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  INSANITY:
  ITS CAUSES AND PREVENTION


  BY HENRY PUTNAM STEARNS, M.D.
  SUPERINTENDENT OF THE RETREAT FOR THE INSANE, HARTFORD, CONN.;
  LECTURER ON INSANITY IN THE MEDICAL DEPARTMENT OF YALE COLLEGE,
  ETC., ETC.


  "It is the mynde that makes good or ill,
  That maketh wretch or happie, rich or poore."
                    SPENSER--_Faerie Queene_, Book XI, Canto IX.


  NEW YORK
  G. P. PUTNAM'S SONS
  27 & 29 WEST 23D STREET
  1883




  COPYRIGHT BY
  G. P. PUTNAM'S SONS
  1883


  _Press of
  G. P. Putnam's Sons
  New York_




  TO JOHN SIBBALD, M.D., F.R.S.E.,
  COMMISSIONER IN LUNACY FOR SCOTLAND, IN PLEASANT
  REMEMBRANCE OF A PORTION OF OUR STUDENT-LIFE
  PASSED TOGETHER, THIS BOOK IS INSCRIBED
  WITH SINCERE REGARD BY HIS FRIEND,
  THE AUTHOR.




PREFACE.


It is something more than two years since I read a paper, entitled "The
Insane Diathesis," at a meeting of the Connecticut Medical Society. The
numerous requests received for copies of that article have led me to think
that something more in detail in relation to the prevention of insanity
might be desired by the reading public both lay and professional. Hence
this little book. It has not been written for specialists exclusively,
though it is hoped it will not prove wholly uninteresting to them, but
rather for those in the general practice of medicine, educators, and the
more intelligent lay members of society.

It has been written during odd snatches of time and with many
interruptions, so that there exists less uniformity of style than there
would otherwise be. Moreover, some of the subjects presented have been
discussed by me in papers which have already been published. These papers,
however, so far as they have been introduced into this work, have been
rewritten, and, it is thought, improved.

H. P. S.

HARTFORD, _Dec., 1882_.




CONTENTS.


  CHAPTER I.

  PRELIMINARY.

                                                                     PAGE.

  Increase of interest in the subject of insanity, resulting
  from, first, more intelligent views concerning its nature; and,
  second, the obligation to make provision for the care of the
  insane in a larger measure than for other unfortunate classes--
  Results in the way of hospitals--Asylum attendants--Change in
  the modes of management, and care of the insane                        3


  CHAPTER II.

  INCREASE OF INSANITY.

  Indications which point to the probability of its increase in a
  greater ratio than that of the population: (1) in relation to
  the general conditions of society; (2) in occupations; (3) in
  the character or tendency of disease--Increased demand for
  hospitals for the insane not a conclusive evidence of increase
  of insanity; other reasons exist for this--Improvements in
  hospitals--The chronic as well as the acute insane now provided
  for more generally than formerly--Accumulations in asylums--
  Statistics--Those of England and Scotland--Their character and
  import as presented in the yearly reports of the Boards of
  Lunacy Commissioners                                                  11


  CHAPTER III.

  INSANITY AND CIVILIZATION.

  Prevalence of disease among savage nations--Conditions of life
  not such as to produce insanity--Definitions of civilization--
  Several conditions attending civilization combine to increase
  diseases of the brain--Increase of brain activity--
  Over-stimulation of the brain in schools and by the use of
  alcoholic beverages--A community of interests exists in savage
  life which is lost in civilized life--In the latter the strong
  thrive at the expense of the weak--Monopolies in land and other
  forms of property--Inference to be drawn from the tendency of
  insanity to increase--The primary condition of insanity one of
  the brain--Investigations should relate to the nature and
  causes of this condition                                              33


  CHAPTER IV.

  THE INSANE DIATHESIS.

  The _ideal_ human system--The _actual_ human system--Physical
  and mental differences among persons in health--Periods during
  which there exist considerable changes in the character of
  mental action in the case of many persons while in a state of
  health--Excitement and depression of mental activity--This
  tendency to unstable activity of the nervous system may be
  inherited or acquired--Illustrations from the effects of
  over-exertion, "writer's cramp," chorea--A similar condition of
  that portion of the brain which is concerned in mental
  operations may exist--Illustrations--The effects of sudden
  mental shocks and long-continued mental application--
  Recapitulation--The condition which we term the Insane
  Diathesis is the prime factor in the causation of insanity            53


  CHAPTER V.

  THE INFLUENCE OF EDUCATION.

  The higher conception of education--The ordinary course pursued
  in schools--Too many subjects studied at one time, and too
  large a number of scholars under the supervision of one
  teacher--Little opportunity to study individual characters and
  tendencies--Numerous subjects of study tend to confuse the mind
  rather than invigorate it--Illustrative cases--Teachers only in
  part to blame--Courses pursued in colleges--The importance of
  avoiding over-stimulation of any portion of the system in the
  period of youth--Ball clubs; rowing clubs--A similar tendency
  to over-stimulation of the brain in study prevalent in
  England--Over-exertion in the use of the brain tends strongly
  to create weakness and instability of action, and a condition
  which may be transmitted to children                                  73


  CHAPTER VI.

  INDUSTRIAL EDUCATION.

  Occupations of persons admitted to State asylums--Percentage of
  those having no education in industry, or regular occupation--
  Importance of industrial education to the brain--Difficulty of
  obtaining it greater than formerly--Education of the brain has
  taken the place of industrial education, and with unfavorable
  results--The education of the schools does not qualify the mass
  of people to earn a living: it tends rather to unfit them for
  industrial labor--The interests of society require that the
  largest number be educated to be self-supporting--To secure
  this it is necessary to begin early in life--The same principles
  apply to education for domestic labor                                 95


  CHAPTER VII.

  MORAL EDUCATION.

  Examples of deficient moral education--It more especially
  pertains to the influence of home and relates to obedience--
  Respect and obedience toward persons in authority essential to
  any efficient system--This must be learned in early life if at
  all--Self-control essential to the growth of mental strength
  and discipline--The tendencies in the modes of home and school
  education                                                            115


  CHAPTER VIII.

  HEREDITY.

  Its importance as a factor in causing physical and mental
  characteristics in families and nations--Illustrations--
  Tendencies to morbid action, both mental and physical, may also
  be transmitted--Insanity--Dipsomania--How may unfavorable
  tendencies be avoided?--The influence of heredity acts toward
  elimination of unfavorable tendencies when existing on one side
  of the family--Importance of understanding this in relation to
  marriage--Education may do much toward aiding in the removal of
  unfavorable tendencies--Weak-minded children--Those born with
  peculiarities of physical and mental constitutions                   125


  CHAPTER IX.

  CONSANGUINEOUS MARRIAGES.

  Different views in relation to the influence of consanguinity--
  The customs of the ancient Egyptians, Syrians, and others--
  Experiments in the inter-breeding of cattle--Popular
  impressions as to its effects--Opposite views explained by
  understanding the laws of heredity--Favorable as well as
  unfavorable tendencies are increased--Hence unfavorable ones
  may be eliminated                                                    145


  CHAPTER X.

  ALCOHOL.

  General considerations concerning its effects upon the nervous
  system--Its use at the present time as compared with that of
  the past--Society now reaping the effects of its use in the
  past--Physiological effects of alcohol upon the system--
  Experiments of Dr. Parkes and Count Wollowicz--Its effect upon
  the action of the heart--Its effect upon the circulation of the
  brain, the blood-vessels, and cells, resulting in a less
  sensitive condition of these parts, and ultimately in organic
  changes--Its effect upon the character of mind; upon the
  electrical currents of the brain; upon other portions of the
  body; upon the brains of children and young persons--The
  alcoholic diathesis likely to be transmitted                         153


  CHAPTER XI.

  TOBACCO.

  Opposite views as to its general effects upon individuals--The
  physiological effects upon the mucous membranes, the heart, and
  the nervous system--Nicotin--Its elimination from the system by
  the lungs, skin, and kidneys--Its effects those of a narcotic
  and not of a stimulant--Its effects upon the brains of children
  and young persons--The use of tobacco by children should be
  forbidden by law--Its general effects upon society, socially
  and politically, as presented by M. Fiévée--It is not directly
  responsible in any large degree for producing insanity--Creates
  a diathesis which causes a diminution of intellectual and moral
  power                                                                173


  CHAPTER XII.

  SEX IN RELATION TO INSANITY.

  Relative frequency of the occurrence of insanity in the sexes--
  The sexual system in the female exerts a larger influence upon
  the nervous system in certain ways than that of the male--
  Sexual derangements dependent upon the debility of the nervous
  system--They are generally _consequents_ and not causes of
  nervous debility--Functional derangements of sexual organs rare
  among the insane--A tendency to recovery in case they do
  exist--Other conditions not favorable to mental health               187


  CHAPTER XIII.

  POVERTY.

  Physical labor one of the largest promoters of health--Sudden
  increase of wealth often results most unfavorably--Too constant
  application to labor and household cares--A case illustrative--
  In the contests of life the weaker go to the wall--They are
  often surrounded by most unfavorable sanitary surroundings,
  impure air, poor tenements--They become the psychological
  windfalls of society--Have been and will continue to be
  dependent when stricken down by disease                              199


  CHAPTER XIV.

  RELIGION.

  Influence of religious belief upon man--Not a cause of
  insanity--Religious belief natural to man--It is found in all
  nations--Man instinctively looks up to a Superior Power in
  hours of suffering and need--He needs such a belief to sustain
  and give hope--The laws of health and a religious life are in
  harmony--A religious belief tends toward health--So long as the
  present conditions of life exist, man will require its
  sustaining influence                                                 211


  CHAPTER XV.

  INSUFFICIENT SLEEP.

  Conditions of the brain which are supposed to produce sleep--
  Congested state of the blood-vessels--An anæmic state--
  Suffering when a person is for any cause deprived of sleep--
  Persons usually sleep too little rather than too much--
  Physiological reasons why children require more sleep than
  adults--They generally sleep too little, especially when living
  in cities--The importance of sleep for the brain learned from
  its universality in nature and especially from the functions of
  other portions of the body--In this state it recuperates its
  exhausted energies and stores them up for use when in a state
  of activity--Inability to sleep a precursor of insanity              223


  CHAPTER XVI.

  CONCLUSION.

  The primary causes of few diseases are fully understood--
  Prevention of insanity must come mainly from education received
  at home and in the school--Difficulties in the way of securing
  any efficient preventive measures--Educational processes may be
  improved in several ways: (1) by securing a larger degree of
  _individuality_; (2) more attention to industrial education;
  (3) more efficient home education--Changes in certain habits;
  (1) in reference to the use of alcoholic beverages; (2) in the
  use of tobacco; (3) the importance of longer periods of rest
  and recreation; (4) improved sanitary surroundings in those
  portions of cities occupied by the poor and laboring classes
  of society--The importance of systematic measures toward the
  prevention of insanity                                               237




CHAPTER I.

PRELIMINARY.


The subject of insanity, in its relation to both individuals and society,
is becoming of greater importance every year. A larger measure of interest
in relation to it has been manifest, not only in the writings of
specialists, who have made it a study, and the care of its subjects a
profession, but also in those of general practitioners of medicine and
philanthropists, who are ever seeking to improve the conditions of
society.

This results from two causes: 1, the change which has taken place in the
public mind in relation to the nature of the disease, it no longer being
regarded as something for which an individual is responsible in a larger
measure than for other diseases, or as entailing a stigma upon those who
are so unfortunate as to have experienced it, but rather a disease which
invades the brain in the same way that diseases of another character
affect other portions of the system, bearing with it neither more nor less
of responsibility or disgrace; 2, and, as a result in part from this
change, a more clear realization on the part of the public, that there
exists an obligation to make provision for care and treatment of those who
are deprived of reason, and consequently unable to care for themselves, to
a larger extent than for any other unfortunate class in the community.

The obligation resting upon the strong to provide for those who become
helpless from the effects of other forms of disease has long been
acknowledged, but it is only within recent times that this obligation
concerning those who become helpless from the effects of insanity has come
into general recognition. Now, however, it is readily conceded that this
unfortunate class appeals even more strongly for sympathy and aid than any
other, more especially by reason of the consequences which result to the
individual himself, as well as to his family, and the community in which
he resides.

The lower we descend in the scale of existence, the less importance does
the nervous system sustain in its relation to other systems of the entire
body; and conversely, the higher we rise in the scale, the larger
importance does it hold, until, in man, it reaches its highest relation,
crowning all the others, and making its possessor supreme in the world of
animal-life. When, however, disease invades the brain, and the individual
no longer holds sway over the purposes evolved from his mental
operations, he becomes the most helpless of creatures. Thought no longer
follows the dictation of the will; designs or plans, for the present and
future, are no longer possible. That intellectual power on which he so
much prided himself, and on which his highest happiness and usefulness
depended, has passed into darkness and confusion. Henceforth, if he is to
be cared for at all, or treated for the amelioration of disease, or for
recovery, it must be by friends on the ground of obligation, or by the
public, in virtue of that charity which is the growth of civilization and
religion.

Persons affected with other forms of disease may be cared for, in the most
part, at their own homes and by members of their own family better than
elsewhere, while the indirect influence of such care and surroundings is
often of much service in promoting both the happiness and the recovery of
the patient. But in the case of the insane the opposite is true: the
atmosphere of home and the care of friends are unfavorable conditions.
More often than otherwise, the disordered mind regards the oldest and
dearest friends as the worst enemies, while the circumstances of home and
scenes long familiar, are those which are the least calculated to improve
the mind.

In most other forms of disease, individuals may exercise their own
judgment or preferences in the selection of medical attendants, nurses,
and such appliances as may be thought necessary to comfort and recovery;
they more or less fully realize their own condition and requirements, are
capable, in some measure at least, of controlling their desires and
feelings, and of explaining their experiences, and are generally
influenced by such favorable indications as may arise in the progress of
their diseases.

But in the case of the insane all this is generally reversed. Individuals
have little or no judgment by which to be guided, as to those appliances
necessary for their care and treatment; they rarely recognize their
conditions fully enough to feel the necessity for doing any thing, beyond
yielding to those impulses which may be uppermost for the time being; they
are not generally capable of controlling their own feelings, restraining
their desires, or of intelligently realizing and describing their
condition, or of caring for themselves.

These conditions, so peculiar and opposite to those existing in many other
forms of disease, and the fact that even under favorable circumstances,
the vast majority of insane persons cannot be cared for in private homes,
except at greatest disadvantage to other members of the family as well as
themselves, renders it imperative for the highest interests of society,
that governments interpose and make provision for their care as wards of
the State, in a greater or less degree.

It appears to have been only within the last half century that this
obligation has become more fully recognized, and, in consequence, society
seems to be striving to make amends for past neglect. Hospitals and
asylums have been erected and equipped at large expense, and physicians,
selected with reference to experience and efficiency, have been placed in
the care of them. In some countries commissioners have been appointed
whose duty it becomes to see that kindness and sympathetic care take the
place of former neglect and cruelty; physicians and others, influenced by
professional and philanthropic motives, have been active in efforts to
secure measures for the most enlightened treatment and the most humane
care for these unfortunate members of society, so that, in process of
time, this charity has become one of the largest importance, affecting all
classes and conditions of society, and influencing, directly or
indirectly, every property-holder and every voter.

And, while it is a most melancholy truth that so large a number become
insane and dependent on society for care, yet the fact, that society is so
ready to recognize its obligation and respond so generously to it, appears
to be a cheering and hopeful indication. So far as it goes, it indicates
a diminution of selfishness and a growth of charity. It indicates that the
more humane, sympathetic, and finer qualities of character are having a
larger measure of influence in the tendencies of the present time.




CHAPTER II.

INCREASE OF INSANITY.


If the general tendency of movement in relation to the public interest in
the care and management of the insane during the last twenty-five years,
has been such as I have intimated in the preceding chapter, I think there
exists at least a probability, that there will be an increase of this
public interest and consequent action in the years to come. The ground of
such probability will be more apparent, I think, from the evidence of
statistics now to be presented. But, as preliminary to this, I propose to
mention several points for consideration, which have a bearing, of more or
less importance, upon the discussion of the subject, and which may serve
to indicate the tendency and general drift of influences in operation in
the present and recent past.

1. It appears almost trite to remark that there have come large changes
over the conditions of civilization since the beginning of the nineteenth
century, and yet, I think, we generally fail to realize how great many of
them, of such a character as especially to influence mental as well as
physical health, have been.

Previous to, and during the early part of this period, the history of
those nations with which we are most familiar, especially of those
portions which now constitute the Empire of Germany, and of France and
England, had been one of wars, which were waged in the interests of the
few in distinction from those of the many.

Kings, and generals of armies, and rulers of petty nationalities and
clans, were the personages who stood out in bold relief; their plans,
intrigues, and movements, and the marshalling of their armies for combat,
together with the results which followed in the way of conquering and
re-conquering of territories, constituted the great business of life among
these nations, and furnished the themes of which historians wrote; while
the conditions of life, pertaining to the great body of the common people,
as to education, modes of living, occupations, and health, were of almost
no account. Education related chiefly to military matters, and was
practically confined to the higher classes, while the well-being of the
common people was of little concern, except so far as it might prove to be
of service in the battles of conquest.

The manufactories, commerce, machinery; the law, and politics as now
existing, and which play so large a part and exert so great an influence
on the lives of the common people of to-day, were then practically
unknown. The people were divided, for the most part, into two classes,
those who fought the battles, and those who tilled the soil, to obtain the
wherewithal to sustain both. These conditions immensely simplified the
problem of life, as compared with that of the present time, and, moreover,
necessitated an existence out-of-doors for the vast majority of persons.

2. At the present time a much smaller number till the soil and follow
out-door occupations, and the improved agricultural machinery now so
largely used, and the numerous other avenues of life which have been
opened so freely to all, are tending constantly to still further diminish
it. Large numbers are congregated in factories and mills, and are engaged
in mechanical occupations, counting-houses, mercantile and in-door
pursuits. Instead of being in the open air, and breathing it in its
freshness and purity, they are, for twenty or more hours of the
twenty-four, in the confined and vitiated atmosphere of the factory,
store, or counting-house, and, what is not unfrequently worse, that of the
illy ventilated sleeping-room. In the one case, the blood is purified and
nourished by the influence of a large supply of oxygen which it bears to
every portion of the system, and especially the brain, while in the
other, it is only partially decarbonated, and bears a taint during its
whole round of circulation. The thousands who are, in the present,
immersed in the dense atmosphere of cities, large towns, manufacturing
establishments, and mines of various kinds, were accustomed, in former
times, to live largely out-of-doors, and were engaged in such pursuits as
tended to develop and strengthen the whole system.

In the former conditions of life, persons were, to a much larger degree,
governed, and their requirements provided for, by legal, or arbitrary,
enactments, so that there existed less care on their part, as to obtaining
those things necessary for self and family, while in the present, the
larger degree of personal liberty enjoyed, and the multiplied artificial
wants created, bring increased care and individual responsibility.

3. Again, there has, within quite a recent period of time, come a
considerable change in the human system itself, attributable in a measure,
probably, to some or all of the above causes, in relation to the character
and tendencies of diseases. During the former period, it is believed that
diseases affected more often the circulatory system, and that they were
largely of a more sthenic character; that they were treated in a manner
much more heroic than would be well borne at the present time is quite
plain, whether it was judicious or otherwise. Now, the force or tendency
of disease seems to be carried over (if I may so speak) into the nervous
system, so that diseases affecting this portion of the body are much more
frequent than formerly. People are more sensitive and nervous; indeed,
nervousness has become exceedingly common among all classes, and modifies
many forms of disease, thereby inducing an asthenic type, which requires
the use of vastly larger quantities of those tonic medicines which act on
the nervous system, than would have been tolerated fifty years ago. And
the keen competitions in business, the intense mental activities which
pervade all the vocations of modern life, the ruling passion for wealth
which extends through almost all classes of society, and the consequent
neglect of those laws which govern health, all tend to further increase
it. From these causes, there can but result, on the whole, a much less
vigorous system and one less able to resist the effects of strain and
anxiety, and much less robust families of children, many of whom have,
from the beginning, in their nervous systems, weaknesses which cling to
them through life.

These considerations, and others which may be referred to more fully
hereafter, would appear to indicate the probability that there have been
in operation such powerful influences as would tend toward an increase of
insanity beyond that which would be anticipated from the increase of the
general population.

The increased demand for hospital accommodation for the insane, which has
been so great within recent years, has been thought, by some, to indicate
a certainty of such increase of insanity. While there may be some show for
such an inference, I do not think it very conclusive, as this demand may
be readily accounted for by other reasons, of which the following may be
mentioned.

1st. The general condition of asylums for the insane has greatly improved
everywhere within the last forty years: buildings, grounds, and the
general external appearances have become more attractive; halls and rooms
have been better furnished, lighted, heated, and ventilated, and
consequently more cheerful and inviting in appearance to patients and
friends. There is much less of mechanical restraint used than was formerly
considered necessary, and a larger amount of personal freedom; while the
introduction of labor among the inmates more generally has served to
render life in asylums more like that at home, especially for the chronic
insane. In consequence, or partly in consequence, the public have come,
more fully than ever before, to appreciate the good results which arise,
both directly and indirectly, from asylum treatment, and have lost, in a
large measure, the distrust formerly existing in relation to these
institutions, and are now more ready to place their friends and relatives
in them for care.

2d. The view has become more general, that those who are so unfortunate as
to become insane, have claims upon the public, more obligatory than any
other class in the community can have, and, consequently, very large
numbers who were formerly detained in almshouses and in county poorhouses,
have been removed and placed under the more favorable conditions of
hospitals better adapted to their humane care.

3d. Formerly it was considered necessary to place only the more acute and
violent forms of disease in asylums for treatment, while the chronic
insane, especially those in a demented and quiet condition, were retained
at home; but more recently persons are inclined to recognize the
importance of placing these classes, also, in asylums, where they may be
under the care of persons who have been educated for the purpose, and
consequently understand better how to manage and care for them; and also
for the purpose of leaving the productive members of the family free to
engage in ordinary industry.

4th. It has also come to pass that many who were formerly considered only
as _eccentric_ or _singular_ in their general conduct and relations with
others, are now recognized as partially insane, and consequently society
is less tolerant of their presence, and more urgent that they be removed
to places of greater safety, and where their general influence may be less
harmful.

