should know where the patient is at all times, foregoing sleep if necessary to protect his charge, and should avoid as long as prudence permits the publicity of an arrest; though the latter may finally be essential to safety, and to the prevention of embarking on a voyage, or taking a train to a distance, or purchasing weapons.

Diversions. Music favorably affects many patients, so the pleasure of listening to it should be afforded at frequent intervals. Patients should be encouraged to absorb themselves in it. It is often possible to take insane people to opera, musical comedy, or concert. Vocal and instrumental practice at suitable intervals is of great value in fixing the attention, filling the mind with desirable thoughts and memories, and allaying irritability. Drawing and painting are of service when within the number of the patient's accomplishments. Intellectual pastimes, as authors, anagrams, billiards, chess, and many games with playing cards, are generally helpful. Gardening, croquet, and tennis are very desirable. Golf, rowing, swimming, and skating are excellent, but are within the reach of very few insane patients. All regular occupation that necessitates attention and concentration is of supreme value; in fact, insane patients not infrequently ask for occupation and find relief in the accomplishment of something useful, as well as in the healthful sleep and increased appetite that attend judicious physical fatigue.

The Beneficial Atmosphere of Sanitariums

After caring for an insane patient for a time at home, the question arises as to the desirability of sending him away to a sanitarium. Generally this is a wise course to pursue. The constant association with an insane person is undermining; the responsibility is often too heavy; children, often inheriting the same neurotic tendency and always impressionable, should not be exposed to the perverting influence; it may not be safe to keep a patient with suicidal or homicidal. impulses in his home; the surroundings amid which the insane ideas first started may tend to continue a suggestion of these ideas. Removal to strange locality and new scenes, the influence of strangers, the abandonment of all responsibilities and duties, and the atmosphere of obedience, routine, and discipline are all beneficial. An insane person will generally make a greater effort for a stranger than for a familiar relative. Discipline, in the form of orders of the physicians, and exact obedience is very often very salutary. There is a feeling with some that all discipline is cruel. This is not so, for the conduct of an insane person is not all insane, but frequently needs correction. Many cases of mental alienation improve promptly under custodial care, many need it all their lives. A great many cases of insanity are never obliged to go away from home, and there is a considerable number who carry on a business while still insane, rear a family, and take care of

themselves. In general, a depressed patient should be kept at home as long as there is absolute safety in so doing. Most other forms of mental disease progress more rapidly toward recovery in sanitariums or hospitals equipped for such patients. Prospects of recovery are never jeopardized by confinement in a proper institution. Mental and physical rest, quiet, regularity of eating, exercising, and sleeping are the essentials which underlie all successful treatment of these cases. Dietetics, diversion by means of games, music, etc., regular occupation of any practicable sort, together with the association with the hopeful, tactful, and reasoning minds of physicians and nurses trained for this purpose are of great value. It must be remembered that in wholly civilized localities madhouses have been replaced by hospitals, keepers have been replaced by nurses and attendants, and the old methods of punishment and coercion have been long since abandoned, in the light of modern compassionate custody.

Certain forms of insanity are hopeless from the start. Few recover after two years of mental aberration. Omitting the hopeless cases, over forty per cent of the cases of insanity recover. About sixty per cent recover of the cases classed as melancholia and mania. Most recoveries occur during the first year of the disease; but depressed patients may emerge and recover after several years' treatment.

APPENDIX

Patent Medicines 1

THE term "patent medicine" is loosely used to designate all remedies of a secret, non-secret, or proprietary character, which are widely advertised to the public. This use of the name is erroneous, and it is better first to understand the exact difference between the different classes of medicines generally comprised under this heading. Only in this way can one comprehend their right and wrong use.

A Patent Medicine is a remedy which is patented. In order to secure this patent, an exact statement of the ingredients and the mode of manufacture must be filed with the government. These true "patent medicines " are generally artificial products of chemical manufacture, such as phenacetin. The very fact of their being patented makes them non-secret, and if an intelligent idea is held of their nature and mode of action, they may be properly used. Physicians with a full knowledge of their uses, limitations, and dangers often, and legitimately, prescribe them, and thus used they are

'The publishers announce this chapter as prepared independent of Dr. Winslow or any of the Advising Editors. Considered as an effort to give helpful information, free of advertising on the one hand and sensational exposures on the other, the article meets with the approval of conservative physicians. But the problems dealt with are too involved at present for discussion direct from the profession to the public.

the safest and most useful of all drugs and compounds of this class.

A Nostrum.-The Century Dictionary defines a nostrum as "a medicine the ingredients of which, and the methods of compounding them, are kept secret for the purpose of restricting the profits of sale to the inventor or proprietor." Some nostrums have stated, on their label, the names of their ingredients, but not the amount. There has been no restriction upon their manufacture or sale in this country, therefore the user has only the manufacturer's statement as to the nature of the medicine and its uses, and these statements, in many instances, have been proved utterly false and unreliable.

A Proprietary Medicine is a non-secret compound which is marketed under the maker's name. This is usually done because the manufacturer ciaims some particular merit in his product and its mode of preparation, and as these drugs are perfectly ethical and largely used by physicians, it is to the maker's interest to maintain his reputation for the purity and accuracy of the drug. Familiar instances of this class are: Squibb's Ether and Chloroform, and Powers & Weightman's Quinine.

From the above definition it may be seen that the only unreliable medicines are those which are, in reality, nostrums. In regard to all of these medicines the following rules should be observed:

First.-Don't use any remedy that does not show its formula on the label.