regular occupation, such as gardening, poultry-raising, etc., can be followed. The epileptic patient should have the opportunity to choose the line of work on the farm most congenial to him, thus employing his mind and preparing him to be self-supporting in the future.

The exercise thus obtained is conducive to long hours of sleep and good digestion, so essential in these cases.

One of the most common mistakes parents of defectives make is to allow the child to run wild, abandoning all discipline, in the hope that the attack will come less often. They should remember that the victim of epilepsy needs more than most people the self-control and good habits which only wise discipline in early life can establish.

Dietetic Treatment.-Too much stress cannot be laid on the dietetic treatment. That evolved at Craig Colony is probably the best. The schedule is here inserted:

This dietary excludes an overabundance of nitrogenous foods, sweets, fats, and hot breads. The meat preferred is beef, and the only other meats ever given are mutton, fish, and chicken.

Potatoes, beans, peas, onions, turnips, oyster-plant, beets, parsnip, celery, corn, tomatoes, carrots, and spinach are the vegetables used.

Medical Treatment.-Space forbids many words on the medical treatment, but if the cause be found the treatment will suggest itself. If adenoids are the existing cause, operate; if foodpoisoning, correct the diet, etc.

Any of the preparations containing the bromides are harmful, only giving temporary relief, and often doing the brain more permanent injury than the disease itself.

Every departure from a normal anatomical or physiological condition should be corrected, so far as possible, in the hopewhich is often realized that it is in some way a factor in the production of the seizures.

Potential Epilepsy. The subject of potential epilepsy can only be lightly touched upon.

The potentially epileptic child has the epileptic or convulsive tendency, and is only waiting for conditions to arise which will favor the appearance of the disease. If these favorable condi

tions do not arise, the epilepsy never appears. Many a potential epileptic has been saved from his epilepsy, beyond doubt, by the early correction of diet and habits, and the early removal of adenoids and other surgical conditions.

The child who is subject to night terrors, or who has had convulsions as a result of dietetic errors or during dentition, who has had any of the specific diseases of childhood, who has had rickets, severe head injuries or cerebral palsy, or who has a bad parentage may be a potential epileptic, and should be watched and have early training begun, even though an epilepsy may never

appear.

Mental Condition of Epileptics.-Mentally all epileptic children are exceptional, some being unusually bright, others unusually dull.

Among the bright and clever ones it is not uncommon to find that they are allowed to outstrip their playmates, by way of proving that there is nothing the matter with them; but to the trained observer there is something pathetic in the ill-balanced morbidness of their cleverness.

Some of the slow-minded ones are found to be extremely conscientious, and it is well to watch and encourage these.

Since the types vary so greatly, the proper disciplinary treatment must vary also, each child being dealt with according to his individual peculiarities.

Possible Improvement. It has come to be regarded that, no matter what the cause of the epilepsy, if the mental condition remain unimpaired, improvement and often a cure is possible.

Patients having Grand Mal attacks are also more amenable to treatment than those having other types, or those in which the types are mixed.

About 85 per cent of all epilepsies begin before the twentieth year, the essential epileptic periods being the years between the fifth and the eighth, and the twelfth and the seventeenth year.

An epilepsy arising in the first period is the hardest to cure, recent cases being twice as likely to respond to treatment as chronic ones.

About 10 per cent of all epileptics become insane. Repeated attacks tend to weaken the mind and to enfeeble the body. Some forms destroy the mind in two or three years, while others persist through life with little or no effect on the mind.

Epileptics are especially prone to tuberculosis, organic heartdiseases, and many sustain fatal injuries during attacks.

XXI. SEXUAL HYGIENE

By DOCTOR ARTHUR W. WEYSSE, Boston, Mass.

The Rôle of the Sexual Instinct.-What can be done for the exceptional child in the matter of sexual hygiene? The rôle played by the sexual instinct in the normal adolescent is a very varying one. In a few individuals the onset and development of the sexual passion are gradual and uneventful, and, while giying rise to new sensations and emotions, they cause no disturbance of the metabolic equilibrium. Such cases are rare, but they do occur. At the other extreme we find individuals who must be regarded as normal in whom the sexual passion occupies a major place in the personal economy It obtrudes itself upon their thoughts, it affects all their bodily activities as well. Between these two extremes we find all possible gradations. The majority of adolescents, then, are in a state of more or less unstable equilibrium in the metabolic processes-a lack of stability that is not due alone to the rapid growth of the child, for it is not present (to the same degree at least) in the normal child before puberty. The exceptional child is in a more unstable equilibrium physiologically than the normal child; hence the need for special attention to sexual hygiene in his case.

Masturbation. Any one who has made an intensive study of sexual matters knows that the practice of masturbation is extremely common in children of both sexes during the adolescent period, so that some writers have been led to consider that it is normal in civilized society, that it is no more harmful than the same amount of normal sexual intercourse would be; and the percentage of children addicted to the practice has been placed in the nineties. However that may be, the fact remains that most children indulge more frequently than they would indulge in normal intercourse, as we know from studies of uncivilized tribes where no restraint is placed on intercourse. Further, the energy thus expended would much better be used for the other activities of the body, and the weakening of the will-power through the repetition of the act is a matter of no small moment. If these

facts are true for the normal child, they are even more significant for the exceptional child. I believe that in the majority of cases masturbation is not a result of viciousness, but rather of excessive stimulation of the reproductive system through a variety of causes for which the child is not personally responsible.

Causes of Masturbation.-The diet of the child is often at fault. Children at puberty do not require the stimulus of caffein, nor is it desirable, yet many of them get it. Excessive quantities of spices, pickles, and sweets result in abnormal metabolism, and a consequent derangement of more than one function of the body. If the sexual system becomes hypersensitive under these conditions, it is the fault of those who have charge of the child. The genital organs themselves should receive expert attention. In some cases the cause lies in an adherent or in a redundant prepuce, in others in phimosis, in others in an excessive secretion of smegma which the boy does not know that he should remove. There is a great variation in the amount of this secretion in boys; in some it is so great that it should be removed by washing at least once every twenty-four hours. Most boys receive no instruction whatever in this matter. Some boys have an unsuspected congenital stricture of the urethra that may lead to enuresis and involuntary manipulation of the genitals. Some have a stone in the bladder; I remember seeing a vesical calculus removed from a boy of 10 in a London hospital a few years ago.

In girls there are very frequently unsuspected adhesions about the clitoris that lead to masturbation. Such cases have been reported in medical literature within the past years; they are readily relieved by circumcision.1 Vulvovaginitis may cause masturbation in little girls; it is a much commoner disorder than many suspect, and its etiology is often obscure. Sometimes it is due to the gonococcus, but very frequently to other organisms. Careful medical examinations of the genito-urinary apparatus should be the rule in the case of exceptional children, and for

Not always, that is to say, only when there are no other complications of a physiological or psychological character. The author has had a little girl of IO (Case 92) under observation who was badly affected. Adhesions to the clitoris were removed, and vulvovaginal treatment established. There seemed to be no other physical or local cause, but the masturbation was not checked by these measures.—】 .-M. P. E. G.