always with the dull cornea and expressionless countenance, would lead to the diagnosis of the cause.'

PROGNOSIS.-"This condition does not continue many days. The cause being discontinued, the stupor becomes less intense, the inclination for repose more marked, and the sleep more natural and refreshing; the sensations of hunger and thirst are once more experienced; the secretions are more active; the cleanliness of habit is attended to; the dress is looked after; the obstinacy decreases, and gradually an inclination and the ability to converse return, and at last, though slowly, the health of mind and body is restored. Such, in favorable cases, is the result, but it too often happens that convalescence is arrested, and that the condition of ordinary or chronic dementia becomes established, and with it the prospect of recovery diminishes."

RELAPSES." Remonstrate with these victims after they are received into an asylum, whilst reason is still not quite destroyed, and they will agree with your remarks. They will express their thankfulness that they have yet been spared some portions of reason; they will express their deep abhorrence of their conduct; they will shed the tears of apparent penitence; and yet the old habit will be relapsed into; and when they think that they are removed beyond control, will once again indulge in their self-destroying practice. The determination to conduct themselves in the pure course is wanting, and in this there is evidence of the pernicious energy-sapping cause.

"Few accidents are more capable of occasioning annoyance and disappointment to the physician, and none more calculated to excite his pity and regret, than to find the recovery he regarded as certain marred and prevented, or delayed, by the preventible act of the patient himself. This cause of relapse is but little believed in, except by those who are intimately acquainted with the habits of the insane; but regarding it as possible, many an unexpected and unaccountable relapse can be readily explained. When any tendency to indulgence has been observed in the early stages of mania, the prognosis ought to be stated in well-weighed words. The fact of a patient, neither epileptic nor the subject of paralysis (although in young men the former is more probable), who, when put to bed was progressing favorably, being in a lost or much confused state when he got up on the succeeding morning, would be significant of some cause acting during the night. In the absence of excitement or a fit, the probability of this cause ought not to be forgotten." TERMINATION OF CASES.-"In the acute or recent dementia, the condition of the patient is most pitiable. His existence is, for a time, merely vegetative, and in well-marked cases the obstinacy of disposition is almost the only indication of a mental action, and the mental origin of this may even be doubted. The sufferer becomes quite silent, and is lost and unable to take care of himself. He becomes statuesque,

and extremely obstinate. He resists passively, and occasionally actively. If he be in bed, he will not rise to be washed or dressed. If up, he will not retire at proper time to bed, or allow himself to be undressed. Everything requires to be done for him. Cleanliess is neglected, and his dress unattended to. He makes no effort to speak, and when addressed, although conscious, does not appear to comprehend what is said. He will not feed himself.

"How earnestly do those who know what the future will bring to such a one repeat these feeling words of Ellis-Would that I could take its melancholy victims with me in my daily rounds (at Hanwell Asylum), and could point out to them the awful consequences which they do but little suspect to be the result of its indulgence. I could show them those gifted by nature with high talents, and fitted to be an ornament and a benefit to society, sunk into such a state of physical and moral degradation as wrings the heart to witness, and still preserving, with the last remnant of a mind gradually sinking into fatuity, the consciousness that their hopeless wretchedness is the just reward of their own misconduct.""

TENDENCY TO COMMIT SUICIDE.-On this point Dr. Ritchie says: "As regards suicide, the greater frequency of this occurs in those whose cases assume a melancholic character with the excitement.

"Although it will be found that various supposed causes may be alleged, still I believe that in the greater proportion of such cases the immediate exciting cause is the feeling of disgust at, combined with alarm for, the consequences of, the patient's criminal conduct. Hence it is that feelings of their own unworthiness arise in such patients, and, under the impression that they have committed the unpardonable sinhave sinned against the Holy Ghost-and that a future world presents no hope of joy or happiness for them, as they are excluded from it by their past conduct, they frequently make attempts to terminate their own existence. Such an act is occasionally incited by hallucination of the aural organ; but I have not found that suicide is so frequently to be traced to this, as in other cases of mental aberration depending on other causes."

SELF-MUTILATION.-" Another peculiarity of these cases is the tendency frequently exhibited to self-mutilation, and, as reports show, the attempts are not unfrequently successful. Thus is indicated an unsound reasoning power, the visiting on the supposed offending organs the faults of the ill-regulated mind.”1

1 During the time this portion of the book was passing through the press, I was called upon to sign a certificate, for a gentlemen of high standing in his profession, who was himself willing to enter an asylum. His case was a very sad one, and exemplifies the ideas a patient, in this state, forms of his own ailments. His history which, however, I gleaned from him with some difficulty, was as follows:-Early in life, he contracted the habit of masturbation, nevertheless he married, and lived

As already stated, the delusions in many instances assume a religious character, and hence it is that it is repeatedly found that the cause of the sufferer's condition is supposed to be religion. The delusions of this class generally are of the melancholic character stated above: fears that eternal happiness is lost-that they have no hope beyond the grave-that they have committed an unpardonable sin-or that they are unworthy to live.

From the true cause of the mental condition of these cases not being understood, the meaning of these reproaches for past conduct cannot be comprehended; and it is easily explained why a young man of appa rently blameless life making these self-accusations is regarded by his friends as suffering from acute religious feelings, whereas remorse or fear has generally more to do with his condition than true religious impression or conviction.