Further, 5th. Allowance has to be made for ordinary accumulation of
persons who may be considered as asylum inhabitants. It is a general rule,
with few exceptions, that persons who have once passed through the
experience of a serious illness never are in quite as perfect a state of
health afterward, and in many cases are more likely to be again affected;
and in reference to insanity this is especially true. Every one who has
once been insane is more likely to become so again; so that the fact that
from thirty to fifty per cent. of the insane recover once, renders the
probability of larger numbers hereafter greater. Then, of the numbers who
do not recover and do not die, many live on for a much longer period than
formerly. There can be no doubt that the existence of even such functional
disease of the brain as may cause insanity, tend to shorten life in the
vast majority of persons so affected, while the lack of care and
treatment, and too often long-time neglect and abuse formerly prevalent
among the insane, served to shorten the period of life still more. The
fact that under the more favorable conditions of hospital life these
persons live for much longer periods than would otherwise be the case,
tends largely to explain the increase of numbers who appear to be so
rapidly accumulating in the asylums and hospitals of the country.

In forming an opinion, therefore, as to the increase of insanity, from
indications based on the _numbers_ which are now provided for by the
public, it becomes necessary to take into the account all the above
considerations, and perhaps some others. Indeed, the item of _numbers in
asylums_ is but one of the factors of the problem, which embraces a large
field for observation.

Bearing the above preliminary considerations in mind, we may now refer to
something more definite in the way of statistics, for the purpose of
answering our inquiry.

It is evident that the usual census, if it could be made frequently
enough, and also accurate, would go far toward a solution of the problem,
but this has hitherto not been practicable in this country. Owing largely
to the migratory character of large portions of the populations, the great
extent of the country, and the sparseness of population in many sections,
and for other reasons, any conclusions from it can be only proximate.

But, while we do not at present possess the data requisite to determine
the question with accuracy in this country, we may refer to the statistics
which have been yearly published since 1858, by the Boards of
Commissioners in Lunacy for England and Scotland; and do so with the
assurance that what may be found to be true there, will, at least, be good
evidence as to what exists with us.

Both these countries have vastly greater facilities for accurately
determining the number of insane persons living at any one time within
their borders, than are possible in the United States. The population is
much more homogeneous; it is greatly more dense, there being about
25,000,000 of people on a number of square miles less than are contained
in some of our single States. The people are not accustomed to frequent
change of residence from one portion of the country to another, and all
classes are readily reached and their conditions of health determined.

In these countries, so favorably constituted in these respects, there have
existed Boards of Commissioners in Lunacy, for many years, whose duties
are concerned solely with the insane, and their system of inspection
appears to be wellnigh perfect. I therefore propose to introduce some of
the statistics furnished by these Boards, from which we may learn in what
direction has been the tendency of insanity there. In this procedure I
shall divide those which I use from both Boards into periods of ten years
each, the first, from 1859 to 1868, inclusive, and the second, from 1869
to 1878, inclusive; giving the numbers of increase and decrease of both
_private_ and _pauper_ patients, as they appear in the reports,
distributed in asylums, licensed dwellings, and with relatives and
friends.

From the report of the Commissioners for England: first, as to private
patients, the whole number was, in 1859, four thousand nine hundred and
eighty (4,980): and there was an _increase_ of this class in registered
hospitals, during the first decade, to the number of two hundred and
thirty (230); and in licensed houses, to three hundred and twenty-six
(326).

Of this class of patients residing with relatives and others, there has
been an _increase_ of one hundred and fifty-two (152); and in naval and
military hospitals, of eighteen (18).

Of this class of patients in county and borough asylums, there was a
_decrease_ of eight (8).

Second, as to pauper patients;[1] there has been an _increase_ of these,
in county and borough asylums, amounting to nine thousand eight hundred
and forty-four (9,844); and in registered hospitals, of one hundred and
ninety-six (196); and in workhouses, of twenty-seven hundred and
twenty-one (2,721); and residing with relatives and others, of one
thousand and thirty-one (1,031).

There has been a _decrease_ of this class residing in licensed houses, of
six hundred and ninety-eight (698).

By adding together the several sums of _increase_ which have occurred in
both classes, and the increase in the number of criminal lunatics, three
hundred and forty-two (342), who have been provided for, since 1864, in a
special asylum at Broadmoor; and deducting the sums of _decrease_ which
have occurred by removals and redistribution of patients among the several
asylums and registered houses, we have, as a grand total of _increase_
during the ten years, fourteen thousand two hundred and thirty-eight
(14,238).

I have presented the above statistics somewhat in detail, in order that it
may be more apparent among what classes of society this large increase has
mainly occurred. It will accordingly be observed that, while it has been
only seventeen (17) per cent. among the private patients, it has been
about seventy (70) per cent. among the pauper class.

It is apparent that the above statistics present only the total number of
increase, without relation to the increase of the population. To enable us
to appreciate their full significance, another statement, therefore,
becomes necessary.

The ratio of the insane to the sane, the total number of the population
being estimated at the middle of the year, for the several years of the
decade, was as follows:

  In 1859 one in 535
  "  1860  "  "  523
  "  1861  "  "  507
  "  1862  "  "  495
  "  1863  "  "  478
  "  1864  "  "  466
  "  1865  "  "  460
  "  1866  "  "  449
  "  1867  "  "  441
  "  1868  "  "  430

exhibiting a higher ratio of the insane to the sane for every year of the
decade.

I now introduce the statistics of the second decade, viz., from 1869 to
1878 inclusive; and perhaps it is fair to assume that these will be more
nearly perfect than those of the former period, as the system employed had
been longer in operation, and the conditions of the problem somewhat
simplified, as the result of previous labors. For convenience, I shall
group together the private and pauper patients.

In 1869, there were of both private and pauper patients in the county and
borough asylums twenty-six thousand eight hundred and sixty-seven
(26,867); in 1878, there were of the same classes of persons, thirty-seven
thousand seven hundred and sixty-three (37,763): exhibiting an _increase_
of ten thousand eight hundred and ninety-six (10,896).

There were in registered hospitals, in 1869, of both private and pauper
patients, twenty-three hundred and fifty-two (2,352); and in 1878,
twenty-seven hundred and seventy-eight (2,778): showing an _increase_ of
four hundred and twenty-six (426).

In licensed houses, there were, in 1869, four thousand seven hundred and
ninety-six (4,796); and in 1878, there were four thousand two hundred and
two (4,202): exhibiting a _decrease_ of five hundred and ninety-four
(594).

In naval and military hospitals, in 1869, there were two hundred and nine
(209); and in 1878, three hundred and sixty (360): an _increase_ of one
hundred and fifty-one (151).

In the Criminal Lunatic Asylum at Broadmoor, in 1869, there were four
hundred and sixty-one (461); and in 1878, four hundred and eighty-two
(482): an _increase_ of twenty-one (21).

In the workhouses there were, in 1869, eleven thousand one hundred and
eighty-one (11,181); and in 1878, sixteen thousand two hundred and
sixty-five (16,265): equal to an _increase_ of five thousand and
eighty-four (5,084).

Residing with relatives and others, there were, in 1869, seven thousand
three hundred and eleven (7,311); and in 1878, six thousand six hundred
and eighty-eight (6,688): giving a _decrease_ of six hundred and
twenty-three (623).

By the addition of these several sums of _increase_, and deducting those
of _decrease_, we have a total of _increase_ during these ten years of
fifteen thousand three hundred and sixty-one (15,361).

The increase, therefore, as between the first and second decade, amounts
to one thousand one hundred and twenty-three (1,123).

The ratio this increase bears to the total number of the population, from
year to year, appears from the following table:

  In 1869 one in 417
  "  1870  "  "  411
  "  1871  "  "  401
  "  1872  "  "  396
  "  1873  "  "  387
  "  1874  "  "  381
  "  1875  "  "  375
  "  1876  "  "  373
  "  1877  "  "  364
  "  1878  "  "  362

It will be observed from the above statistics, that there has been a
considerably uniform increase of insanity, greater than that of the
general population, but that it has been less rapid during the second
decade than the first. By reference to the last Report of the
Commissioners, I find that in 1880 there is one insane person to every
three hundred and fifty-seven (357), which indicates that insanity
continued to that time to increase more rapidly in proportion than the
general population.

I have presented the above numbers somewhat more in detail as to classes
and methods of distribution than was necessary, thinking the lay reader
may be interested to understand something as to these points, in the care
of the insane in England. As these methods are quite similar in Scotland,
I shall, in some measure, omit this detail in presenting the statistics
relating to that country.

From the Reports of the Board of Commissioners in Lunacy for Scotland, it
appears that in 1860 there were of insane persons:

1. Of paupers in asylums and poorhouses, three thousand three hundred and
seventy-nine (3,379); of the same class in private dwellings, eighteen
hundred and forty-seven (1,847).

2. Of private patients in asylums, nine hundred and seventy-one (971); and
in private dwellings, twenty-one (21): making a total of both classes of
six thousand two hundred and eighteen (6,218).

These numbers are understood to be exclusive of criminals and imbecile
children.

In 1869 there were under observation:

1. Of pauper patients in asylums and poorhouses, four thousand four
hundred and ninety-four (4,494); and in private dwellings, one thousand
and five hundred (1,500).

2. Of private patients in asylums, one thousand one hundred and
twenty-eight (1,128); and in private dwellings, thirty-five (35): making a
total of both classes of seven thousand one hundred and fifty-seven
(7,157).

During these ten years, therefore, from 1860 to 1869, inclusive, the total
number of insane persons in Scotland, of which the Board had cognizance,
advanced from six thousand two hundred and eighteen (6,218) to seven
thousand one hundred and fifty-seven (7,157), giving a net increase
amounting to nine hundred and thirty-nine (939).

I introduce the table as before to show the relation this bears to the
number of the population:

  In 1860 one in 487
  "  1861  "  "  487
  "  1862  "  "  480
  "  1863  "  "  490
  "  1864  "  "  490
  "  1865  "  "  487
  "  1866  "  "  480
  "  1867  "  "  473
  "  1868  "  "  467
  "  1869  "  "  458

It will be observed that the increase has not been uniform, as was the
case in relation to that of England. There was a decrease for two of the
ten years, 1863 and 1864, but from that time forward an increase.

Referring next to the second decade, from 1870 to 1879, inclusive, it is
found that in 1870 there were:

1. Of pauper insane persons in asylums and poorhouses, four thousand seven
hundred and twenty-eight (4,728); and in private dwellings, one thousand
four hundred and sixty-nine (1,469).

2. Of private insane persons, in asylums, one thousand one hundred and
sixty-three (1,163), and in private houses forty-nine (49): making a total
of the private and pauper insane of seven thousand four hundred and nine
(7,409).

In 1879, there were:

1. Of pauper lunatics in asylums and wards of poorhouses, six thousand two
hundred and ninety two (6,292); and in private dwellings, one thousand
three hundred and ninety-eight (1,398).

2. Of private lunatics in asylums, one thousand three hundred and
fifty-eight (1,358); and in private houses, one hundred and ten (110):
making a total of both classes of nine thousand one hundred and
fifty-eight (9,158).

The advance, therefore, during this decade was from seven thousand four
hundred and nine (7,409), to nine thousand one hundred and fifty-eight
(9,158); which equals one thousand seven hundred and forty-nine (1,749),
as against nine hundred and thirty-nine (939) during the preceding decade,
or nearly one hundred per cent. larger.

In relation to the general population it was as follows:

  In 1870 one in 448
  "  1871  "  "  440
  "  1872  "  "  438
  "  1873  "  "  434
  "  1874  "  "  436
  "  1875  "  "  432
  "  1876  "  "  420
  "  1877  "  "  408
  "  1878  "  "  400
  "  1879  "  "  392

exhibiting a decrease in relation to the total of population for one year
only of the decade, and on the whole a steady increase for the whole
twenty years.

It further appears from the tables of statistics, that the number of
_insane_ paupers per 100,000 of the population, which was one hundred and
fifty-seven (157), January 1, 1858, advanced to two hundred and seventeen
(217) per 100,000, January 1, 1880, notwithstanding the fact, that during
this period the number of pauper-persons per 100,000 of the general
population diminished from two thousand six hundred and thirty (2,630) to
one thousand seven hundred and eighteen (1,718).

It thus appears that insanity is, both absolutely and relatively, a much
larger element in the pauperism of the country than ever before.

In considering the force of the above statistics there is one element
which may, I think, properly be referred to as entering into the
calculation, to which I have nowhere found any allusion, namely,--that of
emigration. I have not at hand the statistics to show how great this has
been from England and Scotland during the last twenty years, but we know
that it has been very considerable from both countries to Canada,
Australia, and the United States; and I think it fair to assume that this
emigration has generally been from those who have been in good mental
health, at least at the time of leaving these countries; and if at this
time they had relatives who were insane, these would be left behind.
Therefore, so far as this would have an effect upon the statistics of
insanity, it would be toward exhibiting a higher ratio of the insane to
the whole population than would otherwise appear.

Having made due allowance for this, and other considerations, which were
alluded to in connection with the statistics of asylums, I still think the
evidence all points toward a large increase of insanity, both absolute and
relatively to the population, in both England and Scotland.

At the time of this writing, the statistics of the census for 1880, for
the United States, have not been so far completed and published, that
evidence from them can here be presented, but I think there can be no
doubt that, when they appear, they will tend to confirm very strongly
those already presented, which have been prepared with so great care, and
collected under such very favorable conditions, and which demonstrate, or
so nearly demonstrate, both the absolute and relative increase of
insanity.




CHAPTER III.

INSANITY AND CIVILIZATION.


Information in reference to the character of the diseases which formerly
existed among the aborigines of North America, or among uncivilized
peoples of other countries, in the past, is both meagre and indefinite.
Legends concerning widespread epidemics of some forms of disease,
especially the yellow fever and small-pox, among those tribes which
formerly lived on the territory which now constitutes New England, have
been handed down, and there must have occurred cases of insanity, to a
greater or less extent, among all savage nations, arising from injuries to
some portion of the nervous system; but, for the most part, those
conditions and experiences of life which appear to predispose or excite
the nervous system into diseased action, were probably absent.

Those who were born with weakened or defective organizations, either
physical or mental, would, under the exposed conditions and the rude
experiences of uncivilized life, hardly attain to adult age, even if they
were not intentionally left to perish, so that the vast majority of those
who did arrive at those periods of life during which insanity generally
manifests itself, would probably possess such nervous organizations as
would be little liable to become insane.

Their modes of living, also, being for the most part in the open air, and
without excessive labor or exertion, except on occasions, and during short
periods; and living in comparative freedom concerning those uncertainties
of business and property which exist so generally among some classes, and
even nations, under the conditions of civilized life; having few needs,
and those of such a nature as to be easily supplied, would all be
unfavorable to the development of insanity.

Again, uncivilized persons have but little sensitiveness, and are easily
satisfied in reference to that long range of sentiment and feeling which
holds so large a sway, and wields so strong an influence, in the lives of
their brethern and sisters in civilized life; and, moreover, experience
few of the annoyances, disappointments, and vexations which result from
the habits and customs of our forms of domestic and business conditions.

Yet it appears to be a humiliating admission to make, that, with all the
increase of mental power and range of thought, with acquired power over
the forces of nature, with ability to convert the hidden treasures and
forces of nature, into the means of supplying wants and ministering to
comfort, and, with the vast storehouse of mental wealth which comes into
the possession of mankind through the influences of civilization, there
should, somehow, necessarily come with them, greater liability to such a
calamity as insanity. This is, however, but one of many evils which
invariably come into existence under the changed relations and
circumstances of life, not only while passing from the habits of
uncivilized life to those of a high state of civilization, but especially
while living in the latter condition.

It is exceedingly difficult to differentiate, and accurately state in few
words, what is signified by either insanity or civilization. Both are
terms, the general signification of which, for practical purposes, is
supposed to be well enough understood, but when we are called upon to give
a clear and at the same time a fully comprehensive definition of them,
there is much difficulty in doing it.

As has been very clearly shown by Dr. Arthur Mitchell,[2] civilizations
may differ in different countries, as well as at different periods of time
in the same country; they may be old or new, high or low, one thing in
this century, and another in the next. That of the ancient Greek certainly
differed widely from that of the Roman, while both differed largely from
the European civilization of the present time.

In one view of the subject, that which regards it as something separate
and distinct from those unfavorable conditions which always accompany its
progress, we may say that _civilization may be considered as the measure
of perfection reached by society as a whole, toward living in harmony with
its environments, in a civil condition_.

But, inasmuch as no civilization has yet appeared among any people, so far
as we know, or is soon likely to appear, free from those imperfections
which affect even large numbers, some other more practical idea of its
character will be necessary. For my present purpose it may be considered
as _the sum of results, which follow from the total of activities in
operation among any people, while living under those conditions which
always have pertained to civil life_.

These results will vary even largely from one period of time to another,
and will be partly good and partly bad. Indeed, I think it will be found
that, in the degree in which nations have passed from those conditions
which pertain to life in the savage state, upward toward those which
abound in civilized life, in that measure has the sum total of diseased
conditions, in both body and mind, increased; in this measure have there
resulted degenerations of nerve element, and consequent failure to attain
to and live in harmony with those artificial arrangements and conditions
with which society in the civil state has, thus far in its history,
uniformly surrounded itself.

In other words, while man has largely gained in some directions; while his
mind has become more active and far-reaching in its range of thought, and
many-sided in its activities; while the comforts and luxuries of life have
become many times larger, by abandoning those conditions of life which
pertain to the savage state, and assuming others of a vastly higher and
more complex nature, yet, thus far in his history, he has not succeeded in
surrounding society by such regulations, and in securing obedience to such
laws, as will suffice to preserve and retain the health and strength of
body which existed while in the savage state, except among the few.

That many of the conditions pertaining to modern civilization prove to be
highly conducive to physical diseases, needs hardly to be said, and that
they are no less productive of insanity and other diseases of the nervous
system, will be evident from some considerations to be alluded to in
connection with this discussion.

1. At first thought it might appear that the development and extension of
civilization, which carries with it so many and great advantages in many
other respects, should also be favorable to mental health. It is a law of
the human system that the various organs become strong and maintain a high
standard of health, only while under a considerable degree of activity,
and this is especially true of the muscular and nervous systems.
Inactivity and disuse tend toward degeneration, therefore, such
circumstances and surroundings of life as will conduce to harmonious
activity of these organs and parts, would, _ceteris paribus_, be most
favorable to health.

Now the various portions and faculties of the human brain are brought into
a state of full development and activity only under the conditions and
influences of civilization; all of those higher and finer manifestations
of thought, sentiment, and feeling, which pertain only to man; the
satisfaction which comes from the results of mental activities both in
relation to mechanics, education, governments, and the social amenities;
the increase of strength pertaining to thought, and consequent
self-reliance, and ability to rise above the adverse circumstances and
experiences of life; freedom from the conditions of uncertain and limited
supply, with attainment of those of a fairly certain and abundant
character; the results which come from travel, and intercourse with
persons of other nationalities; from trade, commerce, and intellectual
pursuits; together with the possession of knowledge, which is power,--all
come only from the conditions and influences of civilization, and should
rather have a tendency to confirm and make strong mental health.

And this would undoubtedly be the result, if these were all, or indeed
mainly, the effects attendant on living under the influences of
civilization.

But, unfortunately, these are only some of the beneficent results of this
change. Other influences, customs, and practices, and those of a character
highly adverse to the maintenance of healthy mentality, have also come
into operation, to a greater or less extent, and are especially potent in
modern civilization.

With the increase of mental activity alluded to, there have come into a
fuller range of activity those portions of the brain which are concerned
with thought, and which, in the narrow limits and simple conditions before
experienced, had been comparatively inactive. Consequently, a larger
supply of blood has been summoned to these parts of the brain to repair
the loss incurred by this increased activity. This change and consequent
disturbance in the relative blood-supply, as between the brain and other
parts of the system, would be of little importance if sufficient care be
exercised that it comes in the right degree, and does not cause too great
activity in the organ of the mind; indeed, there might be expected
favorable results from a larger exercise of function, or at least not
unfavorable ones.

In the experience of modern times, however, this has not proved to be the
case. With the measure of mental power and scope which attends the change,
there has been a large tendency to over-stimulate the intellectual
faculties, which has been aided and thought to be necessary, in
consequence of the immense competitions and business activities of modern
civilization.

This tendency to stimulation has been manifest even to a much larger
extent than formerly, first, in the matter of education. The new
conditions and employments of life, rendered prominent by some of the
discoveries which pertain to science, agriculture, commerce, and the
general conduct of business pursuits, have developed requirements on the
part of those who are called upon to conduct them, which have been
heretofore unknown. To meet these requirements it has been thought
necessary to pursue such courses of education, and to present such special
incentives to study on the part of the young, by the use of prizes and
grades of scholarship, and public exhibitions, as will bring into
operation the largest possible activity, and secure the highest discipline
of the brain, even at a very early period of life. At this time all the
forces of vitality and physical growth are in the fullest activity, so
that the strain comes upon the brain at the period when it has the least
of ability to bear it, and at expense to other portions of the system.

And again, in the use of stimulants, especially alcohol, in some of its
forms, and tobacco, during the period of growth and early manhood. The use
of these substances, as well as the subject of education, in their effects
upon the nervous system, will be discussed more fully in future chapters,
and are only mentioned, in this connection, as causes of nerve
degeneration, which have come into operation more fully through the
influence of modern civilization.

2. One of the conditions of savage life, is that of _a community of
interests and supplies_, to a large extent. Families and tribes seek for
and possess supplies in common; the weaker depend upon the strong, and the
strong aid the weak, so that when privations, from failure in the chase
and other causes, may come, they affect all together, and generally in
like degree. The passion of avarice is in a latent state; those who are
strong do not thrive at the expense of those who are less so, while the
latter depend upon aid from the former. Wealth and poverty and such
distinctions as arise from these civil conditions are unknown.

Under the conditions and customs which pertain to civilized life, how
great the contrast! All, or nearly all, is changed. Individuality appears
at once. Each and every person, or family, is expected to rely upon his,
or its, individual effort for success in obtaining such things as are
necessary to comfort and well-being. In this he stands, in a large sense,
isolated, and fails, or succeeds, by himself, alone, or with his family.

In other words, _community of interests_, except in some very indefinite
and limited measure, is lost sight of, and swallowed up in those of the
individual. In the conduct of life, the strong are almost sure, not only
to neglect the weak, but often to tyrannize over them; they become selfish
and not unfrequently covetous, and require much for little. The
distinctions and conditions of society incident to wealth and poverty,
knowledge and ignorance, appear, and the latter too often surrounds its
unfortunate victim with such hardships and exposure, as tend rapidly, in
too many cases, toward bodily and mental disease.

