should be in conformity to natural law. And again, the careless manner in which legislators treat the suggestions and opinions of the medical profession, regarding necessary laws for the protection of the life and health of the State, and especially on the subject under consideration, is first, that the lawmakers have no conscience over the mother; they are as ignorant and as superstitious on the importance of the protection of the nation's motherhood as are their constituents, whom they fear. Secondly, in the United States those who engage in the perplexities of the political life, are, as a rule, persons of very moderate pretensions; so it frequently happens. that when a man discovers his incompetence to successfully conduct his own private affairs he is ready to undertake to direct the fortunes of the State.

The Cause of Insanity.*

BY J. R. NICHOLS, M. D., TERRELL, TEXAS.

The determination of any pathological invasion requires the investigation of its cause, however, this is not always necessary in applying measures for its elimination. It is not within the province of our present methods to receive an accurate ancestral and personal history of every case of insanity; therefore, its cause is frequently unknown. Approximately 75 per cent of the psychoses spring from heredity, either direct or indirect, which clearly indicates that it is the most potent predisposing cause. It is tedious to trace the source of heredity, because of the sensitiveness of those that are in position to give the desired information, due naturally of course to keeping of family secrets; in such instances the cause of insanity is not ascertained. Again it is presumptious to expect all persons to know or remember the ancestral and personal history for three or four generations and tell whether any variety of heredity existed, which establishes an unknown per cent of the predisposing causes.

Medical examiners for life insurance companies appreciate fully the ignorance of our citizenship along this line and know that many of the answers to the interrogatories are merely conjecturing. It is a fact that all of the alleged causes of insanity, as printed in the reports of the hospitals for the insane, are not presumed to be correct and in many instances are undetermined. Their careful exam

*Read before the North Texas District Medical Association, Dallas, Texas, 1906.

ination shows nearly every disease has contributed to the etiology of insanity. It is well to emphasize the point that insanity is by far the most hereditary disease known at this time; and is traced from ancestors to ancestors, frequently skipping a generation, or it may spring from the indirect class, as organic nervous diseases and the neuroses; from alcoholism; from strenuous, gouty and syphilitic diathesis. It thus can be understood that an unstable nervous organism is engendered, which at some stage of life will culminate in psychoses.

There are other predisposing causes, as age, sex, civilization, racial and occupation, however, they will not be considered in detail and will be passed by saying that only a very small per cent enter into its etiology.

The exciting causes or stresses are too numerous to mention and attention will only be directed to those that are the most generally recognized. It is reasonable to suppose that excellent health and an anti-hereditary family history for generations back, will, in a measure, establish immunity to the vicissitudes of life; whereas, unstable nervous organisms can not withstand the stress of this age, especially the spirit of commercialism, which was not so evident a century ago. The moral causes deal with that faculty of the mind. pertaining to feeling; therefore, the most common are domestic trouble, bereavement, disappointed affection, business reverses, shock and fright. These inculcate worry and anxiety, which if not relieved, terminate in mental strain. Such conditions are prone to psychoses in those individuals with an unstable nervous system.

There are many physical causes and the list is too long for all of them to be enumerated. There are certain epochs in the lives of women which are designated critical periods, as adolescence or puberty, pregnancy, lactation, menopause and the decline of life. These are potent exciting causes of mental disease in those that have a predisposition. These periods produce physiological changes in the human economy, thereby causing quite a disturbance of the functions of the nervous system. In man, adolescence and decline of life is the same as in women, however, they are more susceptible to dissipation, intemperance and traumatisms.

The absorptions of the various toxines has been demonstrated beyond doubt, as from alcoholism, morphine, cocaine and chloral. One of the most important is the impairment of nutrition from gastro-intestinal autointoxication, as result of disease of this tract and accessory organs; also infections from disease and syphilis. The exhaustive states as caused from protracted illness of any kind enter into the causation of insanity. They produce a neurasthenoid

state and act by destroying the equilibrium of metabolism. Insolation or sunstroke are also etiological factors, especially during the heated term. The extreme high temperature with diminished regulation of the animal heat, produces an active congestion of the brain. Other physical causes are sexual excesses, influenza, surgical operations, physical shock and traumatisms, especially those pertaining to the cranium. Gynecological diseases are not pronounced factors in the causation of insanity, although sometimes the removal of the ovaries, tubes or uterus is performed for relief when nothing but a neurosis exists; however, such radical measures are indicated in those cases of positive pathological origin and when such invasions are terminating in exhaustive states.

There are other exciting causes of insanity but the list is too long to enumerate each and expatiate why they are so recognized. All statistics show a much lower per cent of heredity than reality, because it is not possible for investigators to procure the family and personal history of each case. The doctor is frequently asked what is the cause of insanity and if a positive answer can not be given, then it is necessary to detail in a general way the predisposing and exciting causes, stating that probably a weak nervous system was inherited which would not withstand the stress of life. It is well to remember that insanity may be produced by several causes, which if acting singly, no material impression would be made.