It is probable that many of those young men whose insanity has become developed through such revival meetings as have of late been held in various districts of Great Britain and Ireland, would, on searching inquiry, be found to be cases of the class now occupying our attention.

In some patients, actions of peculiar character are the result of the idea that, by so acting, an atonement is made for the sin committed. The attempt to injure the genitals, to pass blood, and other similar acts, proceed from this; whilst in other instances the object of these actions may be to convince those around and themselves that they still have some power left. In these, the various acts of violence or destructiveness are the result of their endeavours to test their powers and to convince those around.

For a description of the treatment proper for these deplorable cases, I must refer my readers to Dr. Ritchie's pamphlet. He is not sanguine as to the probability of recovery. He has apparently seen these cases at a later stage than I have had the opportunity of doing, and in these advanced forms remedies are not of much avail. The treatment which seems to me most appropriate will be found fully described under the head of Spermatorrhoea (post).

tolerably happily with his wife; and his marital duties were performed, he assured me, in a satisfactory manner. He became, however, depressed, his conscience told him that he had done wrong in abusing himself early in life, and he determined as a punishment, that he would cut away the testes. This he effected, the parts healed, and the patient entered into an asylum, which he subsequently left. At the period I saw him, he was in what, I suppose, I may call a lucid interval. He still regretted most bitterly his early sins, and was satisfied that he had not been justified in mutilating himself. He was conscious that he had not control over himself, and felt that he ought to be watched, lest he should further injure himself (I was told he had attempted his life).-W. A.

PERIOD III.

THE FUNCTIONS AND DISORDERS OF THE REPRODUCTIVE ORGANS IN THE ADULT.

THE following pages will, for the purpose of greater clearness and conciseness, be divided into two parts. In the first I propose to describe the adult sexual condition as a whole, and, in the second, to examine rather more minutely the constituent parts and necessary requisites of the sexual act, viz., erection, ejaculation, and emitted semen. In each of these divisions I shall follow, as far as possible, the course I have hitherto adopted, directing attention first to the healthy discharge of the several functions, and then to the various complications and disordered conditions which prevent or interfere with that healthy discharge.

FIRST DIVISION.

ADULT SEXUAL CONDITION AS A WHOLE.

The

The commencement of adult life is a period in human existence less marked, perhaps, but not less real, and hardly less critical, than that of puberty. The general growth of the body is complete. The soft bones of childhood are hardened into the firm and elastic frame of man. mental powers should be at their highest. The will and judgment should command, and yet be enlivened by the remains of youthful energy and enthusiasm. And, which is more to our present purpose, the virile powers, whose existence commenced at puberty, now at last matured, should be fit and ready to be exercised in obedience to the Creator's command to be fruitful and multiply.

At a certain period in every man's life-occurring generally somewhere between twenty-five and thirty-he his conscious, if he have lived on the whole a chaste life, of a great change in those sexual tendencies of which he has been frequently conscious before. They are no longer the fitful fancies of a boy, but are capable, he feels, of ripening at once into the steady rational passion, or rather purpose, of the full

grown man. The natural longing is there still, but it is no longer towards mere sensual indulgence only (it will be remembered that I am speaking of the continent man) but is deeply tinctured with the craving for wife-and home-and children.

Still, it is not to be denied, that however purified and fortified by these additional elements, the sex-passion in a healthy continent adult is very powerful; very different from the sickly cravings of the voluptuary, or the mad half-poetical desires of a boy,—but requiring his utmost efforts to control, and his best wisdom to guide, when he is able at last lawfully to indulge it.

My object, at present, will be to discuss these sexual desires in the adult with a view to furnish, if I can, some hints and suggestions which may be not without their use, in enabling him to judge wisely, and decide rightly in some of the most important conjunctures of his life.

PART I.

NORMAL FUNCTIONS.

First let us recall the real physical character of the sexual desires. "They are," says Carpenter, "in man, prompted by instinct, which he shares with the lower animals. This instinct, like the other propensities is excited by sensations, and these may either originate in the sexual organs themselves, or may be excited through the organs of special sense. Thus, in man it is most powerfully aroused by impressions conveyed through the sight or touch; but in many other animals, the auditory and olfactory organs communicate impressions which have an equal power; and it is not improbable that in certain morbidly excited states of feeling, the same may be the case in ourselves. Localized sensations have also a powerful effect in exciting sexual desires, as must have been within the experience of almost every one; the fact is most remarkable, however, in cases of satyriasis, which disease is generally found to be connected with some obvious cause of irritation of the general system, such as pruritus, active congestion, &c. The seat of this sexual sensation is no longer supposed to be in the cerebellum' generally, but probably in its central portion, or some part of the medulla oblongata."

1 M. Flourens removed the cerebellum from cocks, yet they exhibited sexual desire -but were incapable of gratifying it. Among animals, there is no proportion to be observed between the size of the cerebellum and the development of the sexual passion. In geldings, the proportionate weight of the cerebellum compared with the cerebrum, is as 1 : 5·97, and only as 1 : 7·07 in stallions. (Kirke's 'Physiology,' and see chapter on "Satyriasis," post.)