In this way the struggle incident to the conditions of civilized life,
becomes tenfold greater than in savage life, for one portion of the
community, and in this struggle, the weaker ones, sooner or later, tend
toward the wall. The strong become stronger from the very conditions and
influences which surround them, while the weak tend to become weaker, and
many are almost sure to fall by the way. Ignorance, poverty, and unhealth
are long-time companions, and lean strongly toward immortality.

Under the complicated conditions and antagonizing interests of
civilization, the strong make the laws and establish the customs, which
become obligatory upon all alike, and these will invariably be of such a
character as will, in the long run, discriminate in their own favor. This
has been apparent in all the older civilizations, especially in reference
to the tenure of land; so that, _once owned, always owned_, might be
considered as the law. Land, once in possession, continues in families for
long generations, or indefinitely, unless it revert to the government. In
either case its resources in ameliorating the conditions of the poor, and
ministering to the productive wealth of the country, are greatly
diminished, while under the influence and laws of a larger community of
interests, it could be made productive toward the support and comfort of
thousands who now live and die in poverty, want, and ignorance, and who,
all their lives, from infancy to death, are in those circumstances of
privation which render them specially liable to disease of mind.

But not only in respect of land does the tendency to unequal conditions
manifest itself; it becomes apparent in reference to property in nearly
all its other forms. In the conduct of commerce, manufactures, trade and
exchange, in government itself, there exist vast ranges of opportunity
unknown to savage life, for the strong to triumph over the weak: To him
that hath shall be given, and he shall have an abundance, while from him
that hath not shall be taken away even that which he appeareth to have.
The rich have an abundance and surfeit, while the poor become poorer, and
suffer for the requisites wherewith to become strong, or even to remain in
physical health. To the one class pertain all those conditions which serve
to invigorate and strengthen, while to the other pertain the opposite
ones. To the one belongs abundance in the way of food, clothing, shelter,
warmth, pure air, change, and education, while to the other pertain
privation, insufficiency of food, impure air, overwork, ignorance, and a
never-ending monotony and drudgery of life.

And in the history of the world, thus far, there has never appeared any
high states of civilization without these unequal and inharmonious
developments. No peoples have as yet ever learned the art of living under
the conditions of civilization without them; no peoples have ever passed
from the community of interests and possessions, which exists so largely
in savage life, up to those conditions which pertain to civil life, except
with attendant results similar to those already indicated; and these
results are plainly those which tend largely toward the development of
mental disease.

If the views presented in the preceding chapter and also in this, in
reference to the tendency of insanity to increase, and which statistics
appear to confirm, are correct, we perceive at once how important, in
relation to both political economy and the future health and happiness of
society, becomes the problem of this disease.

As a subject of science and philanthropy, it has for some years engaged
the study and interest of many who have been desirous more fully to
understand its bearing in both these respects; but in the no distant
future, it will become the disease of paramount importance and interest to
legislators and political economists; and as there exist reasons for
supposing that, under the changing conditions of our modern civilization,
it will more surely tend to invade the homes of many who have heretofore
been exempt, and will in the future even more surely than in the past,
affect all ranks and conditions of society, the increasing importance of
making its causes a subject of investigation, and of endeavoring to
prevent its increase, even in a limited degree, becomes at once apparent.

It may be remarked at the outset that many of the _exciting_ causes of
insanity are uncontrollable. We can do little, or nothing, toward changing
or modifying the demands which are made upon us by the business operations
of the present; nor toward modifying those great activities which are so
loudly calling for development and conduct in life; we cannot do much
toward changing the unequal conditions which pertain so largely in
relation to property, occupations, and modes of living; or in avoiding the
sufferings which result from the bereavements and disappointed
expectations of life; we cannot, nor is it desirable, in all respects, if
we could, do much to promote community of interests in property. But it is
important to bear in mind that, after all, the prime condition of insanity
lies, to a large extent, back of these exciting causes. Thousands have
passed through such conditions and experiences, have suffered from
disappointment and failure in respect to their plans and purposes; have
endured exposures and hardships all their lives; all, without becoming
insane, and thousands more will continue to do so in the future. It is
evident, therefore, that there must exist back of these experiences, a
state of the nervous system which renders it susceptible of the disease.
This, it is, which is the prime factor in the problem of insanity; and it
becomes of the first importance to discover, so far as we may be able to
do so, in what this predisposing tendency may consist, or, at least in
what ways, or through the operation of what causes, it more especially
tends to come into existence and operation to so large an extent at the
present time, and by what means it maybe avoided.

In this study we are proceeding along the same road we follow in
investigations concerning other diseases. In a philosophical sense, there
lies back of all manifestation of diseased action, an antecedent
condition, which is the soil from which morbid actions spring. There exist
the scrofulous, the phthisical, the gouty, the rheumatic diatheses, and,
hence, the question of heredity is of the utmost importance in reference
to many forms of disease.

"To many intents and purposes, we are born one generation at least, and
generally more, before we come into the world. The soil whence the
protoplasm of our grandfathers was formed, has a large significance in
reference to ourselves. We limp, because they were gouty; we groan with
rheumatic pains, because they slept in damp rooms; the neuralgic twinges
of their fifth pair of nerves extend over into ours. The acid of the
grapes, which our fathers ate, has acted on the enamel of our bicuspids
and molars. That intangible tendency to weakness, to unhealth, so
indefinable, so delicate, so inappreciable to our senses, is yet the
mightiest factor in our being, and measures the amount of our physical
pains and sufferings with a greater delicacy than we have been wont to
think. It is the match, which needs only to be rubbed,--or the tinder
waiting for the spark,--or the acid for the alkali.

On no other theory are we able to explain the effects, or absence of
effect, from the exciting causes of disease. For instance: in one case
cold produces neuralgia, in another rheumatism, in another pneumonia, in
yet another bronchitis, and in the fifth person no morbid action at all.
Now in these several persons there must have existed a primary or induced
condition of the several parts affected, of such a nature, that a common
cause, acting upon all alike, yet produced widely different results.

"Again, two persons may be exposed to the same atmospheric conditions, or
be brought within a similar miasmatic influence, resulting in the one case
in fever; in the other, in nothing. The miasm or poison was doubtless
present in both systems alike, and, perhaps, in similar quantity, and yet
in one case with no appreciable effect, and in the other, creating an
illness which may continue for weeks or months. It is evident that there
must have been, in the last case, a condition of the system which rendered
the action of the miasm possible, and without which, it would have been
entirely, or nearly, inert. In fact, strictly speaking, this cause, or
antecedent condition, is rather a part of the disease itself, and cannot,
in fairness, be separated from it. For, if disease be abnormal action,
either in the structure or function of an organ, whether sufficient to be
recognized or not, subjectively or objectively, then this weakness,
inherited or acquired, becomes the chief factor, and those changes, which
are sufficiently gross to be observed by our senses, and which we are
accustomed to term disease, are only the remaining factors of it."[3]

I apply the same course of reasoning in relation to _that necessarily
antecedent condition of the brain_, which renders it especially liable to
become diseased through the operation of those ordinary exciting causes,
which, to a greater or less extent, surround the lives of all persons, and
which we term _the Insane Diathesis_. It becomes necessary, therefore, to
study this peculiar condition of the brain, first, as to its _nature_,
and, second, as to some of those _causes_ which tend especially to create
it.




CHAPTER IV.

THE INSANE DIATHESIS.


The ideal human system would be one of perfection, that is, it would be
one so constituted as to discharge all its functions perfectly. Yet, its
capacities would be limited as they now are, though not to the same
extent. Digestion of such articles of food as the system requires would be
perfect, though this might not be true as to many other articles, which
are appropriate as food for other animals. Sight and hearing would be
perfect, but only within certain ranges and distances; memory would be
perfect in reference to every thing comprehended and understood. The
limitations would be dependent on the inherent nature of the organism, in
its relation to the external world. What is stated above as true, in
relation to certain parts of the system, would be equally true of the
functions of all parts of the human system, both physical and psychical.

Now, the _actual_ human system approaches toward this _ideal_ one in a
greater or less degree. It possesses all the faculties, both physical and
psychical, but they are tainted with imperfections, and their health
varies from the highest state attainable, down to some assumed standard,
below which we say that a diseased condition exists. It will, however, be
observed, and hereafter more definitely appear, that this border-line is
merely one of assumption. No definite standard can be applied to all
persons, and a condition which would be normal for one person may not be
so for another. Besides, the _actual_ condition of many persons is one of
changing stability, both in respect of the body and the mind, and this may
depend upon causes which operate from either _within_ or _without_.

A few simple statements in reference to differences existing among
persons, as to those physical and mental conditions which are inherited,
may be in point, and prepare the way for other considerations.

I. Though we may not be able to determine the causes of these differences,
yet it is quite evident that there exists, from the time of birth, the
largest diversity in reference to the physical constitution of persons:
while some are strong and vigorous, and capable of large effort, and of
enduring exposure to the heat and cold with almost indifference, others
are so delicate and sensitive as to be easily affected by such influences;
while the muscles of some are susceptible of making the most delicate and
difficult movements in all mechanical operations, with very little
training or education, those of others can never be trained sufficiently
to be able to accomplish them; the skin and the lungs of some persons are
so constituted as to be easily influenced by such degrees of moisture and
cold as have little or no such effect on those of others; the capacity for
labor, and endurance, also varies very largely.

Again, these physical conditions are more or less variable with many
persons. They are conscious of feeling more active and vigorous, of
experiencing a larger degree of pleasure in physical activity at one time
than at another; they may be conscious of more or less painful sensations,
experience a measure of indisposition to make effort; they may be more
restless and uneasy, and feel discomfort from slight causes which had
rarely before produced such results.

In short, there may exist not only a difference in the constitution of the
different organs of the body, but these natural conditions are more or
less changeful in their states, within certain limits, while still in a
state of health. There may exist a condition of over-activity, or of
under-activity, in any or all portions of the body, and from the operation
of causes, the nature of which we are entirely ignorant, and concerning
which persons do not much care, so long as they do not experience so much
discomfort as to be unfitted for their usual occupations and pleasures.
Such experiences are common with many persons, who yet remain in a
condition of health.

Passing now to the conditions of the mental side of the human system, we
find, in what are called healthy states, that there exists as broad a
diversity of character as in the physical. While some apprehend any thing
a little abstruse with great difficulty, or fail to do so at all, others
understand it with a readiness which we are accustomed to call intuition;
while many occurrences seem merely to impinge upon and glance off the
minds of some persons never to be remembered again, they pass from the
minds of others only after long years, or remain through life.

Some persons always look upon and judge of occurrences and results in an
unusual way. They are odd or singular in their mental constitution, and
are accustomed to do odd and out-of-the-way things just as naturally as
others would do the same things in such a manner as to attract no
attention. Some persons see, hear, taste, touch, and smell so much more
quickly and delicately than others, that we must conclude there exists a
radical difference in the perfection of the organization of the
nerve-cells of these various organs of special sense.

Again, there are periods in the experience of some persons, when they see,
hear, touch, taste, and smell with much greater readiness and delicacy
than at other times, even in a state of so-called health. Musical sounds
are more delicate and pleasing; harsh and rough sounds are more harsh and
rough; certain articles of food produce a keener sense of relish, and
colors a greater sense of pleasure: all of which would indicate temporary
changes in the structure or function of the nerve element comprising these
special organs of sense.

The same is true to even a larger extent of the emotional nature. Persons,
in certain states of the nervous system, are pleased with persons,
objects, and sensations, which afford them no pleasure at other times;
they are displeased and pained, while in other conditions, with sentiments
which would at other times produce no such effect. They sometimes feel
that the world and its possessions and pleasures are so great and grand
that they can never leave them, and the thought of doing so causes the
keenest anguish; while in another state all these pleasures and
possessions appear as empty and valueless as a bubble of air, and the
thought of leaving them, and throwing off the burdens and cares of life,
which are usually so much enjoyed, seems almost pleasurable.

Again, some persons have periods of being irritable, restless, nervous;
they cannot bear much; little incidents which, in other conditions of the
nervous system, they would think little or nothing of, turn them into a
passion of excitement, which can hardly be controlled for the time being.
In other states they may long to weep, or to be in solitude where they
cannot be disturbed; or they may shout, and laugh, and talk, while
thoughts come coursing through the brain so fast that words fail in their
expression.

The same changes occur among the impulses; these are at times almost
irresistible. Nearly every one, while standing on a high cliff or
house-top, has felt an impulse to jump off or push his friend off,
reckless of the consequences.

In the usual condition of the nervous system persons love their children
and relatives, and are ready to do and suffer and at times even to die for
them, if need be, while at other times all these sentiments fade away, so
that they are unconscious of them, and even the opposite sentiment of
dislike or hatred takes their place.

Periods of mental lethargy come over many persons at times, so that they
care neither to talk nor engage in any of their usual intellectual or
physical pursuits; and such stimuli as are usually sufficient to rouse the
brain into action appear to have very little effect. They feel and say
that there is a state of only partial brain-activity. At other times the
brain acts with the greatest freedom; occurrences which took place long
years before, and which, perhaps, have not been thought of since, come
back with all the freshness of yesterday. Thoughts come rapidly. Keen
flashes of wit, bright scintillations of thought, forms of expression of
unusual felicity, pour forth spontaneously, while the mind apprehends and
retains many kinds of knowledge with the greatest readiness. Similar
variations take place in reference to courage and its opposite, timidity;
truthfulness and suspicion; and, in fact, the whole range of mental
endowments.

Now all this grand play of diverse emotions and conditions in the
psychical functions takes place in a state of health; still, there can be
no doubt that it comes from an unstable condition of the nervous elements
of the brain, or from changes produced in some manner in these varied and
delicate structures. It may be from varying states which are constantly
occurring in the blood, in the processes of reception and elimination; or
from those delicate chemical operations which must be forever going on in
the nerve elements of the brain hemispheres, affecting their recipient and
sensitive capacities; or it may be from other unknown causes: and these
changes occur much more readily and frequently in some persons than in
others.

Bearing in mind, now, these conditions of the physical and mental systems,
the tendencies to which are inherited, and more or less changeful in
character, we may proceed a step farther.

This unstable condition, both physical and mental, may exist not only as
an inherited condition, but it may be produced, or become greatly
increased by causes external to the system, which are brought into contact
so as to influence it.

A few illustrations may serve to make this more clear:

1. When a person who has not been accustomed to use the muscles of the arm
in active and vigorous exercise, lifts, or makes a strong effort to lift,
a heavy weight, if the effort is continued any considerable length of
time, two conditions result therefrom:

First, a state of tremulousness, or spasm of the arm, hand, and especially
of the fingers. The largest effort the individual can make toward
controlling this irregularity of movement, is insufficient, and these
parts remain in a condition of more or less spasmodic action, until the
nervous energy is restored.

Second, there results a sensation of pain, more or less severe, according
to the time the exertion has continued. This would indicate positive
injury, to some extent, in the nerve filaments of the muscles which have
been so unusually exercised. The degree of effect will be dependent upon
the condition of the nerves of the hand and arm at the time the effort is
made, and upon the amount of force expended.

If the effort is repeated soon, there will result a similar condition, and
ultimately the nerve would cease to respond to the call for action in any
degree,--the arm would be paralyzed.

2. All are more or less familiar with that condition which is usually
termed the _writer's cramp_. Sometimes persons of a peculiar nervous
organization, who have been accustomed to spend many hours a day in the
mechanical process of writing, experience such a loss of nervous energy
that the arm fails to respond to the will power. There results spasmodic
and irregular movements in the arm, and more especially in the fingers,
indicating that some morbid condition of the median nerve has been
produced. If the case is neglected, and the exciting causes continue in
operation, after awhile the nerve will become less and less responsive to
the call of the will, and the arm may become seriously affected, after a
longer or shorter period of more or less pain. In this case, as in the
former one, there may exist all degrees of impairment of nerve function,
from that of slight unsteadiness or instability, up to entire failure.

3. The condition of the nervous system in chorea presents another
illustration. Between the ages of ten and fifteen years, in some children,
there may occur such changes in the condition of the nervous element,
from the altered character of the blood, as to render it more or less
unstable in some portion. One arm or one leg, or a hand, or some of the
muscles of the face or neck, cannot be kept long at rest by any effort
which can be exerted by the individual, and this may be so slight as
scarcely to attract attention, or it may be so great as to cause extreme
suffering for a long time, and ultimately destroy life.

Now the primary condition in the above cases is one of _instability of
nerve function_. Such a change has occurred in the elemental tissue of the
nerve, as to injure its power of activity so far as it is under the
control of the will. The nerve has been stimulated to over-activity, or
its energy impaired by other causes arising within the system itself.

These illustrations have related to those portions of the nervous system
which are more immediately connected with motion, and which, consequently,
are located in the muscular system. If, now, we pass from these portions
of the nervous system up to its grand centre, or that part of it whose
function is connected with mental operations, we shall find similar
effects resulting from like causes.

If a person experiences a sudden mental shock, occasioned, it may be, by
sad intelligence of some kind, or if he passes suddenly through some great
personal peril, or if he has made unusual mental effort in some abstruse
study, or in the conduct of business, which has been long protracted, he
becomes conscious of what is called mental fatigue. The brain refuses to
respond to any calls which may be made upon it for further action, or
partially refuses; it becomes confused and bewildered, and unsteady in its
action; it is difficult to force it to further application, or to
connected lines of thought, and if, by a strong effort of the will, this
is done during a short time, it is inclined soon to wander from the
subject, and there exists a more or less distinctly recognized sensation
of pain as well as inability to regulate its action.

In this case, also, as in the others, there may result any degree of
effect, from a sensation of fatigue up to mental spasm, and the amount
will depend on the condition of the brain during the time the effect
continues, and its intensity. The two conditions of instability and pain
may be less marked in the case of the brain than in the nerves of motion,
but there can be little doubt there has resulted something of a similar
character in both.

Precisely in what this change which has taken place consists, may not be
easily determined. There may have occurred actual lesion of nerve element,
or only impairment or exhaustion of functional power without lesion;
probably the latter condition only, in the primary stages of the
operation. Certain portions of the brain have been over-stimulated in
action, and consequently their power of normal activity and stability is
impaired, as was seen in the cases of nerves distributed to the muscles of
the arm and other portions of the body.

II. Again, if the arm or hand of a vigorous person, which has long been
trained to make either large efforts, or the more delicate movements, or
again, to make but little effort in any direction, be placed in splints,
or be suspended in a sling so that there is little or no activity for a
few weeks, more or less, there results a failure of nerve-function; and
there may be any degree of impairment, from that of slight degree, such as
may be evinced by spasm, to that of paralysis.

The same is true in reference to any portion of the nervous system which
can be placed in a state of inactivity.

A few sentences of recapitulation in our process of reasoning will now be
in order.

1. We have seen that imperfection and instability of nerve-function may be
inherited; that weakness, or impairment, exists with many persons from the
time of birth, which affects more or less the functions of the various
portions of the nervous system; and that this is seen not only in the
mechanical operations of the hand and arm, in the execution of all the
more delicate movements of which it may be susceptible, but also in the
mental operations. By no possible amount of training can the nerves of
the arm in certain persons be educated to do the finer portions of
mechanism, any more than can their brains be educated to continuous or
concentrated thought on the solution of problems in the higher
mathematics; that the broadest diversity as to strength and steadiness of
nerve-function exists from the period of childhood to old age: while the
nerves and brains of some bear long-continued and large effort without
disturbance or failure of function, these portions of the system in others
soon manifest the effects of such treatment, and ere long break down; and
there may exist any degree of difference, from the manifestations of
genius, to those of imbecility.

2. We have also observed that disturbance and imperfection of
nerve-function may be produced in all persons by the action of causes
operating from without upon the nervous system, and that the results may
be similar in character, whether there has been too great or too little
exercise of function.

It will further be observed, that we have in a definite and somewhat
continuous line passed from the production of disturbance and irregularity
of the function of simple motion in the hand and arm, up to the more
complicated and less understood activities of the hemispheres of the
brain. We have seen that there exists at least a similarity in the
exhibition of failure in the functions of execution in both cases, whether
acquired or inherited.

I think there can be little doubt that there exists some such condition of
that portion of the brain which is concerned in mental operations, as I
have in a somewhat crude manner attempted to illustrate, which is the
primary condition in a large number of persons who become insane.
Precisely in what it may consist during the earlier stages we may not be
able to explain. There doubtless is no change which can be termed
_organic_ in either the nerve cell or any other portion of the substance
of the brain during the primary stages of this failure in function, but
rather an exhaustion or lack in functional power, which after a longer or
shorter period _may_ lead to organic change of structure.

Now we have only to suppose a person with a nervous system so constituted
that these conditions, which I have described as temporarily occurring
with many persons from exciting causes, are permanent, though in a latent
state, and we have that peculiar organization which we term _The Insane
Diathesis_. That is, we have a nervous system so sensitively constituted,
and illy adjusted with its surroundings, that when brought in contact with
unusually exciting influences, there may occur deranged instead of natural
mental action, and it becomes more or less continuous instead of
evanescent.

The mind passes from the control of the will, and wanders hither and
thither, or persistently holds on in one channel of thought. Its action
may become spasmodic and irregular in all degrees from slight aberrations,
or excitement, up to incoherence and mental spasm; or from slight degrees
of depression, down to almost inactivity and dementia: in short, such
abnormal conditions of mental activity as constitute insanity.

The husband hates his wife, and the wife her husband; the parent his
child, and the child the parent. We have the person, whose brain is so
perverted in its action that he feels no pleasure and experiences no
satisfaction in life, but hates it, and longs to throw off its burdens and
cares, and leaves no effort untried to accomplish it; while another is so
filled with joyous emotion, his brain is so excited in functional
activity, that he can neither eat nor sleep, but ideas flow forth in one
constant stream of words--words; bright visions appear on every side, and
his life is worth a thousand worlds. Or, we may have any other of the ten
thousand perverted mental activities which attend the "mind diseased."

  "And he * * * (a short tale to make)
  Fell into a sadness; then into a fast;
  Thence into a watch; thence into a weakness;
  Thence into a lightness; and by this declination
  Into a madness, whereon he now raves
  And we all mourn for."

In the above view, there does not appear to be any well-defined, sharply
bounded line between what is termed normal and abnormal mental activity in
its primary stage. The one insensibly merges into the other, while both
depend upon the physiological condition of the brain for the time being.
When that portion of it which is immediately concerned in thought is in
what is termed a healthy state, that is, a condition in which its
involuntary functions are normally performed and under the control of the
will, then we have healthy mind; and, _vice versa_, when it varies from
this condition, either from the effect of influences which have been
inherited or acquired, then we have for the time, abnormal mind. Thousands
are born into the world with brains so constituted as to become easily
deranged by external influences and experiences, and thousands more attain
to such conditions of the brain, from the frictions of life, and abuse of
its enjoyments and requirements.

