Close attention to the sense-organs is imperative. Even a layman will readily observe distinct symptoms of disease (redness, swelling, suppura tion) manifesting themselves in the eyes. To overlook the appearance of a milk-like pus in the eyes of the new-born would be the grossest form of carelessness. The discharge of pus or blood from the cars, as Nvell as suppuration of the eyes, requires immediate medical aid. Sight and hearing may be examined by a layman to the best of his ability. If he entertain even the slightest suspicion of disturbances, a physician should be summoned. Discharges from the nose, especially if malodorous, require medical aid. It should be borne in mind that diphtheria of the nose some times occurs without involvement of the throat.
The appearance of dropsical swellings, especially in children who have just recovered from scarlatina, often escapes the attention of parents. If finger-pressure upon the hack of the foot or upon the region of the ankle causes a distinct indention to remain, it is a sign of a dropsical swelling of the skin. Such a condition may be caused by heart-diseases, kidney disorders, etc.
OBSESSIONS.—Ideas which cannot be extruded from the mind, and which impel the subject to continue to think certain thoughts, or compel certain morbid or fantastic actions. The trend of the thought, or the character of the action, is often important in designating such thoughts or actions as obsessions. The education of the individual is a certain factor as well. In ignorant and superstitious people, such thought-compelling actions may not be obsessional which in the educated could rationally be so considered. Thus, " Friday " superstitions, and the host of ideas clustered about the supposed unluckiness of the number " thirteen," cannot be called obsessions in those who know no better ; but when persons of enlightenment are impelled to do or not to do certain things because of the relations to Friday or to the number " thirteen," such impulses are termed obsessions. In general, however, the term has come to assume a more definite form as indicating a mental twist, or idiosyncrasy, if not an actual evidence of insanity. As in all phenomena of life extreme variability is the rule, no dividing lines can be laid down by which the presence of obsessional ideas alone may he considered as evidence of pure eccentricity, or may be regarded as indication of mental impairment.
Some of the more characteristic obsessions are seen in those who cannot pass certain places without committing some slight act, in those who must wash their hands immediately on coming in contact with any foreign body, and in those who are unable to bear anything about sickness for fear of becoming sick themselves, or who cannot Iciok at the contents of a medical book without conjuring up all the maladies with which they might possibly be affected ; these are all types of imperative or obsessional ideas. A great many such thoughts concern themselves with sexual ideas, and many patients afflicted Nvith so-called " lost manhood " arc in reality suffering from a form of mental disturbance, or obsession, from which they are unable to free themselves, largely through misinformation and lack of clear understanding of physiological problems. A type of obsession in which
ideas of suicide are present is very frequent, and is often of grave import. As already indicated, hard and fast lines cannot be drawn whereby a strict classification of all these obsessional states may be made. They are of frequent occurrence in the frank insanities, such as dementia praecox, general paresis, and in epileptic and hysterical insanities. In hysteria they form a characteristic background to the disease itself ; and they are to he found in a number of other conditions shading into almost complete mental equilibrium and emotional stability.
Of recent years it has come to he felt that obsessions often represent almost the only symptoms of an extremely mild grade of mental affection, allied to the manic-depressive states, as some of the most characteristic obsessions are met with in manic-depressive insanity. French authors group them largely about the disease-forms of hysteria, neurasthenia, and psychasthenia. From this discussion it may he seen that those uncon trollable and recurring impulses to carry out certain definite actions are symptoms of a great many differing conditions ; and when a]1 of an individual's characteristics are taken into consideration, they may be manifestations of simple idiosyncrasy or of a definite mental disease. For the latter the lay mind can do little ; but by early recognition of the development of obsessional states in the young, parents can do much towards saving their child from a life of invalidism. It is extremely rare that such morbid ideas can be thrashed out of a boy or starved out of a girl. Too much attention to the morbid thought may be as deleterious as overlooking it entirely. Mental processes have a tendency to recur, and a thought once uttered, or even thought, is more easily repeated.
Constant repetition is one of the essential features in the development of obsessions, and efforts at repression are not usually effective in hindering the recurrence of an unwelcome idea, as everyone knows who has tried to avoid uncomfortable thoughts that kept him awake. Dwelling on morbid introspections makes it a habit ; and obsessions may be interpreted largely as complex habit associations. They can usually he broken up by the sufferers if they seek enlightenment, and will follow the simple rule of distraction. It may be difficult to explain how ; but one skilled in breaking up such thought-habits can usually give valuable advice. It is idle for a regular physician to pooh-pooh these problems. His patients seek further, and are often helped, if not cured, by irregular practitioners, hypnotists, and fakirs of various kinds. This is largely because the physician of the present day is so busy with more material forms of illness that he does not believe he can afford time to investigate the petty affections of the mind ; and, furthermore, because tact, imagination, rare intelligence, and sympathy are more valuable than a ready inateria medica or a facile scalpel. See also the article on INsANcrv.