MEASURES TO BE ADOPTED BY NURSES TO PREVENT THE SPREADING OF CON TAGIOUS DISEASES. BY E. E. LOOMIS, M. D., OF JANESVILLE. Hygiene of the nurse, to prevent the spread of contagious. diseases, is of sufficient importance to adopt the following brief rules as a means of safety to the nurse while in attendance, as well as a preventive measure after leaving the sick room. First. Perfect cleanliness, by frequent bathing, washing the hands in hot water with a liberal use of antiseptic soap each time after care of the patient. Second. Avoid taking the patient's breath as much as possible. Third. Absolute quarantine within the room of the patient and no communication with persons from the outside allowed other than the medical attendants. An adjoining room should be provided when possible, for the exclusive use of the nurse, as a dressing and sleeping room. Fourth. One of the most important safeguards of all is, that the nurse should be provided with a face-guard composed of some light protective material, made antiseptic, to be worn over the mouth and nose when over the patient or administering medicine. Fifth. The hair should be closely coiled on top of the head, and kept constantly covered by a tight fitting cap lined with oil silk. PREVENTION OF INSANITY. BY M. J. WHITE, M. D., OF WAUWATOSA, MEDICAL SUPERINTENDENT MILWAUKEE HOSPITAL FOR INSANE; CLINICAL LECTURER MEDICO-PSYCHOLOGICAL ASSOCIATION; MEMBER NEW YORK The study of the prevention of insanity presents many problems of a most complex nature and most difficult of solution; in fact it would seem an almost hopeless task, considering the various factors involved in the propagation of the disease. The causes, both predisposing and exciting, which are operative in its production will have to be separately considered in order to gain a clear insight into the indications to meet in checking the advance of this dire enemy of the human race. We are accustomed to hear assigned as causes of mental disease: shock, grief, loss of property or friends, fevers, etc.; a sufficient argument against the fallacy of this assertion is the fact that the vast majority of people who, at some period of their existence, have been operated upon by one or more of these causes pass through unscathed. The real solution lies in the fact of the element of heredity entering in as a factor and constituting the prime, predisposing cause. The doctrine of hereditary transmission is, with the laity and with many members of the learned professions also, viewed in the light of skepticism; however, it can be safely asserted, on the strength of statistics obtained, that a vast proportion of cases of mental disease present this element. These statistics are most difficult to obtain, owing to the disinclination of relatives and friends to admit the existence of such a taint in the family for many and obvious reasons. It is a common experience of specialists in this particular branch of the profession to meet with concealment, evasion, and even denial on the part of relatives, in the pursuit of inquiry as to causes operating in an individual case. Usually some cause having the most remote connection will be assigned. To some extent, however, the varying and conflicting opinions entertained as to what constitutes a condition of insanity; the latitude allowed for various eccentricities and the broad range of thought, feeling and action deemed perfectly consistent with a state of sanity, must be taken account of. We have all, in our daily observation, undoubtedly met individuals who, though not judicially declared insane, and possibly not actively dangerous to the community- the average insane person is deemed potentially so at least-were nevertheless, in our opinion, as much if not more demented than many legally adjudged insane persons and inmates of insane hospitals. The family physician who makes a study of the individual member and relatively of the entire family, is in a position to judge intelligently of the peculiarities, the temperament and disposition of the individual case and to attach due and proper significance to the manifestations presented. He is therefore in a position to aid in the work of prevention by furnishing timely advice and warning; directing the education and training of the young; advising the elders as to their methods of discipline, mental and moral, to be employed, and in his professional capacity and with the intimate footing obtained. through long and faithful ministration, his admonitions will assuredly, to a great extent, be of aid in preventing a lapse into fixed habits which are calculated to produce mischief in after life. The alienist meets with the case usually after the mischief is set up, and simply endeavors to combat it and to promote, if possible, a return to healthy lines of thought, feeling and action; so that his part, as a rule, is secondary, save in so far as by concentrated study of causation he can assist the general practitioner by directing attention to the more abstract idea of the same. The prime factor in the causation of mental disease, as stated, is in my opinion an hereditary predisposition, resulting in mental instability, and forming a productive soil for the development of insanity and allied disorders. Scrofula, phthisis and syphilis play a prominent part in the production of mental disease, but I am strongly inclined to doubt the possibility of their occurrence in the absence of a predisposing influence transmitted, it may be, through several generations. It is a biological law that "all beings endowed with life tend to repeat themselves in their descendants." To quote further from Ribot on the subject of heredity, "It depends upon an internal principle of vitality which is so engraven on every portion of the system before birth that its influence remains through life and within certain limits pertains to both the physiological and psychological nature." It is a well established physiological fact that certain diseases, such as scrofula and phthisis, are transmitted from one generation to another, in the form of a diathesis at least, which has been known to result in the final extinction of the family so affected. The tendency to intermarriage between the various nationalities is undoubtedly a saving provision in checking the ravages of these particular diatheses. The same principle holds with reference to the purely psychological only that where scrofula and phthisis have prevailed in the preceding generation, insanity often appears in the succeeding generation. Again, forms of mental disease present a peculiar alternation; in one generation the form presented will be that of mania, while in the offspring the depressed type melancholia will be presented. Time will permit of only a reference to the more important exciting causes; namely alcohol, modern civilization and traumatic influences. It is conceded by all authorities that the former plays a most prominent part in the production, not only of the insane diathesis but acts also as a purely exciting cause, more particularly in cases due to traumatism. The effect of civilization is readily apparent after a retrospect of conditions prevailing among the aborigines as compared with those obtaining in the higher states of modern civilization. The drastic measures employed by savage races in the case of the physically or mentally defective would account in a great degree for the absence of transmitted taint; the philanthropy of modern civilization for the propagation of the defective class of beings. The discharge of insane persons from hospitals or of those partially or even wholly recovered-the latter more liable to a recurrence than one who has never suffered an attack—unquestionably perpetuates the activity of this disease; but sentiment, which is all-powerful, and the impulse of humanity, defeat the object sought, and this defective or damaged class of beings are constantly reproducing their kind. I am not prepared to suggest any remedy at the present time which would meet with any prospect of successful accomplishment; moreover it is an open question whether the constant infusion of new blood will not itself tend to check the ravages of this disease. I think a great deal can be accomplished, however, in improved methods of education of the young. I would recommend every effort being made at individualization in the teaching; not instructing en masse; taking into account individual tastes and proclivities and bending every energy to the development of those which predominate; not forcing a devel |