If these views, in relation to the principal condition of insanity, are
correct, it is evident that the question of largest interest in relation
to its _prevention_, relates, not so much to the long catalogue of
exciting or secondary causes, as to the avoidance of such courses of life,
habits, and tendencies of society, as specially assist to develop and
perpetuate this diathesis. It now becomes necessary to suggest and
discuss, more or less fully, some of the influences which are in operation
in modern modes of education and habits of life, and which have a special
tendency to create this condition of the brain. I shall first refer to
some points in connection with present methods of education as related to
the young.




CHAPTER V.

THE INFLUENCE OF EDUCATION.


The highest conception of an education would include the idea of its being
symmetrical; that is, that the psychical and physical should be trained
together and in harmony; that the system should be considered and educated
as a whole, the brain not being stimulated in its cultivation at the
expense of the body, or neglected while the latter is in process of
development. If both are educated together, and with due proportion of
attention to the laws of development and growth of each, then they will be
in the most favorable condition to withstand the effects of the wear and
tear which come in the lives of all.

That the courses of education at present pursued in the larger number of
our select and common schools, especially those located in cities and
large towns, are of this character, will hardly be claimed by persons who
study educational systems and processes from a physiological and sanitary
point of view.

At five or six years of age, and while for some years the system must be
in the formative, growing period of its existence, the child is confined
five hours a day on a hard seat or chair, in a room often illy ventilated
and irregularly heated. During the larger portion of this time he or she
is expected to have the mind occupied in study, or recitation, which is
quite equivalent to study. In addition to this, after the child arrives at
the age of ten or twelve years, tasks of such extent and difficulty are
imposed, that it becomes necessary to study one or two hours during the
evening. I think that most persons, with much experience in intellectual
occupations, will agree with me, that six hours a day are quite enough for
an adult mind to be occupied, with advantage, in study. I am confident it
will be found that our most successful clergymen, lawyers, and
_littérateurs_, though at times a more protracted period of mental effort
may be necessary, yet, as a rule, do not spend a longer period daily in
intellectual efforts.

Yet in the education of our little children, we find that both teachers
and parents, in their blind ambition to hurry them forward, conspire in
imposing tasks of such a character and magnitude as to require longer
hours of study than we know to be best for the adult brain.[4]

I believe, however, that the largest mischief does not come from the
length of time occupied in confinement and study, great as this may be. A
still larger defect in the system lies in the multiplicity of the subjects
studied and the lack of sufficient individuality in its administration.

In the graded schools children are parcelled out in numbers ranging from
forty to sixty in one room, and put under the charge of one teacher. The
system is too purely a mechanical one; all must come in, go out, rise up
and sit down, study, and recite in very large classes. There is no room or
time for individuality in any department of study, and very little in any
recitation. Each one goes on with the whole, or he drops out and back,
while the half-exhausted teacher has neither time nor opportunity to
bestow the little attention and aid which would often be of so much value.

No teacher can do even half justice to any such number of children, and I
presume it is not expected he will. His task appears to be to find that in
some way or other the pupil seems to be able to recite his lesson, and if
not, that he work at it until he does; and if the unfortunate one fails,
see that he goes back to a lower class. Now, doubtless, one or two out of
every five of these fifty or sixty children will be able to press on with
comparative ease and health through all the studies which all are expected
to master, but for the other three or four of the five, there exists a
large tendency toward confusion of mind and imperfect knowledge, rather
than those clear conceptions and definite understanding which tend to give
vigor and strength of brain.

In this respect, I believe the educational process of fifty years ago was
better than that of to-day. The teacher had a much smaller number of
pupils, and, consequently, had better opportunity to study the
peculiarities and tendencies of individual minds: he was better able to
appreciate their deficiencies and the consequent needs each had. Fewer
books were read, and these of such a character as was adapted to
strengthen the memory; fewer subjects were studied, and there was time to
more thoroughly understand and fully master them. Facts and processes
attained were clear and definite, and there were less confused and
half-understood lessons and theories, so that, as the mind became more
mature, it went out for larger fields and broader pastures of knowledge.

They, doubtless, did not have much information as to the movements of the
heavenly bodies, or of the names of insignificant towns, hamlets, or
rivers on the eastern or western coast of Africa. They might not be able
to define the boundaries of Kamtchatka, nor give the pluperfect of a large
number of irregular verbs; but, on the other hand, their brains were clear
and active, and possessed a recipient capacity. They were not crammed or
confused by the dim memories of a vast multitude of names or facts which,
by no possibility, could have any important bearing on their future lives
or fortunes.

Knowledge, to be of much practical value to its possessor, must be clear
and definite in the mind. When only partially understood or dimly
perceived by the mind, it tends rather to confuse and weaken than
invigorate; consequently, during the earlier periods of life, study in our
schools should be confined to a comparatively few subjects, and there
should be opportunity for the teacher to see that the scholar receives
such individual attention as will enable him to fully master the allotted
tasks. We must ever bear in mind that the grand object in attending school
is, physiologically considered, to make the brain vigorous and stable in
its operations, and as little liable to instability and irregular action
as possible. Any course of training, during this early formative period of
life, which tends to crowd the brain or stimulate it to over-activity,
must tend to after-weakness and instability.

This leads me to protest against the modern tendency to continually
increase the requirements for entering and continuing in the graded
schools of our cities. The number of dates and names, relating as they
often do to many different subjects of study, and the amount of writing in
a short space of time, tend to mental confusion; and while the number of
studies is increased, the time for their acquisition must remain
unchanged, so that the scholar is hurried on through or dropped by the
way. To avoid this latter result, too great and too protracted mental
effort is necessary on the part of some children, while in many cases the
results are manifested in a state of mental confusion and uncertainty, or
a nervous, hysterical condition.

I have in mind at this writing cases which will illustrate my point. One
was that of a young lady of ordinary mental endowments, whose parents
usually brought her to me for advice as often as every two or three weeks,
because she was nervous, and suffered from frequent and protracted
headaches. Inquiry elicited the fact that she was obliged to study during
the evening until ten or eleven o'clock to accomplish the tasks which were
assigned to her class. It was thought by the parents that this practice
was all right, that it evinced faithfulness and ambition, and it was with
much difficulty that I could convince either her or her parents that her
ill-health was due to the constant violation of the laws of health; that
her brain and whole nervous system required longer periods of repose and
quiet at her age than it would be likely to need later; that the future of
her whole life as a member of society might, and must, in a large degree,
depend, not on the grade of the marks she might receive in her daily
recitations, but largely on the nervous and physical strength she might be
able to build up before she should become twenty-one years of age. This
young lady was of a healthy parentage, and inherited a good physique, and
with proper habits of life and study would have had excellent health. As
it is, her system will not for years, if ever, recover from the effects of
her habits of excessive hours of study.

The name of another patient occurs to me: a young man of good parentage,
and apparently inheriting a good constitution. He was ambitious in study,
and his parents permitted him to do all he might choose to. He entered
college at sixteen, standing among the best scholars of his class, but
before the end of the first year, began to be troubled with noises in his
head and confusion of mind. He was removed from college, and remained out
till the end of the year, but partially kept up his studies at home. He
entered the sophomore class but was obliged to leave earlier in the course
than before. He tried the junior year with a like result, and from this
time exhibited more pronounced indications of mental impairment. He
travelled both in this country and in Europe; he consulted some of the
most eminent physicians, but all to no purpose; the mischief had been too
effectually accomplished. The delicate tissues of the brain had been
over-strained, and so impaired that when his parents awoke to the gravity
of his condition, it was too late to repair the mischief.

I have under my care at the present time a young girl, thirteen years of
age, who has come to me from one of the seminaries for girls in New
England. She informs me that the pupils in that institution are required
to spend eight or more hours a day in study and recitation, and some
portion more of every day in household work, and that _she_ was permitted
to study and recite some ten hours a day, as she was behind her class in
some of the studies when she entered.

It is not surprising that in less than one year she returned to her home,
suffering from headaches, cold feet, nervousness, and inability to sleep,
and in a short time became so excitable and incoherent in thought and
language, that it became necessary to remove her from home. After a long
period of rest with appropriate treatment, she has become so strong that
she will soon go into the country, where I have directed that she remain
for one or two years without study, in the hope that the nervous system
may regain its health under the influence of a life spent largely in the
open air.[5]

A young man, standing, so far as was indicated by marks, in the front rank
of his class, had strength of brain barely to graduate, and then for years
was able to do but little study, and spent his time in a vain search for
that health which by judicious habits in study he would never have lost.
Many other cases of similar character could be cited if it was necessary
to adduce additional confirmation of my views.

I desire, however, not only to call attention to, and greatly emphasize,
the effects of study so far as they may manifest themselves on the
individuals themselves, but the effects which these persons are certain to
transmit to their posterity. The brain may and does, in many cases, so far
recover that it may fairly do the work, or _a_ work in life, but it has
attained a bias--a twist,--which will be seen to manifest itself in the
next generation in something more than a twist; it will be an insane
diathesis--a brain constituted in so unstable a manner, that the friction
of ordinary life will upset it, ending in insanity.

I have often thought that teachers are only partially to blame, as they
are countenanced and encouraged by the parents in this injudicious course
of mental stimulation in early life. Especially is this the case if a
child happens to be so fortunate--I perhaps should rather say
_unfortunate_--as to have in any measure a higher order of mind than his
fellows; he is likely to be the theme of conversation, in relation to his
studies, not only in his own home, but with all the cousins, aunts, and
neighbors, until finally the child comes to form altogether a false
estimate as to the importance of its own attainments and ability. It is
quite possible, also, that the freedom of our educational and governmental
institutions may serve to help it on. Every child is taught, at home and
in school, that all the prizes of life are within his grasp, _if he will
only make the requisite effort_, while every parent is anxious to have his
child higher up in the social scale than he is. These conditions not
unfrequently serve to stimulate those specially ambitious to
over-exertion, while again, there is less of the controlling element, both
at home and in social life, than exists under most other forms of
government.

It becomes necessary here to refer to the system, so universally prevalent
in our colleges, of competition in grades of scholarship. I do this with
greater reluctance, knowing very well how fully men of long experience
have studied the subject, and how extremely difficult it may be to devise
and carry into operation any plan which may prove to be more desirable for
all concerned.

In any considerable number of boys, from the ages of fifteen to twenty-two
years, there will be some who realize so little the objects and benefits
to be obtained through the discipline of study, that they will care little
for honors or standards of scholarship, and are in no possible danger of
over-exertion to obtain them. With such persons we need not concern
ourselves at present.

On the other hand there are those who so fully appreciate the grand
advantages resulting from an education, that they would be sure to do a
fair amount of labor, and honestly employ their time, under almost any
system of management. Now it is from the latter class, that come the
students who are to attain to and hold the positions of influence in
after-life, and too great care cannot be exercised that their
characteristics of mind be judiciously brought into exercise and strength.
They are, for the most part, ambitious; and in many cases this ambition
stimulates them to the largest effort to carry off the prizes which may
come in the way of scholarship during their college course.

These prizes frequently depend on extremely small differences in
proficiency which may be obtained, in many cases, over long periods of
time. It is understood that it is commonly the case that the differences
in scholarship of those who obtain the highest five or six honors in
college are often very small, and that these honors may be assigned to one
or to another by failure or success on some point, the knowledge
concerning which could by no possibility have any influence in after-life,
and which must be but an imperfect indication of true scholarship and
mental ability; and yet so strong is the power of ambition as to lead
some few of the highest minds, in almost every class, to neglect the
commonest laws of health in reference to physical exercise and sleep, that
they may secure these temporary honors. The brain is stimulated to long
and weary hours of study by the effects of tea or coffee, or in some cases
by the use of more objectionable substances, when regard for health would
require it to be in a state of repose and sleep; and this is during the
period of life when it has not yet attained to its full growth, and while
its substance is still in a more sensitive and delicate condition, and
consequently more likely to be unfavorably affected by such treatment than
in the maturity of later life.

From personal observation I am satisfied that some of the brightest minds
are essentially ruined for the accomplishment of any large work in life by
such a course of conduct in their education, who, under some other course
of management, in which these mental tendencies could have been better
understood and guided, might have been saved; and that often these are
minds with the best natural endowments.

How it is possible that instructors of young persons can suppose that any
larger power of intellect, or any greater capacity for usefulness in
after-life, can possibly be secured by such treatment, or rather by such
abuse of the organ of the mind, or why they have not been more careful to
instruct those under their care as to this most important of all subjects
to them in their future work, it is not easy to imagine, and can only be
accounted for by the supposition that they have not studied the subject
carefully enough in its physiological relations.

It should always be borne in mind that excessive use or stimulation of any
part or organ of the system can in no sense be considered as education of
it, but as a sin against its nature, which will be sure to require
retribution. It may be made to accomplish more in a given time, but it
must be at a discount on its future activity; there must come a reaction,
that is, a condition in which there will be performed less of function
than before; and that such a course of treatment has a tendency to produce
a condition of _instability_, and more or less of _uncertainty of action_.

Within the last twenty years there appears to have come, in some measure,
a reaction in reference to exclusive attention to brain discipline, and in
favor of more attention to physical exercise during the college
curriculum. There have been organized in most of the colleges and
academies, boating clubs, base-ball clubs, and other associations with the
avowed object of securing a higher state of physical development and
education. This has been a step in the right direction, and none too soon
have we come to realize the fact that the brain depends very largely upon
the health of the body for its exercise of the best thought. The
importance of a physical education will be more fully referred to
hereafter, but at this stage of the subject it is pertinent to suggest
that violent use of the muscles for short periods is generally not the
best mode of exercise; that the sudden expenditure of so much nervous
force in training and in contests, as is necessary in order to secure the
highest attainable power in rapidity, skill, and strength of stroke,
during a half or one hour; or to attain the highest skill in throwing a
ball, or in receiving it in hand, or in many other of the manoeuvres of
base-ball playing, which require such quick changes of position, and
violent motion of the body, is in great danger of ultimately defeating the
very object for which they are ostensibly practised.

The skill and power may be obtained, and the winning crew or club may have
the satisfaction of receiving the welcome plaudits or the crowning laurels
bestowed on victors, but how far all this will prove to be of service in
securing either strength or health of body, may be a question; or rather
it will not be a question at all. In nine out of every ten cases there
exists almost a certainty that a larger measure of physical health and
capacity of endurance in after-life would have been attained by some other
course, or method, attended with less stimulation and expenditure of
nerve-force. The period of reaction no less surely comes than in cases of
other kinds of stimulation, and is frequently manifested in functional or
organic derangements of the heart and other organs. Healthy and continuous
muscular power comes more surely by the expenditure of a medium amount of
nerve-force, and no other method can properly be considered as physical
education.

Lest, however, it may be thought I have placed too much importance in this
matter of over-study and nervous exertion, and to show that we Americans
are not the only ones at fault, I will here introduce some statements from
an English physician[6] of the highest authority.

He says: "The master of a private school informs me that he has proof of
the effects of overwork in the fact of boys being withdrawn from the keen
competition of a public-school career, which was proving injurious to
their health, and sent to him, that they might, in the less ambitious
atmosphere of a private school, pick up health and strength again. He
refers to instances of boys who had been crammed and much pressed in order
that they might enter a certain form or gain a desired exhibition, having
reached the goal successfully and then stagnated." He further says: "Too
many hours' daily study, and the knowledge of an approaching examination,
when the system is developing and requiring an abundance of good air and
exercise, easily accounts for pale and worn looks, frequent headache,
disturbed sleep, nightmare, and nervous fears. When the career of such
students does not end in graduating in a lunatic asylum, they lose for
years, possibly always, the elasticity and buoyancy of spirits essential
to robust health. A strong constitution may be sacrificed to supposed
educational necessities."

"Mr. Burndell Carter,[7] in his 'Influence of Education and Training in
Promoting Diseases of the Nervous System,' speaks of a large public school
in London from which boys of ten to twelve years of age carry home tasks
which would occupy them till near midnight, and of which the rules and
laws of study are so arranged as to preclude the possibility of sufficient
recreation. The teacher in a high school says that the host of subjects in
which parents insist on instruction being given to their children is
simply preposterous, and disastrous alike to health and to real steady
progress in necessary branches of knowledge. The other day I met an
examiner in the street with a roll of papers consisting of answers and
questions. He deplored the fashion of the day; the number of subjects
crammed within a few years of growing life; the character of the questions
which were frequently asked, and the requiring a student to master, at
the peril of being rejected, scientific theories and crude speculations
which they would have to unlearn in a year or two. He sincerely pities the
unfortunate students. During the last year or two, the public have been
startled by the number of suicides which have occurred on the part of
young men preparing for examination at the University of London, and the
press has spoken out strongly on the subject. Notwithstanding this, the
authorities appear to be disposed to increase instead of diminish the
stringency of some of the examinations."

These statements were made as showing a tendency on the part of the
prevalent modes of education in England, to produce in its subjects either
insanity or a tendency toward it. I here reproduce them as confirmatory of
my own views already expressed, and would especially call attention to the
fact that though this influence may fail in producing actual insanity, yet
it is of such a character as will tend to develop instability of brain
tissue, and in the coming generation the insane diathesis. Parents
transmit acquired tendencies toward disease as well as, and indeed I think
more frequently than, disease itself.

I must beg, however, not to be misunderstood. I think I appreciate the
importance of an education for the development and discipline of the brain
as profoundly as any one. I believe the lack of brain discipline for those
who are to compete in the midst of such a civilization as that of the
present, is one of the greatest misfortunes; but I do desire to protest
with much emphasis against the system of indiscriminate cramming toward
which the schools appear to be so rapidly drifting. It defeats one of the
most important ends to be sought. It tends to confusion and weakness of
mind instead of strength. Children have so many subjects to learn about,
that they do not have time to fully understand subjects studied. The brain
is occupied so many hours daily that its energy is exhausted, and there
remains little ability to accurately appreciate, discriminate, or fix the
attention.

The same conditions result, as there would from the too long and
continuous use of the muscles of the arm, when one is learning to execute
a piece of delicate work--the drawing of a picture, or making a work of
art. In such a case the importance of only limited periods of application
would be readily appreciated; great care would be exercised by the teacher
lest the pupil should continue the work too long, or after the muscles had
become weary and consequently incapable of accurate work.

We observe the same care in our treatment of the young of domestic
animals, and are watchful that they be not over-driven or over-worked
while their systems are undeveloped and in the growing period. When one is
looking for the best growth, or the highest strength or speed attainable,
if judicious, much vigilance will be exercised lest the animal be
over-driven or worked many hours a day, until the system is developed and
firmly knit together. Shall we be less careful or less wise in our
treatment of children?

Surely, there should not be need that I plead for such a course of
education as will render the brain stronger and more capable of vigorous
work in life, and of transmitting to another generation a sound mental
organization, instead of, as is too often the case, a tendency to unstable
and irregular action, which will have a final ending in insanity. That
this may be the outcome of education there must be changes in the present
system, and I plead earnestly that these may relate to at least two
things, if no more: first, a larger measure of _individuality_,--smaller
schools and fewer pupils for each teacher, that each may have more special
assistance and _special_ training; and, second, _a less number of subjects
of study_. Let there be fewer subjects studied, and let what is studied be
more thoroughly mastered. Have fewer half-understood problems and
half-remembered lessons, and I believe we shall have more stable brains
and stronger intellects in after-life.




CHAPTER VI.

INDUSTRIAL EDUCATION.


I have lifted at random from my table five yearly reports of institutions.

The first is that of the Conn. Hospital for the Insane at Middletown. By
reference to the table of occupations of persons admitted last year it
appears that more than thirty-four per cent. were of persons, the larger
portion of whom had never been educated in any regular method of obtaining
a living. Some of them had been accustomed to depend upon the precarious
results attending common labor, and some upon domestic labor, while others
were without any regular occupation. Probably some of these persons may
have had a measure of education in some occupation in early life, but if
so, this does not appear in the statistics.

The second is the report of the Hospital for the Insane at Taunton, Mass.
Of those who were admitted last year to this institution, it appears that
thirty per cent. would be included in the same general classes of the
population.

The third is that of the new Hospital for the Insane at Worcester, Mass.;
and of the admissions here last year, we find that more than forty-two per
cent. were from the above-named classes.

The fourth is that of the Western Pennsylvania Hospital, and of the
admissions here, thirty per cent. were of these classes; while an
examination of the occupations of those admitted to the Somerset and Bath
Asylum, England, shows that nearly forty per cent. were of persons
similarly circumstanced.

In these statistics I have included those persons who, in the reports, are
classed as _domestics_, _laborers_, and persons of _no occupation_. I have
not included wives of laborers, or persons whose occupation was
"_unknown_." I think it may fairly be assumed that, in the case of
laborers, those who dig and shovel and labor on the public works, or in
other places, under supervision, and in the case of domestics generally
throughout the country, not one in ten has ever had any training or
education in any special line of service before they undertook to earn a
living in following these avocations; that, in fact, they could not do any
thing else.

Possibly reports of other asylums might show statistics varying somewhat
from these, but I take it that these are sufficiently accurate for my
purpose, which is to show from what class of persons, so far as an
education in any of the ordinary employments is concerned, a very large
percentage of the admissions to our State hospitals comes. Without doubt
a still larger per cent. of the admissions to some of the county asylums
in England comes from this class of persons.

But so far we have shown only the per cent. the admissions of this class
sustain to that of all admissions to asylums. Their true significance will
appear only when we bear in mind the percentage this class of persons
sustains to the whole population. The whole number of domestics, common
laborers, and persons of no occupation, must be small as compared with the
whole number of persons above fifteen years of age, and from whom
admissions to asylums come. If, therefore, this amounts to more than one
third of all admissions, it must amount to a very much higher per cent.
than comes from any other class in the community to these asylums.

It may be proper to add to the above classes of persons the no
inconsiderable number who, throughout the States, are engaged as mere
operatives in our factories and manufacturing establishments. Many of
these are engaged, and have been for years, in tending to some portion of
machinery which is nearly automatic in its operations, and which requires
little or no special training or education on the part of the operative.
There might also be included, for my present purpose, that not
inconsiderable class whose education for any business has been only
partial, and who, with little previous training, have assumed the full
responsibilities of such business.

