Vol. 60, 1909 - University of North Carolina at Chapel Hill

ease itself. The deportment of the physician
should inspire confidence, and little
fluctuations uecessarily met with should be
silently watched; but not treated through
fear: for generally by the next visit they
will be different. The constant and frequent
change of medicine does serious
harm.
Complications demand appropriate treatment.
The Value of Employment in Cases of
Dementia Praecox.
By I'aiil V. Aiider.son, M. I)., State Hospital, Mor-
gaiiton, N. C.
In attempting to write on any phase of
dementia praecox, 1 realize fully that the
groutid has been covered in every respect
and my only reason for selecting this subject
is to call attention to the importance of
early emjiloymeut iu these cases and to plead
for a more systematic attemjn at their reeducation
before they are cast aside as hope
less derelicts. At least, give them the ben-
efit of a trial.
We should not be absolutely pessimistic.
Advanced methods of treatment have robbed
many other diseases of their horrors.
Therefore, is it not possible that the baneful
after-effects of dementia praecox may—to a
degree, at least—be mitigated?
It is conceded that many of these cases
retain to a considerable degree the knowledge
and skill formerly acquired. livery
physician can easily call to mind numerous
individuals in his own jiractice who have
suffered physical loss, but who, in spite of
serious handicap and because of enforced
adjustment to a changed bodily condition,
live fairly active and productive lives.
Almost every vocation has in it the semicripple,
those who have lost a leg, an arm,
an eye, the function of an ear, or who have
chronic hepatitis or nephritis or cardiac
or pulmonary disease and yet, some of these
men and women have, l)y sheer force of
circumstances and will i)ower, taught themselves
to disregard the thorn in the flesh, and
have given full proof of their ability to add
to human progress. The proposition that
brain disease and the consetiuent intellectual
disorganization is more serious than
the loss of any limb, I have no wish to deny.
I do wish, however, to emphasize the humaneness
and the hopefulness of the modern
view point which encourages us to look
upon the mentally defective—especially
upon the praecox cases—as those who, because
of cerebral disorders, have entered
again only into an intelleetual infancy, and
•Read before TriState Med. .Society, Charleston,
S. C.
ORIGINIAL COMMUNICATIONS.
that it is possible to educate, literally to
lead out of this mental gloom many of these
cases, I shall hope to establish.
The physician, especially the phy.sician
who works with the insane, should have
always in mind that he has two duties to
perform. The first of these he owes to the
patient, and this highest obligation is to
make the patient comfortable and happy.
The other duty is to society and that duty
is the awakening in the mentally enfeebled
the dormant tendencies to provide for themselves
and thereby lighten the State's everincreasing
burden. The few cases to be
cited will tend to make these propositions
seem the more plausible.
A woman now thirty-two years of age
has been in the Hospital for twelve years.
L'ntil the past three years, she spent most
of her time on the floor, took no interest in
her personal appearance or her surroundings,
kept her head covered with a shawl
almost all the time, and had occasional violent
outbursts of temper. By careful persausion
she was induced to sit in a chair.
Next she was given a broom and was persauded
to help with the sweeping; then she
was encouraged to sew, and as she improved
she became more careful of her appearance.
She was sent to the mattress factory and
there did excellent work. Xovv, she works
in the laundry, is tidy and goes regularly
to the dances and to chapel.
Another case occurred in agirl of eighteen,
whose father, ijrother and uncles have been
])atients in this Hospital. For quite a while
after admission, she had to be dressed
and taken to the dining room. She would
hide under the bed, lay on the floor most of
the time, was silent and sullen and resisted
every effort made in her behalf. She manifested
no pride at all in her dress. By patient
effort she was induced to dress herself,
to sit iu a chair, then to help on the ward,
then to sew and finally she was sent to the
laundry. She soon became cheerful and
very industrious. She gained weight and
took quite a pride in her dress. Later, she
was able to go home and has been doing
nicely there for more than two years. Her
brother, also a praecox case is, now at home
and is doing very well.
.\ woman of twenty-nine had been in the
Hospital one year. For several months
after admission, she was obscene, profane
and filthy in her habits and tore up everything
she could lay her hands on. At times,
she fought viciously. The dementia seemed
to be marked. Yet, she was by degrees
induced to help on the ward and to sew.
As she improved, she dressed more neatly,
ceased fighting and tearing her clothes, and
as in the other cases went to the laundry
and soon became one of the best irouers.
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