct. The high frequency current, used sometimes for its sedative effect and sometimes as a stimulant, has proved most beneficial. Mechanical vibration helps those patients who have sensitive areas along the

spine. It often relieves the troublesome headaches and congestions of the nervous and mental invalid.

A rational hydrotherapy is one of our most valuable therapeutic agents. So many of the cases that come to the sanatorium are victims of unwise bathing habits. A patient has read in some newspaper or magazine that the cold plunge bath, taken each morning upon rising, is an excellent procedure. "It wakes one up so thoroughly in the morning." Or a kindly friend recommends the cold sponge bath every day. Both these forms of bathing are good for some people, but the proportion of persons who may take them safely is exceedingly small. Cold bathing, except in cases of hysteria, is distinctly contraindicated in nervous diseases. The harm that may result from this daily severe shock to the nervous system is incalculable. The tepid sponge bath and hot bath of various kinds are valuable and necessary measures. For insomnia and restlessness, the hot bath, continued for periods long or short, is helpful. The brine bath, the modified Nauheim bath, the spinal douche, and many others are proving useful.

Phototherapy-the application of light to these diseases-is the latest agent adopted at the sanatorium. The sun bath has long been known to be of benefit, but the value of the electric light is a comparatively recent discovery. The electric light bath assists general metabolism and helps greatly in treating persons of low vitality. In general, the electric light bath increases the haemoglobin-carrying power of the red blood-corpuscle and is to be ranked as a nerve sedative or a nerve stimulant according to the intensity and duration of the treatment.

The high candle power electric light for the localization of light upon various parts of the body is said to be of value, but I have had no experience with it. Colored lights are being used to some extent, but as yet no startling results have been reported.

I am frequently questioned as to the practical value of medicines in the treatment of mental and nervous disorders. There is, doubtless, no department of medical practice in which the relation of drug to disease is more uncertain. In the sanatorium many adjuvants are constantly employed,and it is impossible to ascribe the recovery of a patient to any particular treatment or medicine. Any remedy in the materia medica may be called for, and I use them in the form that is found to be best suited to the individual. Some patients are extremely sensitive to the action of medicines, others are less sensitive. The individual is the thing. Again, certain forms of disease require more heroic treatment than do others. Depressed states are more difficult to prescribe for than are states of exaltation. Harsh and harmful drugs need never be used by the properly equipped sanatorium physician.

The environment of the patient in the sanatorium should be as harmonious as possible. There must be a studied avoidance of

the hospital atmosphere. Artistic and comfortable furnishings of the room assist in making the private institution homelike.

The personality of the nurse and of the physician is of the utmost importance. Our cases require infinite care, patience, and tact. Many of our patients require complete mental and moral reformation. Their education in thought and action has to be rebegun. Patients are forbidden to talk with other patients of their own symptoms or the ailments of their neighbors. The visits of the physician often partake more of the nature of social than of professional calls. To be able to cheer and encourage a patient frequently does more real good than any medicine or other treatment that can be given. So that if you find the sanatorium physician depressingly cheerful you may ascribe its cause to extensive and protracted experience in that state of mind. The psychic treatment, as this influence upon the patient of physician and nurse may be called, is of the greatest importance. I can not conceive of any successful treatment of mental and nervous disorders without it.

The keynote, then, of successful treatment in a sanatorium is the individualization of the case. To attempt to run the patients all in the same mould is to invite failure here as elsewhere in medicine. Nervous and mental invalids require painstaking and sympathetic care far from the worries and cares of home environment. By cautious leading, combined with appropriate medical, physical, and moral treatment, many patients, a burden alike to themselves and their families, are restored as useful and desirable members of society.

GOOD DOCTORS CHEAPER THAN FUNERALS.-A Chicago medico tells of two physicians in a Wisconsin town, the one elderly, with a long record of cures, the other young, with his record still to make. The older doctor, it appears, was inclined to surrender some of his night work to the younger man. One bitter night in winter the veteran was aroused by two farmers from a hamlet eight miles away, the wife of one of whom was seriously ill. The doctor at once referred them to his young colleague, but they refused the latter's services.

"Very well," replied the doctor, thinking to put a convincing argument before them. "In that case my fee is $10, payable now."

Finally one of the men asked the other:

"Well, what do you think I ought to do?"

"I think you'd better pay him the $10," said the other. "The funeral would cost you more."-Harper's Weekly.

THE THIRD "SEX"?-During the time that a certain Middlesex regiment was quartered in Cawnpore a large order was sent to a shoemaking firm for boots for the men. The manager sent the order to the chief baboo with instructions that it was to be attended to without delay. The baboo took the paper and read it with evident surprise on his face. He re-read the order and appeared more mystified still.

He read it a third, then a fourth, and finally a fifth time. Then he went off to the manager. "Please, sir," he said, "not understand. Male sex I know, female sex I know, but what is Middlesex?"-London Mail.

THE INDICATED REMEDY FOR DISEASES OF THE

RECTUM.

HENRY EDWIN SPALDING, M. D, BOSTON.

(Continued from November number.)

SABINA.

Savin

OBJECTIVE:

(None recorded.)

SUBJECTIVE:

Rectum and anus:

Bleeding from the anus, which smarts on pressure, after a hard painful stool.

Burning in the anus, with pain in the colon.

Pressing pain in the sphincter ani; with feeling as though almost paralyzed.

Hemorrhoidal tumors, painful early in the morning.

Biting sore stitches in the anus, during stool.

Jerking stitches in the anus and in front of the thighs while walking.

Crawling in the anus.

Abdomen:

Heat and weight in the stomach.

Flatulence; borborygmi.

Violent stitches through the stomach to the back.

Bruised pain over the abdomen.

Writhing and pinching about the umbilicus, with feeling as

though he would vomit, but no nausea.

Pressure in the abdomen towards the genitals.

Pain as if the bowels were contracting.

Pain and extreme distension of the abdominal walls.

Pyloric region sensitive to deep pressure, with painful, anxious, grasping feeling.

Shooting, tearing in the stomach, with pinching above the umbilicus.

Back:

Drawing pain in the sacrum; tearing stitch.

Stitch in the sacrum when stooping, leaving a severe feeling as if the parts were torn.

Tearing sharp pains in the lumbar muscles, and lower dorsal vertebrae and ribs.