The fact that more than one third of all admissions to those State
hospitals which are located in the older portions of our country are from
those who have never been properly educated in any of the regular
occupations of life, is certainly significant, and I think will appear
more so as we proceed. This, however, is only one element or factor in
their condition, and it would be far from correct to conclude that this
lack of education is in all, or nearly all, the only cause of their
insanity. Doubtless many other causes have united in producing this
result, as in other classes of society; but in many cases these other
causes would have proved to be insufficient of themselves to effect such a
result.

The amount of brain irritation, and consequent stimulation; the worry and
anxiety attendant on the lives of the above-named classes of persons is
oftentimes very great, and that there may not result actual injury to the
brain, there can hardly be any thing of so much importance as an education
and training in some regular pursuit. Without this, the individual is left
at a large disadvantage in the use of all the ordinary means of success,
or even of securing a living by any honorable course of life; while,
having had such a training, he always has the consciousness of possessing
these resources; and not only this, but the brain remains in an
undeveloped and comparatively weak condition without it.

Mental operations have been more or less active, as this is a necessity
during the hours of consciousness, but they have proceeded in an
exceedingly limited sphere of thought; they have gone on day after day in
a few channels only, while the larger portion of that part of the brain
which is connected with thought, or, more accurately speaking, many of the
faculties of the mind, have been left in a comparatively undeveloped and
inactive condition. The result is similar to that which would occur if
only a portion of any other part of the system should be brought into
exercise, for instance, one hand or arm, while the remaining portion
should be left in an inactive state for a long period.

So true is it that certain trains of thought proceed only in limited
channels of the brain, that it is found in experience, that a change of
study from a subject which has long been under consideration, to another
which has not been, and which is of a different character, and which
requires combinations of memories and reasonings of a different order, is
almost equivalent to a period of rest. After a period of application in
the solution of mathematical problems, and the mind begins to weary of
this study, it may, with ease and pleasure be turned to the study of some
language; so that persons whose duties cover a wide range of thought and
subjects of diverse character, are frequently able to employ themselves
with ease more hours in the day than others whose occupations are more
uniform and less diversified in character. The law of health and strength
applies alike to all portions of the system, and requires a certain degree
of activity in all portions, else they remain in an undeveloped or weak
condition.

Besides, in the case of the brain and nervous system in general, this lack
of education in the direction of labor tends largely to produce too
frequent self-distrust and introspection. The individual has little range
of mental vision, or measure of that self-confidence which arises from
ability in skilled labor, and not having any training in those activities
and occupations of life which tend to develop and strengthen the nervous
system; and, consequently, being unable to engage in these with any degree
of satisfaction, if at all, is likely to pass into a state of
self-distrust, doubt, and, after a few years, actual inability to take on
any considerable measure of education of the nervous system.

It is, therefore, not surprising that, in the adult period of life, when
the care and responsibility of providing for others in addition to one's
self, come upon such persons; and especially when periods of uncertainty
and long-continued depression in the market of simple manual labor occur,
individuals so illy equipped and helpless amid the competitions of society
should become insane in large numbers. And I think it must be confessed
that there are in operation certain tendencies, in the progress of modern
civilization, which are at present very potent in their influence, as
against remedies for this condition; influences which tend to push out of
sight the individual, or merge him into a large whole, which moves forward
for the accomplishment of purposes, regardless of the individualities
which may fall out by the way.

In the strife and competition attending life in all our large towns and
cities, there have been developed new methods of conducting business, as
well as most of the occupations. Formerly the trades were conducted vastly
more by individuals, either alone or in small numbers. Work was done by
hand, and frequently at home, so that every father could easily have his
child or children, from an early age, in some measure under his own
supervision. The natural outcome of this was that children very often
followed avocations similar in character to those of their fathers, and
began to learn them early in life. Beginning thus early, though the
progress toward any considerable degree of proficiency was slow, yet there
resulted a symmetrical training and consequent strengthening of the
nervous system, during its growing period, which tended to render it
largely self-reliant, and was of inestimable value in after-life in
securing stability of action. In cases, too, where the children followed
other lines of employment, they were early placed in training for them,
while the influence of home-life was still strong, and before other habits
of thought and less definite and profitable purposes of life had become
developed.

In consequence of the great changes which have come to pass by the
introduction to so large an extent of machinery, and by the conduct of
almost all the trades and mechanical occupations by large numbers of
persons in the form of companies, it has become extremely difficult for
the young to have any special training for these vocations; there would
result too much trouble and inconvenience from their presence.[8]

What now has been substituted in the place of this home-training for
business occupations and trades?

One of the substitutes, indeed almost the only one, is that of the public
school. We have built palatial houses at the public expense in all our
large towns and cities, and into these the children flock by the hundreds,
at all ages from five up to eighteen years, and with the largest diversity
in reference to physical and mental constitution: the highly sensitive and
nervous, with the lymphatic and dull; the weak with the strong; those with
the largest mental capacity, with those who have but little. In other
words, routine education of the brain by means of books has taken the
place of that which was formerly directed to other portions of the system
and toward the more practical side of everyday-life.

The importance of such an education of the brain up to a certain period of
life, which may vary somewhat according to the individual, both in the
interest of the State and of the individual, is readily conceded; but
that it should extend beyond the period of thirteen or fourteen years, for
that large portion of the community which is to obtain a living by some
form of productive industry, is not so evident.

That the brain should have all the training and discipline it can receive
with a due regard to bodily health, till that period when the system
becomes capable of manual effort and of receiving education, is clear; but
from that time forward, why not have it educated in the line of its future
industry and activity, whatever that may be?

Does the ability to work out some algebraic or geometrical process, or to
conjugate some verb, or decline some noun in the Latin language, or the
ability to speak German or French, or the study of music, very much assist
him who is to follow any of the ordinary businesses or occupations, unless
in exceptional cases? And would not the limited number who are benefited,
and who, in consequence, or partly in consequence, are able to push on and
enter other spheres of active life, be quite sure of finding the means of
doing so in other ways? These acquisitions may be well enough; indeed,
should be made essential for persons who are to follow such employments as
require mainly brain action alone. But in any country, these persons are
the few. There must exist the producing classes, and in almost any state
of society these must comprise by far the larger number, both of men and
women.

But not only is that part of the public education which is generally
obtained between the ages of fourteen and eighteen of little practical
value for the ordinary productive avocations of life, but I think it has a
strong tendency to unfit persons for entering upon these pursuits. The boy
and girl are inclined to think they have secured an education by means of
which they are entitled to a living in the world without manual labor, and
frequently look upon it as something tending to degrade them, and as
appropriate only for those who are ignorant. They have lived too long in
the atmosphere of book-learning, and the physical ennui of the
school-room, to be willing to undertake and thoroughly master the details
of a trade or avocation, and yet have been there too short a time for any
thing else. They may make an effort, however, looking toward some middle
course, and if any trade is selected they are unwilling to take sufficient
time to fully master it; they try to enter by some "short cut," while in
too many cases they prefer to depend on the precarious mode of simple
employment in any direction which, for the time, lies open to them. They
consequently are in danger, in process of time, of drifting into the class
of persons who have no regular occupation.

When viewed in the light of physiology, or of political economy even, the
State should educate her young in such a manner and to such an extent as
will tend to give the largest measure of health, both of body and mind, to
the individual, and make the most self-reliant and self-supporting
citizen, rather than give a smattering of algebra or music or astronomy,
the remembrance of which will be almost certain to fade into darkness in
less than five years after the individual enters upon the active duties of
any kind of work in life which does not require their practical use.

How far short of such a procedure she comes by her present methods of
education, may be inferred in some measure:

First, from the large numbers who, in all our cities and large towns, fail
in the conduct of any general business which may require much skill and
experience in its conduct.

Second, from the large numbers of foreign-born and foreign-educated
persons who are at present employed in most of the oldest and best known
manufactories throughout New England and indeed through the whole country,
the number being greatly larger, I understand, than of American-born
citizens.

Third, from the fact which has long been recognized, and in some degree
commented upon, especially by those who have longest had large
opportunities for observation, that during the last twenty or thirty years
there has been a rapid diminution in the number of those, especially of
the American-born, who apply at the manufacturing establishments to be
received as apprentices. While formerly more used to apply for such an
education than were required, now very few make such application, while
those who do, rarely desire to remain long enough to fully apprehend and
apply to practice the details of the industry.

Fourth, from the large numbers who have been educated in our common
schools, who are drifting around from place to place, and frequently
changing from one kind of business or occupation to another, not
unfrequently imagining that they are eminently qualified for some office
of a political nature, and dissatisfied if it is refused them, and unable
to succeed in any of the callings they may seek to follow.

Fifth, from the large numbers of that class which has no regular
employment nor any training for one, and which, at the present time,
furnishes so many admissions to our asylums.

Of the inestimable value of brain discipline alone for all that class of
persons who are to follow certain vocations, there can be no question; but
have we not been hugging the vain delusion, that because the rudiments of
book-learning are necessary for every person who is to become a citizen of
the Republic, therefore, something further in this direction would be of
still greater value to everybody? that, somehow or other, a smattering of
book-knowledge would enable everybody to get on in the world without hard
work? Have we not forgotten that an education of the nervous system in an
occupation, is also one of the brain, and often one of vastly more value
in the way of success and health in after-life? I fear that in our
appreciation of, and zeal for, the public-school system, where so-called
education is poured into the brains of waiting children by the wholesale,
we are in danger of forgetting the grand truth, that, after all, the vast
majority must earn their living, if at all, by honest labor, and that
these persons require such an education as will best qualify them for
practical industries.

In saying this much in reference to our public-school system, I am fully
aware that I am approaching a subject and calling in question principles
which have been supposed long settled, at least so far as this country is
concerned. The system of education has become one of great power and large
significance, especially in all our cities and large towns. The cost of
that in the city of Boston alone, was, last year, more than three millions
of dollars, and that of New York and other cities correspondingly large.
The disposal of such a vast patronage has become one to be sought for by
interested persons; while the introduction of new school-books every few
years proves to be sufficiently remunerative to secure large fortunes to
those interested.

The question of expense, however, is of little importance as compared with
the results of the system in the way of qualifying the subjects for the
duties of life, and when this is considered, I am persuaded that a
considerable portion of the sum now used could be better used in some
other method; and I would, therefore, venture to suggest whether, instead
of supporting public schools as they are now constituted for all classes
of boys and girls between the ages of thirteen and sixteen or eighteen
years, at so large an expense, it would not be better both in the interest
of the State and of the individual, so far as the future health of the
body and mind, and consequent ability for self-support are concerned, to
make some provision whereby future citizens could learn, at least, the
elemental steps in some mechanical or business calling?

By beginning thus early, the highest skill in any occupation or calling
may be best attained. The nervous system grows into the strength requisite
to conduct it in all its diversities much more readily and thoroughly
while in its years of growth, than is ever possible in later years. The
occupation at this period becomes, so to speak, wrought into the texture
of the nervous system, constituting, as it were, a part of it, so that in
after-life it is conducted with much less friction and mental anxiety than
would otherwise be certain to exist; while the discipline which comes to
the brain in the process of learning, should be of quite as much value as
may come from other modes of education.

There can be little doubt that statistics would confirm the statement,
that a large majority of those men who attain to success in almost any
mechanical occupation, are those who began their education in this way,
while young; the large majority of inventors in any kind of machinery are
those who have thoroughly mastered the details of the kind of work to be
done, in early life; while, on the other hand, the larger number of those
who fail, are persons who have not been carefully educated in the pursuits
they have chosen to follow.

The inferences to be drawn from the above considerations would appear to
point in one direction. There can be no doubt that the irritation
attending the conduct of a business or employment which has been only
half-learned, and the disappointments which come from failure and
recognized inability, have largely to do with creating instability of
brain-action, and consequent insanity. If, therefore, we desire to do any
thing toward diminishing the large numbers from these classes which now
require care and treatment in asylums, one of the most efficient means of
accomplishing this would be some such change in the course of the public
system of education, as would enable these persons to qualify themselves
for self-support by various modes and kinds of labor.

The same principles apply equally to _domestic service_. This, certainly,
is one of the most important kinds of labor when regarded in relation to
the comfort, happiness, and health of society, while its indirect
influence upon family-life is, perhaps, greater than that of almost any
other. Probably there exists no other source of so much irritation,
discomfort and dissatisfaction, in home-life as the utter inefficiency of
domestic service in this country. Perhaps no one cause has more largely
contributed toward creating a dislike for family-life, and a tendency to
seek hotels and boarding-houses. There is no one more potent influence in
creating dyspepsia and ill-health of various kinds than illy prepared
food, leaving out of consideration the loss of enjoyment which would come
from its use when skilfully prepared.

But the irritation and consequent ill-health are not confined to one party
in the contract; they come to both sides. The poor, uneducated, and
ignorant servant has perhaps done the best she knew how to do; indeed, it
has been her desire and for her interest to do so, but with no previous
training, or with the little that could be obtained while at service with
wages, what could be expected except failure during the first few years,
with consequent worry, anxiety, and ill-health? It would be as
unreasonable to expect a person who had never been educated as a
cabinet-maker to make good furniture, as to expect food nicely prepared,
and a house well cared for, by a person who has not had the means of
learning how to do this kind of labor.

Success and ease in the conduct of all kinds of labor are the largest
promoters of health and happiness, and yet society goes on satisfying
itself with having established public schools in which Bridget may make
any proficiency in book-learning she may prove herself capable of, fondly
dreaming, that somehow or other, this kind of education, _if it only be
carried far enough_, will make good cooks and efficient housemaids; while
schools in which persons could be thoroughly educated for these most
important duties, could be established and conducted in all our large
cities at a very trifling expense. The results in the way of mental
health, as well as convenience and happiness, would, I believe, prove to
be of inestimable value to society.




CHAPTER VII.

MORAL EDUCATION.


A few words in reference to deficiency of education in another direction,
and bearing especially on the future of the mental health of children,
will conclude what I have to say on this branch of my subject. Perhaps I
cannot introduce these remarks in a better way than by relating two
occurrences recently observed by me.

When sailing with a party of young people, during the last summer, on Long
Island Sound, and while there was blowing a stiff breeze, three of the
younger members of the party went forward very soon after we started, and
stood together on the front part of the boat, in an exposed position. The
captain quickly called to them to return to the rear part of the boat,
saying there was danger of their becoming wet, or washed from the prow of
the boat by the waves, which were rapidly becoming larger. No attention
was paid to his call, and he again and with great earnestness warned them
to return. Greatly to my surprise, not the slightest attention was paid to
his second order, but the young persons continued laughing and talking as
if no orders had been given. As the boat was rapidly passing out of the
harbor and into a locality more exposed to the wind, and the waves were
becoming more dangerous every minute, the captain again shouted to them to
return, and had but just done so, when a wave partially covered all of
them, and one was barely saved from being washed over-board.

A few days after the above occurrence I was standing not far from a
stage-coach which was near the door of a hotel. Very soon a little girl,
nine or ten years of age, came near to one of the horses, and began
endeavoring to put some flowers into the bridle. The animal soon became
restive and looked vicious, while the driver at once warned the child to
desist and to keep at a distance. Apparently not the slightest attention
was given by the child to this warning, and she was still persisting in
her effort, when the driver again, and this time in an angry tone, shouted
to her to keep away, adding some statement to the effect that the animal
was vicious and would hurt her. No more attention was paid to this than to
the driver's former order by the child, and before any one could remove
her, the horse had struck her head with his teeth, leaving a wound, the
scar of which will remain for life.

As will be observed, in both the above cases the children were in
positions of great danger; they were, in both cases, warned by those who
fully understood and explained to them the danger, and who had charge (the
one of the boat and the other of the horses). In both cases the children
were old enough to fully understand what was said to them, the danger
described, and the duty to obey orders so urgently and repeatedly given;
and yet their conduct seemed to differ in no respect from what it would
have been had no orders been given. Indeed, after the _denoûment_, they
did not appear, in any measure, to realize that they had been to blame for
neglecting to obey the directions given.

These cases have not been related as unique, or in any measure remarkable
or uncommon in character, but as illustrations of such as may, almost any
day, be seen by the visitor at a summer resort, or by physicians in the
experience of their daily duties. The children were not half so much to
blame as were their parents, who utterly failed in their appreciation of
the importance and duty of parental government; who imagined that in order
to be a good and kind parent, and to avoid the trouble arising from
refusal, one should constantly yield to every wish and whim of the child;
and that to refuse a request indicates a lack of kindness and sympathy on
the part of the parent, and thus ere long, and indeed very early in life,
the child becomes the master of the situation, and feels little or no
obligation to yield obedience to authority.

The child who has not learned to obey the parental command is out of the
way of learning obedience to any other. Growing up under such an order of
home influences, and indulged in nearly all his wishes, he soon comes to
believe that he need be under no restraint from authority or duty outside
that of his home, and will be in danger of experiencing the penalty of
violating both the laws of society and of his own health.

If such cases were rare or exceptional, or if the results were of a
temporary nature, they might be considered as of less importance; but this
is far from the case. Every physician will readily recall many cases of
sick children who have died, not from the irremediable nature of the
disease, but because the mother will persist in allowing the child to
refuse the use of the necessary measures of relief. Darling Johnnie or
Minnie will not submit to disagreeable measures, and fights and screams if
any attempt is made to use them. This is extremely unpleasant, and the
mother cannot endure to have her pet crossed or thwarted, or obliged to do
what it does not wish to, _especially while it is ill_; and never having
required obedience when the child is in health, she is entirely unable to
do so, even when the greatest necessity may arise.

Such cases are pitiable in the extreme, as well as highly censurable. If
the mischief ended in the less grave instances, as between the child and
its parents during childhood, it would be of less importance; but this is
far from being true. The effects of such training, or rather lack of
training, continue through life with a tendency to much suffering to both
children and parents.

One of the first requisites in any course of education for the young is to
learn to obey. From the cradle to the grave, man is in constant danger
from the effects of violated laws. He is surrounded by laws as with a wall
of fire, and their infringement in any measure or degree requires that the
penalty be paid to the full. Home and school education should aid the
child in learning obedience to these laws while in childhood, that in
later life it may constitute a part of his character. No person can become
a good citizen, or useful in any considerable measure to either the State
or the community in which he may live, without such an education, and is
largely liable to become a nuisance, a criminal, or an invalid.

If, however, it is important that the child be educated to obedience so
far as his relations to others extend, it is doubly so for his own
physical and mental health. I have sometimes thought that the freedom of
our institutions and State and national governments greatly favored the
general tendency toward lax rules as to conduct, both at home and in
school, so that there exists less of self-control, both in home and social
life, than under most other forms of government. But, however this may be,
I regard it of the highest importance that the child should learn
self-control and some self-denial, both for individual and the public
good, and when this element of education is lost sight of, and the child
is permitted to grow up having his own way in most things, and his every
wish gratified, he has a large disadvantage when brought into contact with
the friction of adult life.

I have seen not a few young men and women hopelessly stranded in life,
whose early education had been one of extreme indulgence. They had never
been controlled in home-life, and when projected against the rough
experiences of actual life, were brought up with a round turn, or with no
turn at all. The shocks were too much for them; they could not bend, nor
yield, and were, therefore, broken. The lesson of obedience, which is
often one of the most difficult to learn, must be learned, like most other
lessons, when young, if it is to be effectually learned.

Again, the acquisition of self-control and obedience to law is essential
to mental discipline and training. The operations of the brain are more or
less under the control of the will, and the more thoroughly the habit of
obedience and self-control is gained, the more fully are all mental
operations under individual or will-control. The will is the highest and
grandest manifestation of the _Ego_ possible. This it is which lifts man
so immeasurably high above all other creatures, and so largely helps him
to control his own destiny on earth. By the judicious use of this, he
guides his mental operations into channels which lead to happiness and
health, or to those tending in the opposite direction; he brings into
subjection and control the vast army of his lower passions and desires,
making them minister to his own and the higher welfare of society, or he
leaves them to run riot, and ultimately to become his master.

If, therefore, he would have a brain capable of healthy mental action, he
must learn to have its operations early under the control of his
will-power. He must learn to guide it toward its higher and better
impulses, and to strengthen it with the best nourishment. He must learn
how to use not only his brain but his whole nervous system, and by this
means acquire skill in the accomplishment of various kinds of labor. In no
other way can he become self-supporting and independent, in the midst of
the conflicting and competing tendencies of modern life. Without such
self-control and independence he is constantly in danger of drifting down
and backward in the grand race in which the society of the present is
competing.

I must repeat that obedience to law, whether it be parental, social, or
civil, is one of the corner-stones, in fact, the fundamental element, in
any efficient and worthy system of education. While I would not go back to
the strict system of a hundred years ago, wherein all individuality was
lost, and nearly every thing was made to yield to the law element in
society, yet I fear that, in the recoil from that system, we have been,
and still are, in great danger of going too far in the opposite direction.
Freedom of individual thought and action, especially for the young, is in
danger of degenerating into mere license, so that, in too many quarters,
respect for parental, school, and civil authority is considered an
indication of weakness and indecision.

If something beyond mere knowledge of right and wrong always has been
necessary, and is likely to be necessary for some ages to come, among
adult persons, to deter many of them from violating the laws of society
and of their own health; if persons need the fear of penalty in the way of
illness, helplessness, and suffering to aid them in conforming to
obedience, how much more necessary it is in relation to the young, whose
experiences have been so limited, and whose reason is so immature. Hence
it is, that the parent and the educator must not only _instruct, but
enforce obedience_.




CHAPTER VIII.

HEREDITY.


It may be remarked, in a general way, that the subject of heredity is one
of profoundest significance in its relation to society. Through its
influences the peculiarities and characteristics of families and nations
are largely developed and perpetuated. It "is that biological law by which
all beings endowed with life tend to repeat themselves in their
descendants."[9] It depends upon "an internal principle of vitality" which
is so engraven upon every portion of the system before birth, that its
influence remains through life, and within certain limits pertains alike
to both the physiological and psychological nature. Not that this
influence is such, or operates in such a manner, as to repeat itself in
any stereotyped form, but rather in an endless variety of forms; while no
child resembles its parents in all respects, yet there ever occurs a
blending of the characters of both parents, together with a large number
of those characteristics which have, for long generations, been interwoven
in multiform shades and degrees in ancestors.

Passing now from the general to the particular, we find, first, in
reference to physiological characteristics and peculiarities, that these
tend to repeat themselves more or less directly, so that when they have
once appeared, they may, with reason, again be expected. Peculiarities of
the fingers and toes, of the hair, the shape of the head, the conformation
of the face, and even particular portions of the face, remain for long
periods in the same family and nations. The characteristic form of face
and nose peculiar to the Jew, is an example in point, and so invariable as
to lead to recognition, in spite of the changes and vicissitudes incident
to travel and residence during many hundreds of years, under climatic
conditions of large diversity, and ofttimes experiences of great and
protracted severity.