In conclusion it can be practically said that heredity and stress are the two great factors that originate insanity. It is a source of much gratification to the medical profession to note the interest that the thoughtful citizenship of this nation is taking in shaping sentiment for the better protection of the masses from epidemics and hereditary diseases. All observers agree that insanity is on the increase and that the leading predisposing cause is that of heredity. The remedy is education of the people by advocating reforms, which, if enacted into statutes, will prevent to a great degree the transmission of the different diathesis, if enforced to its fullest extent. Such enactments would lessen the annual fixed and increased charges on the public purse, besides the good to be derived from the improvement of the body and mind of succeeding generations.

NELL "She has an automobile tongue."

Belle "What do you mean?"

Nell "Oh, she's always running other people down."

The After Treatment of Abdominal Operation. *

BY J. T. WATSON, M. D., DALLAS, TEXAS.

It is not the intention of the writer to attempt to teach the medical profession something new or strange, but to try to say something to bring out a discussion on the after treatment of abdominal operations, for we have had at various times free discussion upon the technique and proper time to operate, etc., but very little has been said upon the after treatment, for no small part of the success of all abdominal operations depend upon the after treatment, so we begin at the operation table.

As soon as the patient is returned to bed, she is placed flat on her back with little or no pillow for a few hours until the effect of the anesthetic has passed away. Then a small pillow is allowed at first, increasing the pillow several hours afterward, or as the condition of patient as regards circulation and respiration; then external heat is applied about the patient to bring about a reaction as quickly as possible. Thirst is most always distressing for the first twenty-four hours. It can be relieved by allowing the patient to flush out the mouth frequently with soda water. Nothing is given the patient to drink until the feeling of sickness due to the anesthetic is passed, but after that a few sips of water are given at first. If this is retained and there is no nausea the quantity may be increased; forty-eight hours free from vomiting or nausea, a couple of pints of fluid may be given during the day. I don't think the patient should be stinted in the matter of fluid as was once the universal practice. Milk, tea or soup should be given first and that as hot as can be borne. The giving of solid food should be withheld from five to eight days according to the condition of the patient and the nature of operation. If the fluids are withheld as was formerly the custom the amount of urine excreted is often very small. The excretion of urine is always diminished after any abdominal operation, but more than a pint should be passed in the first twenty-four hours. I don't like the catheter idea as a rule, but if there is difficulty in voiding urine a hot fomentation will be helpful. If no urine is passed at the end of twenty-four hours and the patient is uncomfortable, the catheter is then resorted to, with all the usual precautions as to cleanliness. Rectal injections of hot saline solution should be given at stated intervals for twenty-four to

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*Read before the North Texas District Medical Association, Denison, Texas, June,

forty-eight hours, or until the patient is getting a fair quantity of fluids by the mouth: Of salt one teaspoonful to a pint of sterile water and ten to fifteen ounces every four hours seems to meet the requirements.

If flatus can not be passed freely a little turpentine may be added to this, or the rectal tube may be passed with decided benefit for the passage of flatus.

If the stomach becomes distended with gas it may prove a very troublesome factor and should be relieved as speedily as possible. The administration of a large dose of asafoedita or a few drops of turpentine or chloroform sometimes act very nicely, but in some cases all medication fails to relieve this distressing condition, then the stomach tube should be resorted to. The abdominal bandage is generally applied very firmly on the operating table for two reasons, the blood pressure is somewhat raised thereby and it also gives good support to the abdomen should there be vomiting. If the pain is very severe after an operation accompanied by shock a hypo. of morphine ( gr.) and Atp. (1/100) should be given and repeated if necessary. I think morphine should be avoided if possible, and in some cases it can be avoided, but if given when necessary, and that with the immediate sanction of the surgeon himself, is of great benefit. It is a most valuable drug, but rarely needed. Usually when the first twenty-four hours have passed the need for a sedative is over in most cases. During the whole time that the patient remains under treatment after an operation the most careful attention should be given to the toilet of the mouth. The teeth should be brushed frequently with some fragrant mouthwash. If the mouth is kept clean the thirst is less noticeable.

When drainage is employed the gauze or drain tube will need daily attention for cleaning and replacing. If granulations are slow and feeble silver nitrate, 40 gr. to the ounce, painted over the margin of the incision, will aid granulations very much. Equal parts of castor oil and balsam Peru applied on gauze back is also very valuable for sluggish granulations and makes a very nice and comfortable dressing.

If there is elevation of temperature at any stage, and we have reason to suspect sepsis, the bandage should be removed and an inspection made, and if stitch abscess exists the statch should be removed at once to allow drainage. If there be no stitch abscess and yet have an elevation of temperature then we should try to get the alimentary tract to work at once; for this magnes. sulph. in small and repeated doses and calomel in one grain doses dry on the tongue one hour apart if the stomach will tolerate it. If the