Not only are such peculiarities as may be considered normal transmitted,
but also such as are abnormal,--a supernumerary finger or toe, or a mole
on some portion of the face or part of the body. A supernumerary finger or
toe may be transmitted for at least four generations, though not to every
member of the family, and the experiments of Mr. Darwin, with birds, go to
show that the tendency to perpetuate such a peculiarity, exhausts itself
after a few generations, the type returning to its original character.

_Fecundity_ is also well known as an inherited character. A mother is
referred to by Girou,[10] as having had twenty-four children, five of
whom, in turn, gave birth to forty-six. A granddaughter of this woman gave
birth to sixteen. The females of some families have all or nearly all
daughters, who, in turn, have more daughters than sons for several
generations. A grandmother had nine daughters, several of whom had no sons
in the third generation.

_Longevity_ has long been recognized as one of the most transmissible of
family traits.

_Cæteris paribus_, persons connected with long-lived families have a much
more tenacious hold on life than others: the capacity for resisting the
changes of climate, the morbific conditions of the atmosphere and soil,
the influences of epidemic diseases, and the experiences of privation and
hardships, is greater than with other persons; and, conversely, the
capacity for resisting these influences is much less with persons whose
ancestors have invariably died at an early age.

So also if a person resembles in physical form, complexion, and
constitution, the ancestors of one side of his family who have lived to
old age, while those on the other side have died comparatively young, his
prospects of longevity are generally strengthened in proportion to the
extent of such resemblance. M. Levy says: "To be born of healthy and
strong parents is to have a good chance of longevity; the energy of the
constitution is the best buckler against the assault of destructive
causes. Rush did not know an octogenarian whose family did not offer many
examples of advanced old age. This observation, made by Sinclair, has
acquired the force of an axiom, so common is it to meet with longevity as
a frequent occurrence among many members of the same family. Inheritance
exercises the same influence on the total duration of life of short
period: in the Turgot family scarcely a member passed the fiftieth year;
he, who rendered it illustrious, died at the age of fifty-three, in spite
of the appearance of great vigor of temperament."

So familiar to every one are the facts connected with the transmission of
morbid physiological processes, that I need not refer to this point
further than to remark, that the phthisical, the cancerous, and the
scrofulous diatheses are those well known to be more surely inherited, and
that through these channels of diseased action whole families cease to
exist after two or three generations, unless the tendency is counteracted
by more vigorous and healthy influences from the other parent.

Passing now to the psychological traits and characters, we observe that
the same law pertains. The heredity of mental qualities is quite as
persistent as that of the physical; imagination, memory, will, intellect,
the sentiments and passions, may all be inherited. It is estimated that
not less than forty per cent. of eminent poets have had illustrious
relatives. The families of Darwin, Cuvier, Bacon, Sir Benjamin Brodie,
John Adams, Lord Macaulay, Madame de Staël, present good illustrations of
the inheritance of intellectual ability.

But no less surely are the characteristics of _morbid_ mental activity
transmitted from one generation to another. The records of asylums all
indicate that the tendency to insanity, in some of its forms, is one of
those most likely to be inherited. It is thought that more than one half
of the admissions to English asylums present evidence of an inherited
taint. The same is probably true in reference to admissions to asylums in
the United States, though it is exceedingly difficult to arrive at the
truth in all cases, inasmuch as many persons are inclined to deny that any
such tendency exists in their families, lest such a fact should appear to
its prejudice in some way or other.

It is not the case, however, that definite forms of insanity always repeat
themselves, but, on the contrary, change, so that a case of mania may
appear in the second generation as a case of melancholia, or acute
dementia; and, _vice versa_, melancholia may appear as dementia.
Information concerning the inheritance of general paralysis is not so
definite; indeed, this form of insanity generally manifests itself in
those having no tendency by inheritance, and would seem to be more
frequent among the strong and robust, and also has a tendency to appear in
the very prime of life.

It is not necessary that the tendency toward unstable mental action should
be fully developed in the parent in order that it may so appear in the
child. Parents who have for years been very odd or singular in their
habits of life and manner of speech and mental operations; those who are
subject to periods of depression, and are accustomed to look upon the dark
side of daily experiences; mothers, more often, perhaps, who have all
their lives been "nervous" or irritable and easily excited, impress more
or less profoundly these abnormal conditions upon their offspring. Great
singularity of conduct habitually displayed, periods of depression,
irritableness, and nervousness, when crossed with similar characteristics
in the other parent, or other unusual ones, not infrequently develop into
actual insanity in succeeding generations.

A good example of such a tendency is related in the April No. of the
_Journal of Mental Science_, 1881.[11] It began on the male side, the
father being "eccentric" or "peculiar," so much so as to attract the
attention of the village children. The wife had no peculiarities of
sufficient import to be marked. They had four children, three of whom were
affected mentally, one female and two males. The female was "uncommon" and
"slightly weak-minded." One of the males was said to have been
"weak-minded"; the other was "strange-looking," and odd in general
conduct. He married a woman in good health and free from any special
tendency, either mental or physical. There were born eleven children: of
these, five were imbecile; two were idiots, and the remaining four were
sane. Of these four, two had one child each, one of whom died of phthisis,
and the other is at present an imbecile.

A consumptive parent may have children who are free from this particular
form of diathesis, and yet at some period of life may be affected with
insanity; or parents with an insane diathesis may have offspring who are
tainted with scrofula, or phthisis.

Perhaps there are no habits or acquired tendencies which are more surely
transmitted than that of dipsomania or alcoholism; nor are there any which
are more difficult to eradicate when inherited, or acquired in early life.

This diathesis, however, is not always repeated in form, but frequently
passes into other abnormal conditions. Sometimes it manifests itself in
some of the forms of insanity; and again in uncontrollable passions, or
cruelty, or in idiocy, or again in a failure of moral character, or in
epilepsy.

One of the most marked cases which have come under my own observation,
occurred in a family resident in K----. The grandfather and father both
died prematurely from the effects of alcohol, and one of the children, a
lad of seven years, had such a passion for liquor, that he would swallow
at once half a tumbler of wine or whiskey unmixed with water, and could
never be near alcohol in any of its forms without begging for it. This
child, at that age, could not enunciate clearly enough to be understood by
those not familiar with him, and had been unable to learn letters, though
much care had been expended to effect it.

Gall refers to a similar case, in which both the father and grandfather
had prematurely died as drunkards, and a little grandson, exhibited strong
tendencies for alcohol when aged only five years.[12]

"Charles X----, son of an eccentric and intemperate father, manifested
instincts of great cruelty from infancy. He was sent at an early age to
various schools, but was expelled from them all. Being forced to enlist in
the army, he sold his uniform for drink, and only escaped a sentence of
death on the testimony of physicians, who declared that he was the victim
of an irresistible appetite. He was placed under restraint, and died of
general paralysis.

"A man of an excellent family of laboring people was early addicted to
drink, and died of chronic alcoholism, leaving seven children. The first
two of these died at an early age, of convulsions. The third became insane
at twenty-two, and died an idiot. The fourth, after various attempts at
suicide, fell into the lowest grade of idiocy. The fifth, of passionate
and misanthropic temper, broke off all relations with his family. His
sister suffers from nervous disorder, which chiefly takes the form of
hysteria, with intermittent attacks of insanity. The seventh, a very
intelligent workman, but of nervous temperament, freely gives expression
to the gloomiest forebodings as to his intellectual future."[13]

Dr. Morel, after having an opportunity of studying the subject in a very
large number of cases observed among the "_gamins_" of Paris, came to the
conclusion, that the effects of alcohol were of the most terrible nature,
especially when used in boyhood and early manhood, not alone on those
using it, but on their descendants; and that it became manifest in
"physical, moral, and mental degenerations."

Echeverria,[14] who has collected a large number of statistics on the
subject, gives the following in reference to the histories of sixty-eight
males and forty-seven females who had experienced alcoholism in some of
its forms: The number of children born to these persons was four hundred
and seventy-six: and of this total, twenty-three were still-born; one
hundred and seven died from convulsions in infancy; thirty-seven died from
other maladies; three committed suicide; ninety-six are epileptic;
thirteen are congenital idiots; nineteen, maniacal or hypochondriacal;
seven have general paralysis; five, locomotor ataxy; twenty-six, hysteria;
twenty-three, paralysis; nine, chorea; seven, strabismus; three are deaf;
and nineteen are scrofulous and crippled. Of these children, two hundred
and five (205), or nearly fifty per cent., have exhibited drinking
tendencies.

From the above statistics it appears that of all the nervous diatheses
which may be inherited, there are none which are more invariable in their
effects, or more surely disastrous to their unfortunate victims, than that
of alcoholism.

In short, imperfection and abnormality of nerve function in its relation
to mind, especially of intellect and character, of all shades and degrees,
may be inherited as well as acquired; and this is equally true when the
condition has not attained to that of actual disease, but simply a
tendency toward it. And if such tendency should exist on both sides of the
house, it becomes increased in the offspring in geometrical ratio, except
in so far as it may become modified through the influence of counteracting
qualities of character under the law of atavism.

The question now arises: By what measures, or through what influences, if
any, can such proneness to nervous diatheses be avoided? It may be
replied, that there are two channels through which partial relief may
come; but that any substantial results may follow, it will become
necessary that education concerning the laws of heredity shall become more
general, and the importance of right conduct in relation to them impressed
especially on the minds of young persons.

First.--Through the influence of that law of heredity by means of which
there may occur an elimination of weaknesses and proclivities toward
disease. This influence comes from the healthy side of parentage; for
instance, in the case of parents, one of whom has physical or
psychological tendencies toward disease, if the other has a healthy and
vigorous constitution, and is endowed with mental qualities of an opposite
character, these forces of the system may prove to be quite sufficient to
affect or neutralize those which, on the other side of the house, lead
toward disease, and the offspring may have an inheritance nearly, or
quite, free from such influence.

This is not unfrequently witnessed in the case even of the strongest
hereditary diseases, namely those of phthisis and insanity. The offspring
of mothers with proclivities toward either of these diseases, in case the
father is strong, may escape entirely or nearly so; this is very often
true when the well parent has an unusual power of transmitting
race-characteristics, and belongs to a family which has been noted for
longevity during two or three generations.

In this hereditary influence there lies a power of incalculable value to
the human race, a power conducing toward the elimination of morbid
diatheses, which otherwise would go on increasing in almost geometrical
ratio, until families, or even whole communities, would become diseased.

The tendencies toward health, under favorable circumstances, are greater
than toward disease, and, therefore, there exists a probability that
race-characteristics on the healthy side may prevail over those on the
unhealthy side of the house, though this may not always be found to be
true in actual experience.

Through this line of influence, and this only, can there exist any
probability of diminishing the increase of inherited insanity.
Governments and society encourage, and rightly so, the institution of the
marriage relation; the family is the corner-stone of society, and on it
are reared the fabrics of civilization and civil institutions. Probably
from no other practice or custom does there ensue so large effects in the
way of happiness, prosperity, morality, and well-being to the human race,
as from that of marriage; but the conditions of a large part of the
beneficent results of this institution, depend upon freedom from certain
tendencies to disease. Communities and states are composed of units, and
their strength and stability must depend upon that of the individuals
composing them. Quite in the degree that disease or degenerations,
physical or mental, exist in any community, in that measure prosperity and
happiness are diminished; so that from the stand-point of political
economy, even, it becomes of vast importance that the laws of hereditary
influence should be more fully understood.

The instinct of love, however, is so powerful in the vast majority of the
human race, that it overrides almost all other considerations. Persons do
not stop to consider consequences to themselves, or to those who are to
come after; they are borne on by the considerations of a present fancy or
sentiment, and there is reason to fear that any legal enactments, or
regulations, even, in the present state of knowledge on this subject,
would not be worth the paper on which they might be inscribed.

Probably the only thing which can be done is to instruct the public, and
make known, so far as possible, the influences of hereditary tendencies,
publishing them in the higher text-books of schools, and in periodicals.
It might be more clearly understood in reference to marriage, that a
sentimental fancy or a choice founded on the existence of like
characteristics, either mental or physical, not only often proves to be of
little real value in after-life toward securing happiness, but on the
other hand proves, too often, to be the source of vast misery to parents,
their children, and the community in which they may live; that the highest
consideration for the present and future should lead to careful
examination as to inherited characteristics on both sides, and of a
selection which may tend toward elimination, rather than an increase, of
these. It might be more fully understood that, generally, characteristics
of body and mind of _different qualities_, within certain degrees of
limit, contribute toward securing a well-balanced and healthy system, and
also toward a larger degree of happiness in domestic relations; that
acquired diatheses, as well as those inherited, are transmitted to those
who come after; that violations of the laws of healthy brain activity are
almost sure to be punished in the persons of children, whether they have
consisted in immoderate devotion to business or study, or in any of the
physical indulgences. In this way some advance may be hoped for, in
guiding toward that course in which lies the least danger.

The old adage, however, that "the fathers have eaten sour grapes, and the
children's teeth are set on edge," was a truth well understood some
thousands of years ago,--and yet the fathers go on indulging in sour
grapes, because the great truth fails to have taught its lesson, and the
heedlessness of youth requires line upon line, and precept upon precept,
as well as, ofttimes, the sternest of discipline. The future will
doubtless be, in a large degree, as in the past, but we may hope that when
the laws of inheritance are more commonly known, when the learning of them
becomes a part of the general education of the young, their influence will
be more beneficent than at the present time.

Especially may we have reason to expect that such will prove to be the
result in reference to those diatheses which are formed through the
influence of alcohol and tobacco, or by the indulgence of the lower
passions, but the elimination of insanity by these means can, at the most,
be only partial.

The second measure by means of which the unfavorable influences of
heredity may be modified in their subjects, is that of _education_.

I confidently believe the day will come when the first question which will
be asked concerning a child who is to commence an education, will be as to
his or her inheritance; and after obtaining all possible information
concerning this point, it will be a part of the teacher's duty to study
the physical and mental traits and tendencies of each child in the light
of this information. The time will come when the importance of
_individuality_ in education will be so highly appreciated that it will be
considered as essential in all recognized systems. Already there has been
a beginning in this direction, in reference to certain classes of
children. It is not many years since _feeble-minded children_ were treated
as most others now are, and were left to get any little education they
might be able to, with all others. Gradually the importance of individual
education for these weak-minded ones has dawned on the public mind; so
that by systems now in use, many of these, otherwise almost utterly
useless members of the community, have been trained to a degree of
usefulness and self-support.

What has been done for this class should be done for all classes of
persons whose inheritance has in any measure been of a morbid character.
These pyschic neuroses group themselves into certain forms, often at an
early age, and require special care and training from childhood, lest they
develop into actual disease in later life. Among these may be mentioned
the following:

  1. The Precocious,          }
  2. The Passionate and Cruel,}
  3. The Timid,               }Child.
  4. The Wilful,              }
  5. The Lonely,              }

For each of these classes of children special lines of education and
management should be followed, and they should be of such a character as
may tend to repress and correct tendencies of character which in the
future will be almost certain to become morbid. The professional
observations of most physicians who have large experience with diseases of
the nervous system, will suggest the cases of patients who have become
insane, and in whose inheritances and histories some of the above-named
characters have been specially prominent in childhood.

Whatever, therefore, is to be done with a view to modify proclivities
toward those morbid neuroses which result from hereditary influences, or
have been acquired through the force of habit, must be accomplished mainly
through the influence of education, reaching, in different channels, both
parents and children.




CHAPTER IX.

CONSANGUINEOUS MARRIAGES.


Something relating to the subject of consanguineous marriages, which are
not uncommon in some communities, may properly be added here, as bearing
on this subject, and as in some measure supplemental to the preceding
chapter.

There have been differing opinions among physicians in reference to the
effects upon offspring, both physical and mental, of consanguineous
marriages. Several French physicians have written able articles, the
tendency of which is to indicate that such marriages result in deaf-mutism
and idiocy. It has been claimed that the statistics of asylums for the
deaf and dumb, the blind, and the idiotic, give color to such conclusions.
Among those who have more or less fully and carefully examined the
subject, with results tending to confirm such a theory may be mentioned
Dr. Bemis, of Kentucky; Dr. Chazarain, of Bordeaux; and Mr. Boudin.

On the other hand, there have been adduced numerous statistics which
indicate that no unfavorable results follow such marriages, which can
fairly be considered as arising from consanguinity. Without entering fully
into the details of this discussion, I propose simply to indicate certain
principles and facts which have been pretty definitely settled, and such
inferences as may appear to be entirely legitimate, and also have a
bearing on our subject. For a more exhaustive examination of the question,
I may refer the reader to Ribot, on "Heredity," and Miles, on
"Stock-Breeding."

1. The ancient Egyptians, the Persians, the Syrians, and some other
nations, were accustomed to practise consanguineous marriages. Brothers
married sisters, cousins married cousins in all degrees of relationship,
and sometimes even fathers cohabited with their own daughters. Dr.
McGraw[15] says "there can be no doubt that close and continual
interbreeding has taken place time and again, without evident injurious
consequences, among simple and uncultivated communities. Notable examples
are the Pitcairn Island settlements, formed from the close
in-and-in-breeding of the progeny of four mutineers from the ship
_Bounty_, and nine native women; the small community of fishermen, near
Brighton, England; the numerous small and isolated villages of Iceland;
and the Basque and Bas-Breton settlements among the Pyrenees. We must
admit, from overwhelming evidence, that under such circumstances as the
settlements just mentioned afforded, consanguinity among married people
does not necessarily cause evil results to the progeny. If it be asked how
it would be with men of more civilized habits, we are unfortunately
obliged to confess that there are no statistics whatever on the subject
which can give us any exact and trustworthy information."

2. Experiments in interbreeding of cattle go to prove that in some cases,
at least, this may be continued for many generations with no unfavorable
results. A friend of mine has bred in-and-in a herd of Jersey cattle, as
close as a father to his progeny, for five generations, and with
apparently good results.

I have a flock of India pigeons which have been in-bred for fifteen years
to my own knowledge, and apparently with no deterioration. They are still
strong, vigorous, and prolific.

There is a herd of wild cattle now in the Chillingham Park, England, which
has been confined there for several hundred years, and strictly isolated.
No new strains have been introduced, and the herd still remains hardy and
healthy.

On the other hand, there exists a general impression among physicians,
based upon experience and observation of a general character, that
marriages of consanguinity result, more often than other marriages, in
unfavorable effects upon offspring; and the statistics collected by Dr.
Bemis and others appear, on first examination, to confirm such
conclusions.

The majority of farmers and stock-breeders in this country act upon the
theory that it is important and, indeed, necessary, in order to maintain
herds and flocks in a healthy condition, to frequently introduce other
strains of blood; and the farmer who should fail to do this in reference
to his cattle, his swine, and fowls, would be entitled to little sympathy
in case his animals should degenerate in any measure physically, or become
less prolific.

Now, the well-established principles of heredity appear to confirm, in a
general way, both these views. The qualities of parents whether healthy or
unhealthy are transmitted to offspring; and if all herds of cattle and
swine and flocks of fowls were in a strictly healthy condition, there
would exist no reasons why they might not remain so indefinitely, so far
as interbreeding is concerned.

The conditions of animal life, however, under the influence of
civilization, are certainly more unfavorable to health than when in a
native condition. This is especially true of those classes upon which we
depend for labor. The change from animal life on the broad prairies and
woods of a temperate zone, to life in stables of crowded cities and yards
of farmers, many of which are in any thing but a sanitary condition, and
to the experience of daily exposure and labor, and ofttimes to ill
treatment and improper food, induces disease no less surely among animals
than among the human race.

If either men or animals were in a condition of perfect health, there
would be no unfavorable results from marriages of consanguinity, or other
marriages, as there would exist no imperfections, either physical or
mental, to be transmitted. No such persons, however, are found. All are
tainted with the seeds of disease to a greater or less extent, and health
is a question of degree. If, now, two persons of a phthisical or insane
diathesis contract marriage, the tendency toward such a diathesis will be
greatly increased in the offspring. If this tendency in each parent be
represented by two, then it will be two multiplied by two in the
offspring, except so far as it may be modified through the influence of
atavism. This would be the case without reference to the question of
consanguinity.

But blood-relatives are vastly more likely to inherit a similar
diathesis--indeed, are quite sure to do so, if it be one of unhealthy
character,--and the atavic influences would also be similar; so that any
counteracting effect through this influence would be much less between
blood-relations than with others, and would probably be the greatest when
no such relation exists.

Here, then, becomes apparent the danger arising from consanguineous
marriages, _i. e._, that of perpetuating and intensifying unfavorable
physical and mental traits, which may be alike on both sides. Where no
such relation exists, there is a great probability that other
counteracting qualities of character and hereditary influences may modify
and even remove weaknesses, while, with such a relation existing, there is
every probability that weaknesses or tendencies toward disease, both
physical and mental, whether inherited or acquired, will become greatly
increased.

Therefore, as there exist in many families, undesirable traits of
character, both physical and mental, a removal or diminution of which is
desirable; and as there is a greater probability that this can be more
surely done, of whatever nature they may be, by introducing other and
opposing tendencies from unrelated families, it would appear to be highly
important, as a rule, to discountenance marriages of persons who are
related to each other by ties of blood.




CHAPTER X.

ALCOHOL.


Of the several individual factors, which are especially potent, as tending
to develop and perpetuate the Insane Diathesis, there are none which can
be regarded as more influential, either directly or indirectly, than
alcohol. Over-education of the brain, under-education, and heredity, all
may exert an influence which tends toward this result, and their victims
may be found in large numbers in all our asylums and hospitals; but the
effects of alcohol are so insidious, it has been so generally used in the
past, and its effects are so often transmitted to succeeding generations,
that probably the sum total of its effects are far greater than those of
either of the above-named agencies.

I therefore regard it as a happy omen for the future of society, that the
physiological effects of this substance, and its absolute uselessness and
positive injury to the human system, except as a medicine and under
exceptional circumstances, are beginning to be more clearly recognized by
the medical profession, and more generally understood by the educated
portion of society. And yet I fear we are far from the realization of any
millennial period, as to its use and abuse, in this or other countries.
Indeed, while probably there is much less of alcohol used as a beverage
among the more intelligent portion of the community at the present time
than there was fifty years ago, yet I think there is more used in that way
among the operative classes, and especially the young of large towns and
cities. The facilities of obtaining it are so much greater, that the
temptations to its use are greatly increased, and the habit of using lager
beer, ale, and wine, among those from fourteen to twenty-four or
twenty-six years of age, is certainly greatly increased, if the numbers of
this class who frequent and assist in sustaining the large number of
saloons and public-houses now so prevalent in cities, may be taken as an
indication of existing facts.

Granting, however, that actually less of alcohol is now consumed than
formerly, per capita, it by no means follows that the amount of its evil
effects is less. The conditions of life are so greatly different to-day
from those existing fifty years ago; populations reside to a so much
larger extent in-doors, so that alcohol would be much less freely and
easily eliminated from the system, than when exercising and breathing in
an out-of-door atmosphere; life is so much more intense in many of its
avocations which were then unknown, necessitating very much larger drafts
upon the brain and nervous system; the means with which to purchase and
use alcoholic beverages by the laboring classes are so much more abundant
and easily obtained now than formerly, and while living in places of
larger population than would be possible if residing in the country, or in
small villages,--all these conditions and others unite in rendering the
probability of its use greater, and its effects upon the nervous system
vastly more injurious than formerly. Under these conditions of modern
civilization a small quantity goes a long way. Besides, society is to-day
reaping the harvest of its abuse of this drug during a long period, in the
shape of a diathesis which manifests itself in various ways and under many
forms of disorder.

Some years since I had occasion to examine the history of admissions to
the Retreat, which at that time amounted to more than five thousand cases,
and it was found that in more than one tenth of these cases the cause of
insanity had been traced to the use of alcohol. This, however, did not
embrace those cases which had inherited an unstable condition of brain in
consequence of the use of alcohol by parents, and became insane for this
reason.

Of the sixteen hundred insane and imbecile or feeble-minded persons in
Connecticut at the present time, it is estimated that not less than one
fifth have become so either directly or indirectly through the influence
of alcohol. Some writers estimate the amount of insanity which is caused
through the influence of alcohol, on parents and their children, in
England, at a much higher proportion, than this. Statistics indicate that
a considerably larger amount of spirits, beer, and wine, per capita, is
used yearly in Great Britain than in the United States.

My present purpose, however, is to draw attention to the part it plays,
more particularly when used not immoderately as a beverage (if any use of
it as such can be so characterized), in creating a diathesis which renders
the brain liable to unstable and irregular action. And I may remark at the
outset that it does not so much signify in what form of beverage it may be
used. The _quantity_ taken is the important point--whether it be in the
form of beer or wine, brandy or whiskey. The alcohol contained in any or
all of these articles is _the_ thing sought for, and _its_ influence upon
the brain is that of paramount importance and consideration.

In order that we may more clearly understand the manner in which the use
of alcohol, in its various forms, as a beverage, tends to create an
unstable condition of the nervous system and irregular mental activity, it
becomes necessary to study, in some measure, its physiological effects
upon the system, as they have been demonstrated by means of experiments
conducted with scientific accuracy. This becomes the more necessary, as
there has always existed, and still exists, in the public mind a firm
belief that its effects are quite harmless, and may be even beneficial,
_if it is used in moderation only_.

I. That the primary physiological effects of alcohol upon the nervous
system are such as to cause, either directly or indirectly, a large
increase of some of the functional activities of the body, has always been
so well known, that alcohol has long been regarded as one of the most
active stimulants. Hence its so general use in medicine. And yet, to how
great an extent it acts as such, and how much is physiologically signified
by its effects as a stimulant, especially upon the primary tissues of the
body, has not been so well understood. That this may be rendered more
clear in the mind of the reader, I shall now introduce some of the results
of experiments conducted by Dr. Parkes and Count Wollowicz. These
experiments were upon the person of a strong and healthy young man, and
were intended to be as accurate as possible. They extended over two
periods: the _water period_ and the _alcohol period_, and were continued
many days in succession. During the first period, the person used no other
fluid than water, and the action of the heart was registered at regular
intervals, a mean of the several registrations being taken as a basis for
computation.

The same plan was followed during the alcohol period, and during the days
while increased amounts of alcohol were administered. I herewith give the
results in the words of their own report:

"The highest of the daily means of the pulse observed during the first, or
water, period, was 77.5; but on this day two observations were deficient.
The next highest daily mean was 77 beats.

"If, instead of the mean of the eight days, or 73.57, we compare the mean
of this one day, viz., 77 beats per minute, with the alcoholic days, so as
to be sure not to over-estimate the action of the alcohol, we find:

"On the 9th day, with one fluid ounce of alcohol, the heart beat 430 times
more.

"On the 10th day, with two fluid ounces, 1,872 times more.

"On the 11th day, with four fluid ounces, 12,960 times more.

"On the 12th day, with six fluid ounces, 30,672 times more.

"On the 13th day, with eight fluid ounces, 23,904 times more.

"On the 14th day, with eight fluid ounces, 25,488 times more.

"But as there was ephemeral fever on the 12th day, it is right to make a
deduction, and to estimate the number of beats on that day as midway
between the 11th and 13th days, or 18,432. Adopting this, the mean daily
excess of beats during the alcoholic days was 14,492, or an increase of
rather more than 13 per cent.

"The first day of alcohol gave an excess of 4 per cent., and the last of
23 per cent.; and the mean of these two gives almost the same percentage
of excess as the mean of the six days.

"Admitting that each beat of the heart was as strong during the alcoholic
period as in the water period (and it was really more powerful), the heart
on the last two days of alcohol was doing one fifth more work.

"Adopting the lowest estimate which has been given of the daily work done
by the heart, viz., as equal to 122 tons lifted one foot, the heart,
during the alcoholic period, did daily work in excess equal to lifting
15.8 tons one foot, and in the last two days did extra work to the amount
of 24 tons lifted as far.

"The period of rest for the heart was shortened, though, perhaps, not to
such an extent as would be inferred from the number of beats; for each
contraction was sooner over. The heart, on the fifth and sixth days after
alcohol was left off, and apparently at the time when the last traces of
alcohol were eliminated, showed, in the sphygmographic tracings, signs of
unusual fulness; and, perhaps, in consequence of this, when the brandy
quickened the heart again, the tracings showed a more rapid contraction of
the ventricles, but less power than in the alcoholic period. The brandy
acted, in fact, on a heart whose nutrition had not been perfectly
restored."[16]

In reference to the result of the above experiments, it will be observed
that no special notes are made except in relation to the action of the
heart. The primary effect of alcohol is upon this organ, through its
influence upon the nervous system. It, however, by no means ends here, but
through it extends to all other portions of the body.

Now, the heart (and all other organs of the system) may be said to have a
unit of power--so much, and no more inherent strength of action; so much
capacity of function. If, therefore, under the influence of alcohol or any
other drug, an organ is made to do two hours' work in one, or in any
measure an increase of its normal activity is secured, a draft is made
upon its _reserve_ power, and, that it may regain this, there must
necessarily afterward occur a period of so much less than normal activity.
In other words, what has been gained in action under the effect of
stimulus, must be lost on its withdrawal, and there must ensue a period of
feeble and imperfect action, which is radiated to all other portions of
the system, and is manifest in none more fully than in the brain. Indeed,
upon the action of the heart as to frequency and regularity, depends the
action of the brain as to continuity and strength of thought; and this, in
even a greater measure than in relation to the functions of other parts.

The brain at all times contains a much larger portion of the blood than
any other organ, and this quantity is imperatively necessary to its normal
action as to thought. To such an extent is this so, that consciousness at
once fades into darkness, and all thought ceases instantaneously, upon the
check of its circulation, even in certain limited areas of its surface.

We therefore perceive how even more important than for other organs it is,
that the circulation of the brain, the tissue of which is the most
delicate and sensitive, should remain unaffected by over-stimulation of
the heart's action, which, in reality and effect, is the controlling power
of the system, and may be likened to an engine, by means of which is kept
in operation the force requisite to move the machinery of all other
portions of the system, and maintain them in harmonious activity.

But, let us study this physiological effect of alcohol a little further,
that we may more fully understand how much is signified by it.

Every heart-beat causes a certain amount of blood to pass through the
larger arteries to the brain, and thence through its minute vessels or
capillaries. It is by means of the capillary circulation that the brain,
its cells, connective tissues, and all membranes, are supplied with the
requisite material for life and activity. So important is the _regularity_
of this supply to the brain in the discharge of its functions, that a
special arrangement of blood-vessels is provided, or rather the number of
arteries is larger and their distribution more complicated and various
than for any other organ. If now this supply of blood is increased by one
fourth or one sixth, or in any other degree, through the action of the
heart, there must result a relative increase of it to the brain-cells and
tissues, together with a corresponding increase of function.

The anatomy of the brain teaches us that every fibre, brain-cell, and even
nucleus, is enclosed with an exceedingly thin covering, through which its
contents may be nourished, and also through which, when its constituents
are no longer of any use, they may be eliminated and removed from the
body. These coverings, or membranes, as they are called, in turn, derive
their materials for growth and function from the minute capillary
blood-vessels which, in almost infinite number, supply them, while all
portions of brain tissue are together dependent upon the _regularity_ of
the heart's supply of blood to enable them to discharge their functions
in a normal manner.

Now, physiological experiments have shown that the effect of alcohol upon
that portion of the nervous system--the vaso-motor--which presides over
and supplies power of action to these capillaries, and also regulates the
action of the heart, is that of a narcotic. Its effect is to partially
paralyze this nerve, and leave the heart to act more freely and rapidly
under the influence of the motor nerve; in consequence of this partial
paralysis of the coats of the capillary vessels, when the blood passes
through them so much more rapidly than when in their normal state, they
fail to absorb from the blood the material requisite to nourish them, and
also fail to remove material which has already been used.

One of the most important of their functions however, is the removal of
this used-up material of the brain-cell, connective tissues, and fibres.
If this is imperfectly performed, and some portion of this secondary
metamorphosis of material is left unremoved, there must result at least
two not very remote effects.

1. A less sensitive and delicate condition of these several constituent
portions of brain-substance, and they will become correspondingly less
responsive to both objective and subjective impressions or influences.
There must result, therefore, a less perfect discharge of thought-function
in its various manifestations, both moral and intellectual.

2. This imperfect removal of material which has once discharged its
function, and is consequently useless, will ultimately cause a thickening
of the coverings of these cells and fibres of the brain, which, in process
of time, must render the discharge of their function more difficult and
imperfect.

II. So far, it will be observed, we have referred only to the indirect
effect of alcohol upon the brain, which results from its influence upon
the heart-action. I wish now to refer, in a few words, to its direct
physiological effect upon the mind, when used as a beverage. Its primary
effect is to cause a more rapid flow of thought. It is, as if that portion
of a watch which holds its spring and prevents its too rapid uncoiling
should be removed; the result would be a quickening of movement, and its
power of action would be greatly increased for a little time. So it is
with the mind under the primary influence of alcohol; as the blood flows
through the brain more freely, thought becomes more accelerated, and there
is an excitement of utterance and imagination. This period, however, soon
passes by, and before long the mind becomes less clear and accurate in its
perceptions; it is partially clouded; it loses the nicety of its moral
sense; it does not perceive the moral side of conduct so clearly and
definitely as formerly; it does not judge so accurately in reference to
the claims of friends and society; and there is not that sense of
propriety as to personal conduct which formerly existed. Moreover, the
rapidity of impressions becomes lessened, and consecutiveness of thought
is impaired, so that the mind fails to carry through a train of thought,
or conduct a course of reasoning, as it would do when free from the
influence of alcohol. This effect may continue under the repeated
influences of alcohol until impressions, both objective and subjective,
become less and less vivid and more circumscribed, and ultimately there
may result partial paralysis of the power of thought. It becomes more and
more liable to irregularity, confusion and weakness; the will loses its
power of control in a large degree over mental operations, and insanity in
some of its forms not infrequently ensues.

III. There is reason to believe that there results a further action of
alcohol upon the electrical currents of the body, which originate in and
proceed from the brain. Dr. Mulvaney, Staff Surgeon of the Royal Navy of
England, conducted some experiments upon the effects of alcohol on these
electrical currents, with the following results: "He discovered that an
ounce of brandy, equal to about half an ounce of alcohol, taken by a
healthy man, raised the galvanometer in a few minutes, in one case
twenty-five degrees, and in another case forty-five degrees. He concluded
that the thermo-electric currents of the system were strongly excited by
small doses of alcohol, and that this excitement may be profitably
employed when there is 'clear evidence of derangement of function
springing from enfeeblement of the organic system of nerves'; but that 'in
health, when function, nutrition, and blood and nerve influence are
harmonized by structural integrity,' such artificially excited currents,
by tending to abstract an undue amount of water from the brain-cells,
'must interfere with their normal working.'"[17]

It appears, then, that there are three well-recognized and clearly
pronounced effects upon the elements of brain-structure which must result
from the use of alcohol even in small doses. It will be observed that
nothing has been said as to its physiological effects upon membranes in
other portions of the body. I hardly need enter upon this branch of the
subject in order to establish proof of its very great effect as an agent
in producing a changed and unstable condition of brain-action. And yet we
need to bear in mind how greatly its effects on the nervous system in
general are increased by its affinity for water; and how it absorbs this
from all portions of the body with which it may come in contact, thus
tending to leave them in a shrivelled and dry condition,--one unfavorable
to discharge of function.

That this may be more clearly understood in relation to the membranes of
other portions of the system, as well as those of the brain, I quote from
Dr. Richardson[18] a few sentences:

"Upon all these membraneous structures alcohol exerts a direct perverting
power of action. It produces in them a thickening, a shrinking, and an
inactivity that reduces their functional power. That they may work rapidly
and equally, the membranes require to be at all times properly charged
with water. If into contact with them any agent is brought that deprives
them of water, then is their work interfered with; they cease to separate
the saline constituents correctly; and if the evil that is thus started be
allowed to continue, they contract upon their contained matter, in
whatever organ it may be situated, and condense it.

"By its effects upon these membranes, envelopes, and coverings, alcohol
becomes one of the most extreme causes of modification of animal function,
and one of the greatest sources of structural degeneration."

In the consideration of the subject as above, reference has been made to
the effect of alcohol upon the adult system. But there can be no question
that it is vastly greater and more ruinous in its effects upon the brain,
when used during the period of youth and early manhood. At this time, the
whole system is much more susceptible to unfavorable influences of all
kinds, and especially is this the case with the brain, and that portion of
it which is concerned in mentality.

The more highly sensitive and delicately organized any portion, or the
substance of any part of the system may be, the more easily and rapidly
are impressions and changes of a permanent character made upon it. The
brain, being more highly organized than any other organ or portion of the
body, and the metamorphosis of its tissues being more rapid during the
earlier periods of life, becomes greatly more susceptible to the bad
effects of alcohol, and a diathesis is more rapidly created. And, it may
be added, that, when this diathesis has once become developed during early
life, there exists almost no hope of eradicating it, or of again rendering
the brain healthy.

Improvement may take place while abstinence from alcohol continues and the
person is under restraint, but when once again the unfortunate victim is
thrown upon his own resources, and left to his self-control, he always
falls, and returns again to his cups, as a sow to her wallowing in the
mire.

In the preceding chapter upon Heredity in its relation to the Insane
Diathesis, it was shown that the effects of alcohol are such, that they
are most surely transmitted from parent to child; and that its effects,
both moral and physical, are of the most serious character.

We have now seen how it comes to pass that such is the nature of its
effects. By its too frequent use there results a changed condition of the
coats of the blood-vessels, and an abnormal state of the brain-cells and
fibres. In accordance with the laws of heredity, a tendency to this
condition is transmitted from parent to child, to the third or fourth
generation, unless it be sooner eliminated, and may manifest itself in any
one of the many forms mentioned, all of which are of a serious nature and
generally exist through life. The importance therefore of abstinence from
the use of alcoholic beverages by all parents, and especially by the young
of both sexes in its relation to the subject of healthy brain action, can
hardly be overestimated. No one change in the customs of society and the
habits of individuals could occur, which would exert a larger influence
toward the prevention of insanity.




CHAPTER XI.

TOBACCO.


As this substance is so generally used and so often referred to in
connection with alcohol as to its effects upon the human system, it
appears proper to allude to its physiological effects upon the brain in
this immediate connection.

Views of an opposite character as to its use have long prevailed. Much has
been written in relation to its baneful effects upon the human system, the
active poisons it is known to contain, and its demoralizing tendencies in
general. It has been accused of being the cause of numerous diseases of a
grave nature, such as cancer, chronic bronchitis, insanity, diseases of
the throat and the mucous membranes of the mouth and nose, etc., etc.

It bears the blame of causing filthy, and ofttimes disgusting, habits, and
of being not only a useless but a pernicious and expensive luxury.

On the other hand, much has been and continues to be said as to its
comforting and soothing effects, and the sense of enjoyment and luxury
resulting from it, when used in the form of smoke and with moderation.
And if an opinion as to its excellencies and value to the human race could
be formed from the amount yearly consumed, or the vast sums of capital
invested in its culture, manufacture, and sales in the United States
alone, it would take rank as an article possessed of the highest value to
mankind.

This, however, cannot be considered as a fair criterion by which to judge
of its virtues or its vices; neither can we look for an impartial judgment
as to its influence upon individuals or society, from those who may form
opinions founded on impressions or prejudices only. It becomes necessary,
therefore, to study its physiological effects as accurately and
impartially as possible, and accept such results as this course may lead
to.

For my present purpose it does not become necessary to go into details as
to the effects of all the elements of tobacco, or of the effects of any of
these elements, except as observed in their action upon the nervous
system. I shall not, therefore, enter upon any minute analysis of the
substance, preferring to leave this for those who write with a view of
covering a more extended field of research.

When tobacco, in substance, or in the form of smoke, comes in contact with
the mucous membrane of the mouth, throat, and nose, there results a more
or less distinct biting sensation on the tongue and in the throat, unless
these parts have already become accustomed to its effects. This increases
in the case of the beginner, until in a few minutes a feeling of warmth
and faintness comes on, often attended with nausea, vomiting, and
headache. If the dose has been sufficient, the person becomes faint and
unable to stand, the skin becomes cool, a perspiration appears on the
forehead, the heart acts feebly, the respiration is short and hurried, and
life itself is in danger.[19]

One of the elements of tobacco, nicotine (which is itself composed of
several bases), passes into the blood, and is conveyed in it to the brain.
As this is one of the most active poisons of which we have any knowledge,
and, as such, acts directly on the brain, rapidly inducing the conditions
mentioned, and overpowering the functions of the nervous system, it will
readily be comprehended how profound its influence must be upon the
nervous filaments and brain-cells. This influence is one of paralysis--a
deadening of the functional activity of certain portions of the brain,
and, if continued long enough, is radiated through the nerves to the heart
and other organs.

If, however, a small quantity only has been absorbed into the circulation,
the effect upon the brain is less permanent than would be expected from
its profound influence. It soon becomes eliminated from the system through
the agency of the lungs, the skin, and the kidneys,[20] and the nervous
system resumes its normal activity.

Subsequent experiences after the first few are widely different. The brain
becomes _tolerant_ of the poison, so far as relates to its more manifest
and paralyzing effect, and in the process of time the smoker realizes very
little, if any, other than a sense of soothing, and, therefore, grateful
influence upon the system. The brain even comes, in the process of time
and experience, to crave its influence. A condition, abnormal as to
experiences and cravings, has resulted, which will demand the frequent and
continued repetition of those pleasing sensations which result from its
use. When this influence passes off, there comes again into operation a
more acute activity of nerve function, and a consequent sensation
bordering upon or akin to pain as the brain begins to act under the
freedom and force of a vitality not blunted or partially paralyzed by the
presence of the poison. To relieve this there must be a repetition of its
use, and this process continues until there becomes developed a true
_diathesis_ of the nervous system, as in the case of alcohol and opium,
though one not, in general, so difficult to overcome.

Moreover, the influence of tobacco upon the brain is essentially different
from that of alcohol. From the effect of the latter there results a vast
increase of functional activity of the heart, and, in the primary stage of
its influence, of that portion of the brain which is concerned in
mentality, while no such increase of functional activity of any portion of
the nervous system results from the physiological effects of tobacco. On
the contrary, these are of a paralyzing nature while they continue. The
field of consciousness is less broad, the imagination and reason less keen
and active.

But, on the other hand, the immediate effects of tobacco are much less
permanent than those of alcohol; its elements are more speedily eliminated
through the action of the lungs, to which they pass in the blood, and also
by the skin and kidneys, toward which organs the essential oil contained
in tobacco has a much stronger tendency than alcohol has.

It must be borne in mind, however, that the effect of tobacco upon the
brain-cells is essentially and directly that of a narcotic, and in this
respect differs from that of alcohol, which acts only indirectly as such,
through its paralyzing influences upon the vaso-motor system; and
therefore its immediate effects, while they continue, are more injurious,
than would be those of alcohol, though, in reality, they are much less so,
as they so soon pass off.

It is the narcotic influence upon the brain which renders tobacco so
injurious when used by young children and youth. The frequent repetition
of this narcotic upon the nervous system in early life, serves to
partially check its growth and development, and consequently must impede
very greatly its normal activity and power of application and mental
attainment. Both the intellectual and moral powers of the mind become less
keen and sensitive, so that a less high standard in these departments of
mentality is reached by those children who use tobacco than would
otherwise be possible for them; and I am not surprised, therefore, to
learn that, in consequence of observations as to the influence of tobacco
upon the youth in the schools of both Germany and France, legal
enactments, as against its use by these scholars, have been made. Such
enactments ought to exist in the schools of all civilized countries, and I
have no doubt the time will come when they will.

It appears to me to be especially important that such legal enactments as
against its use by children should obtain in this country, where the
facilities for obtaining it are greater than in most others. The example
of its use is almost constantly before little children when on the street.
It is generally and lavishly used by a large proportion of men; the tax on
it is lower, and the price cheaper, than elsewhere; and there exists a
custom of throwing away half-used cigars on the streets and sidewalks, so
that children can easily obtain the article without cost. It is rarely the
case when in town that I do not see boys from six to twelve years of age,
smoking together these half-used cigars.

The children of the poor are frequently or nightly on the street long
after dark, and are, consequently, very little under the restraint of
parental government; they are constantly under the influence of the
example of older persons in reference to this habit of smoking, and,
therefore, are in danger of contracting it very early in life. In the
absence of other restraint they specially need that of the guardians of
law, and the highest interests of society require that they have it.

The _Boston Journal_ has recently published the results of investigations
concerning the number of boys in the public schools of that city who use
tobacco. The master of the Latin School informs the reporter that one half
of the boys from fourteen to eighteen years of age had used the weed,
though probably few had fully contracted the habit. Many of them smoke on
the sly, though some have the permission of their parents to use it. In
the English High School, it is thought that few of the boys smoke, and
none are allowed to chew. The master's view, however, is that a teacher's
precepts are of little use in preventing the habit unless they are
reinforced by his example. The principal of the Dudley School, Boston
Highlands, is of the opinion that something like forty per cent. of his
boys use it more or less. The master of the Emerson School, East Boston,
having studied the subject, concludes that out of four hundred boys there
are forty habitual smokers, and that one third of the whole number
occasionally smoke. He thinks that it is rarely the case that boys begin
smoking _before they are eight years of age_. In the Grammar School at
Charlestown it is estimated that forty of the three hundred boys use
tobacco habitually, and that many more have occasionally smoked. Master
Harrington, of the Eliot School does not think that a larger proportion
than one third of all his boys have yet contracted the habit.

Not a few young men have consulted me professionally, whose nervous
systems have been greatly impaired from the habit of smoking, and who say
they formed the habit when not more than eight or ten years of age, and
they would gladly give it up, and undo its influence if such a thing were
possible. In such cases society should protect itself, at least until the
individual has become old enough to realize, in some measure, the results
of his action.

Of the effects of the use of tobacco upon other portions of the system
than the brain it is not within my province, or necessary to my purpose,
to refer at this time, though they may be, and doubtless are of a grave
character in some cases. To sum up its effects upon the mental and moral
character of the young, when it is daily or frequently used, I cannot do
better than use the words of a pamphlet published by Monsieur Fiévée in
relation to its general effects upon society:

"We do not insist principally on the material disasters resulting from
tobacco, knowing very well that any reasoning on this subject will not
produce conviction. A danger of far greater interest to those concerned in
the preservation of the individual, is the enfeeblement of the human mind,
the loss of the powers of intelligence and of moral energy; in a word, of
the vigor of the intellect, one of the elements of which is memory. We are
much deceived if the statistics of actual mental vigor would not prove the
lower level of the intellect throughout Europe since the introduction of
tobacco. The Spaniards have first experienced the penalty of its abuse,
the example of which they have so industriously propagated, and the
elements of which originated in their conquests and their ancient energy.
The rich Havana enjoys the monopoly of the poison which procures so much
gold in return for so many victims; but the Spaniards have paid for it
also by the loss of their political importance, of their rich appanage of
art and literature, of their chivalry, which made them one of the first
peoples of the world. Admitting that other causes operated, tobacco has
been one of the most influential. Spain is now a vast tobacco-shop, and
its only consolation is, that other nations are fast approaching its
level.

"Tobacco, as the great flatterer of sensuality, is one of the most
energetic promoters of individualism--that is, of a weakening of social
ties. Its appearance coincides fatally with reform and the spirit of
inquiry. Man inaugurates the introduction of logic in matters
inaccessible, at the same time that, as Montaigne says, he gives way to a
habit destructive of the faculty of ratiocination--a contradiction which
shows us that necessity of defect by which he is tortured."[21]

Two inferences may be drawn from the results of our discussion.

1. It does not appear from the considerations presented above, that
tobacco is an agent _directly_ responsible in any large degree for the
production of insanity, nor does this appear to be the case as indicated
by the statistics of asylums for the insane, nor by observation or
experience. It rather appears that it is responsible as an agent which, in
some measure, from its effects as a poison on the brain, must tend to
check the growth and development of the intellectual and moral power in
the individual, especially when indulged in during the period of youth and
early manhood; and thus it becomes allied with other agencies which, in
many cases, would not otherwise become operative in the production of
insanity.

2. It also becomes a factor of importance in indirectly producing disease
of the nervous system, through hereditary influence. As we have so
frequently had occasion to observe hitherto, any abnormal condition which
has existed sufficiently long to become a true diathesis, not only may,
but is very likely to be transmitted in some form or other to those who
come after. This has been shown in relation to the influence of
over-stimulation from application to study, and from the effects of
alcohol; and though the effects of both these are essentially different
from that of tobacco, yet we can but consider the latter as very injurious
in its influence. Indeed, I am inclined to regard the physiological
effects of tobacco when used to excess as likely to appear in offspring in
the form of a lower grade of intellectual and moral character, though to a
less extent than are those of alcohol.




CHAPTER XII.

SEX IN RELATION TO INSANITY.


The relative frequency of insanity in the sexes varies somewhat in
different countries and under the differing conditions of civilization.
There can be no doubt that under circumstances and surroundings adapted
equally to the maintenance of the health of both sexes, there would be as
little disease of brain in the one as in the other. The conditions of
life, however, nowhere exist bearing alike on both. While there are
certain hardships, exposures, and dangers to be endured by the male to
which the female is little liable, on the other hand there are many
unfavoring experiences growing out of the nature of her labor and duties
as arranged in modern civilization, as well as from the constitution of
her system, from which the male sex is exempt. While the male is more
often exposed to the inclemency of weather, the cold of winter and the
heat of summer; while he must endure the hardships of war by sea and land,
and the larger expenditure of physical force in the performance of his
labor; while he is much more liable to injury of the nervous system from
accidents arising in connection with his exposures in the larger sphere of
locomotion; on the other hand the female is much less favorably situated
in relation to the beneficial effects arising from living much in the open
air. The sphere of her activities is much more circumscribed, and the
larger portion of her time is passed in-doors, and often in an atmosphere
less favorable as to its hygienic conditions.

There are, however, certain physical conditions of the female sex which
are intimately connected with the sexual system, and which have been
supposed, by both lay and professional persons, to be closely allied, as
causes, to mental derangements, to which I desire to call attention for
the present. These will relate more especially to the unmarried.

In a general way the sexual system in the female exerts a much larger
influence on the whole physical and mental economy, than in the male. A
very intimate sympathy exists between it and both the stomach and the
brain. This becomes especially manifest at the period of puberty, and
continues until after the cessation of menstruation. The whole moral
nature appears to become changed, or rather it appears to come into
existence and activity when the child becomes a woman, and thereafter, for
thirty or thirty-five years, the whole person is largely affected one
fourth of the time by the functional activity of the pelvic organ.

The amount and quality of the blood, and its physiological effect upon the
vessels and cells of the brain, must largely depend upon the regularity
and perfect discharge of this function; and in the case of married women
the whole economy is subject to the large changes which come from
conception, pregnancy, child-birth, and lactation.

The cessation of menstruation must also, in most cases, be attended by
such changes as are of grave import: the calling into a larger activity
other organs of the body, especially the liver and the skin for the
purpose of eliminating those products of secondary metamorphosis which
before had passed from the system by the uterus; the consequent
disturbance of the circulation while this adjustment of functions is being
made; the increased amount of carbon left in the blood, and its effects
upon the brain;--every general practitioner of medicine has abundant
occasion to witness how great effects all these experiences produce upon
the nervous system; how excited or depressed, how irritable and nervous
and changeful the brain becomes from their influence upon it.

But in addition to these generally obvious effects, the gynæcologist has
occasion to observe other, and which he may regard as no less potent,
results of reflex influence on the brain from uterine disturbance of
other kinds, which more especially affect the unmarried class, which every
year becomes larger among all the older civilizations.

The condition of marriage is doubtless the normal one for both sexes, and,
as a rule, a larger degree of physical health is enjoyed by persons who
live in this relation. In no other is the discharge of the natural
functions of the sexual organs possible. As society is at present
constituted, however, more especially in the older civilizations, marriage
and its consequent responsibilities become more and more difficult, and
the female is the larger sufferer by a failure to consummate this
relation. All those instinctive yearnings for objects of affection and
love in the way of husband and children; all the outgoing of longing for
all that is implied in home, the care of it, and all connected with it;
with no one to cling to and depend upon in hours of sickness and trial;
the turning back, keeping down, and putting forever away into darkness all
those natural desires and passions which arise and tend to press forward
for recognition from time to time;--in short, the failure to develop and
bring into its mutual relation to other portions of the system this, which
is arranged and designed by nature to play so significant a part in the
female economy of life, can but tend in no small degree to cause a
somewhat abnormal condition and activity of the general nervous system.

Persons become nervous, capricious, irritable, and hysterical. A feeling
of lassitude and weariness results from any considerable physical effort,
and they are unable to endure the friction and annoyances of ordinary
daily life without much complaint. They feel badly without knowing why,
and are unable to long apply the mind to any particular task, or
persistently to carry forward any kind of employment. An experience of a
year or two, more or less, of this kind of nervous debility and suffering
generally lands many of these persons in the hands of the physician, and
no small number in those of the gynæcologist.

On examination there is frequently found to exist uterine derangement of
one kind or another: it may be congestion or a sub-acute inflammatory
condition of the neck of the uterus; in some cases there is endo-metritis,
or peri-metritis, abrasive ulceration attended with discharge, or there
may be displacement in the way of any of the flexions. Or again, there may
be defective, or irregular menstrual discharge, dysmenorrhoea, or
amenorrhoea. My impression is that some one of these various lesions of
the uterus will be found to exist in a large number of females who have
exhibited, for some time, such physical and mental conditions and symptoms
as have been detailed above.

Now, one of the inferences of the gynæcologist is likely to be, that the
uterine lesion, of whatever nature it may chance to be, is the cause of
the failure in mental and general health; that it is the "_fons et origo_"
whence has arisen the long train of nervous symptoms, and, doubtless, in
some cases this may be a correct inference; but in a vast majority of
cases my impression is that both the existing debility of the nervous
system and the uterine lesion are to be regarded as _consequences_, and
that neither is a cause of the other, but rather that they both result
mainly from a failure in the discharge of those functions which more
especially pertain to the sexual system, and a disregard of the laws of
health as to physical exercise.

But what I desire to specially note in this connection is, that these
symptoms or manifestations of nervous derangement are not those of
insanity, that they rarely pass over or develop into those of insanity.
There is prevalent, both among lay and professional persons, an idea that
a large number of females become insane, from the existence of some such
uterine conditions, or that these have a large influence in producing
insanity. My experience, however, points to an opposite conclusion. It is
rare to find any of the uterine lesions referred to existing among insane
women; and this is doubtless explicable for physiological reasons.

In almost all cases of acute insanity there exists a much larger amount of
mental activity than when the brain is in a normal condition. The
processes of thought go on during a larger number of hours every day, and
the period of sleep, in which there is a demand for a more limited supply
of blood in the brain, is correspondingly diminished. Then, again, the
character of mental operations is generally of much greater intensity;
impressions are more numerous, sensations are more vivid, and thoughts
press their way onward through the channels of nerve-cells and fibres of
the brain with greater rapidity and constancy.

Almost the whole force and energy of the nervous system appear to be
centred in the brain, and to supply the wear arising from such increased
activity of the brain, the system calls for a larger supply of blood in
this organ. It is therefore diverted from other portions, and there
results a diminished sensibility and activity especially of the sexual
system. In a large majority of these cases also, the monthly discharge
ceases to appear, and the sexual functions are in partial abeyance.

Now, in consequence of those changes which tend to occur in the vessels
and cells of the brain when a person becomes insane, if there were
existing any such functional uterine lesions as I have referred to, there
would at once arise a tendency to recovery from them; the monthly
congestions generally disappear, and such passive congestions as may have
long existed would also tend to pass away. An inflamed, or irritable, or
ulcerated neck would, in the absence of the usual physiological activities
of the organ, have a tendency toward recovery, except in some few rare
cases; and by the removal of congestions there would exist little if any
cause for displacements.

This may be said to be mere theory, but it happens to be certainly in
accordance with the experience of those psychologists who have studied the
tendencies and conditions of the uterus during periods of insanity. In an
experience extending over many years and embracing many cases, the number
of the above-named uterine diseases found by me could almost, if not
quite, be counted on my fingers.

While, therefore, such diseases of different kinds and degrees may, and
generally do, co-exist with general debility of the nervous system, they
are rarely found to be, and probably seldom are sufficient in themselves,
as causes of insanity, though they may sometimes be allied with other and
more potent influences in its production.

I may add that similar conditions of the female nervous system not
unfrequently arise among the married, when persons long live in the
relations of marriage, and yet without its natural results in the way of
a number of children, especially if, as is almost always the case,
improper measures are used to prevent the increase of the family.

I might in this place refer to another of those conditions of life
inherent in our civilization, which is unfavorable to the mental health of
the female sex, viz., the limited sphere of physical and mental
occupation, as compared with that of the male sex. So much, however, has
been written on this subject in its relations to and effects upon the
general welfare of women, and there appears to be so large a tendency on
the part of society, at least in this country, to admit her to any and
almost all such occupations as she may qualify herself to follow, that I
shall not refer to it further than to remark that, in so far as there may
exist a disposition on the part of women to avoid the care and
responsibility incident to home life and family, and, instead, to indulge
in physical inactivity; in so far as they avoid physical exercise in the
open air, and spend their hours of leisure in reading exciting novels, or
love-stories, whose heroes and heroines are generally of almost any other
kind of character than real, living, healthy, ones; in so far as they
avoid the conscientious discharge of those duties which devolve upon them
by virtue of their high mission as wives and mothers, and seek, instead,
to follow occupations or professions for which they cannot be best
qualified by reason of the nature, physiological activities, and duties of
their sex; in so far as they divert that nervous energy and physical
strength which is designed by nature to enable them to discharge the
sacred function of motherhood into other channels of activity, however
high and ennobling they may be,--in just so far are they deviating from
that great highway which leads to mental health and the highest interests
of humanity.

No aspirations of woman can ever reach so high and grand a sphere in the
activities of the world as that enshrined in the name of mother; and since
Nature has crowned her with this supremest function, all effort to forget
or change it, to belittle or push it aside for other more transitory
pleasures or missions, can only lead, in the end, to unhappiness and too
often to disease.




CHAPTER XIII.

POVERTY.


Physical labor is one of the greatest promoters of both physical and
mental health, and its necessity should therefore be regarded as a
blessing rather than a curse for the vast majority of mankind. On the
other hand, idleness of mind and body, or conditions of life which give
neither opportunity nor necessity for exertion, tend toward ill-health and
unhappiness, and consequently are to be avoided.

The condition of poverty creates the necessity for labor, and, if its
stress is not too great, is not to be regarded as an unmixed evil. It
stimulates to exertion, and exertion tends to develop and strengthen all
portions of the system. The natural tendency of the mind is to run riot,
to avoid hardship, and to follow the enjoyment of the present moment
irrespective of the future, and it is only that discipline which comes
from the necessities of life in the midst of civilization, which can lead
it up to a higher standard of endurance and health.

If, therefore, the effects of poverty were to end here, they might
properly be regarded as blessings. But this is not the case; for the vast
majority of the poor they go much beyond the requirements of health-giving
labor and discipline, and manifest themselves in quite an opposite result.
The lack of brain-discipline, ignorance, too many hours of toil, too few
of relaxation, illy-prepared or unsuitable food, foul air in sleeping
apartments, unsanitary surroundings, and other conditions always attendant
upon the poor, especially in large towns and cities, all tend toward
deterioration of brain-tissue.

There have also resulted, for that class of the poor which has, in more
recent periods, and in some cases by fortuitous circumstances, come
suddenly into the possession of considerable sums of money, even greater
evils than those experienced from poverty. There are many persons who get
along well enough while obliged to live in the simplicity and continence
of a laborious life which provides for them food and raiment, who, when
possessed of the requisite means, will suddenly rush into wild excesses,
and in a few years their nervous systems become poisoned and wrecked. This
is especially the case in many of the new cities which have been springing
into existence within the last fifty years, stimulated thereto by
manufacturing industries. These cities provide the temptations toward, and
the means of gratifying, physical excesses, and the influence of example
serves to drag down thousands who might otherwise escape.

Moreover, the accumulation of wealth in these large places exerts an
influence not only upon those residing there, but also upon the ignorant
poor living in the vicinage, and serves to allure them to dangerous
courses of conduct who have never learned that the violation of laws which
should preside over and regulate their appetites and passions leads to
death, or, what is frequently a thousand times worse than death, viz., a
poisoned and wrecked life.

If the effects ceased with those primarily concerned, the mischief would
be less: but, unfortunately for society, they pass on to the next, or
succeeding generations, unless, as is frequently the case, through the
operation of a merciful law there does not come another generation. We are
told that the intemperate and the vicious will be shut out of the kingdom
of heaven. We have only to observe that they are shut out of the kingdom
of health while upon earth, and that the retribution of their works
follows them with a surety, and often a severity, which can be fully
realized only by physicians.

As illustrative of this point, I may refer to a class of laborers in some
of the northern portions of England. When living on the simple necessities
of life and obliged to practise the habits of frugality and industry, that
form of disease which is termed "general paralysis of the insane" was
almost unknown among them; but in consequence of physical excesses made
possible and easy, by obtaining through labor combinations the means
necessary, this most formidable and incurable disease has appeared among
them to an extent hitherto unknown among any class of society.

Similar influences are silently working and similar results are following
in a less marked degree in all our great cities and their vicinage, so
that there are to-day in all the large hospitals for the insane which are
located near these places, as indicated by statistics, more than three
times as many cases of this disease as existed thirty years ago.

There is another class of the poor, or rather of those who are living in
the conditions of poverty, and yet have, by virtue of hard labor and
economy, succeeded in accumulating some property, which contributes a
large number yearly to the admissions to hospitals for the insane. These
persons go on year after year in one unvarying routine of labor and care,
allowing themselves little or no change or hours of recreation. Perhaps I
cannot delineate more clearly the courses of daily conduct followed by
them which not unfrequently eventuate in insanity, or better illustrate
the results of such a course of life, than by reciting a case from my
yearly report for 1881.

Mrs. M., aged forty-four years, the mother of eight children, was admitted
to the Retreat in the month of January, 18--, affected with acute mania.
The husband, when asked if he could suggest any cause, or causes, of her
illness, exclaimed with much animation that he could not conceive why his
wife had become ill. "Her is a most domestic woman, is always doing
something for her children; _her_ is _always_ at work for us all; _never_
goes out of the house, even to church on Sundays; her never goes gadding
about at neighbors' houses, or talking from one to another; her always had
the boots blacked in the morning; her has been one of the best of wives
and mothers, and was _always_ at home."

This appreciative husband could hardly have furnished a more graphic
delineation of the causes of his poor wife's illness if he had understood
them ever so thoroughly, and I allude to the case as a type of many, and
to the husband's statement as evincing how thoroughly ignorant many
people, who may be shrewd and quite thrifty in worldly matters, may be as
to the primary conditions of mental health.

This woman's utter disregard of the simplest laws of health, had rendered
her in her husband's eyes chief among women, had raised her so high on the
pedestal of housewifery, that he could not conceive how it was possible
for such a model of excellence ever to become insane. If, however, she
had committed a few of the sins which were so heinous in her husband's
sight; if she had gossipped more; if she had broken away from the spell of
husband and children, forced herself from that ceaseless round of
household care and duty; if she had taken herself out of the house, into
the pure air and sunshine of heaven, even at the expense of much tattle
and large gossip, and, if need be, at the expense of less cleanly floors
and _boots_, and an occasional tear in her husband's shirt, or her
children's frocks, the probabilities are largely indicative that she would
never have come to the Retreat insane.

This case, so homely in its presentation, is one representative of many,
especially of persons who live in the country portions of New England, a
little more pronounced in character perhaps, and a little more exaggerated
in detail, but, nevertheless, it exhibits how insensibly and slowly
operate many of the influences existing among the ignorant, which
ultimately land victims in institutions for the insane.

The currents of thought and care have gone on day after day, and month
after month, from early morning until late at night in one ceaseless
round; wakeful and anxious often for children sick, for children who are
to be clothed and fed and schooled; anxious in reference to the thousand
and one household cares, which never lift from the brain of such a
mother; with no intellectual or social world outside the dark walls and
many times illy ventillated rooms of her own house; with no range of
thought on outside matters; with no one to interpose or even understand
the danger; with no books to read, or, if she had, no time to read
them;--in short, with no vision for time or eternity, beyond one unending
contest with cooking and scrubbing and mending,--what wonder that the poor
brain succumbs! The wonder rather is that it continues in working order so
long as it does without becoming utterly wrecked. More fresh,
health-giving air, more change, more holidays, more reading, more
gossiping, more of almost any thing to change the monotony of such a life,
to break the spell which so holds these poor women, and to lead their
minds in pastures more green, and by rivers whose waters are less stagnant
and bitter.

But below and far beyond this class of persons, there are the innumerable
ones who are born into a world of poverty and vice. It is their
inheritance from long lines of ancestry; they are crippled from the
beginning and have but half a chance in securing or retaining the prizes
of health and success.

In the great contest of life the weaker go to the wall. That term so
commonly now in use, "the survival of the fittest" in the struggle of
life, covers a large ground, and numberless are the tales of suffering,
want, and consequent disease which, hidden from the light of day, are
known only to the physician or the philanthropist. I hardly need refer to
the sanitary surroundings of those portions of our large cities, and those
of Europe, which are occupied by the poorer classes of society: the impure
air from overcrowding, the effect of which upon the delicate tissues of
the nervous system is deleterious in the highest degree; the lack of all
facilities for bathing; the insufficient, irregular, and often unwholesome
food-supply; the habit of drunkenness from the use of alcohol in some of
its worst preparations, and habits of daily tippling which keeps the brain
in a state of constant excitement; together with the immoral practices
which grow out of such surroundings and habits of life,--all tend strongly
in one direction.

By going through some of the hospitals for the insane in the vicinity of
New York, or those which are the recipients of the mental wrecks which
drift out of the lower grades of society, in the great manufacturing towns
and cities of this country or of England, one may gain some more vivid
conceptions of the influences which expend themselves upon the nervous
system among these poorer classes of society.

We have seen, in the spring season of the year, the trees of an orchard
white with unnumbered blossoms. Myriads on myriads feed every passing
breeze with delicious odors for a day, and then drop to the ground. And
when the fruit is formed from a very few only of these innumerable
blossoms on the trees, a limited number only of the whole attain to
maturity and perfection, while the ground is strewn with the windfalls and
the useless. Why the one goes on to maturity, while the other perishes so
prodigally and so soon, we may not say with certainty, but doubtless it is
due to some slight degree of advantage in the starting of the voyage; it
may be a moment or an hour of time, or a particle of nourishment, but to
whatsoever cause it may be due, it is sufficient, and there is no remedy.

So it is in the grand struggle of human life. Myriads perish at the very
start, and as the process of life goes forward, as its conditions become
complicated and antagonistic, one by one--always the weaker,--by reason of
some poverty in organization, inherited or acquired, falls out by the way,
while the vast procession of humanity presses on and upward on its
mysterious mission. So it has ever been in the past, and so it will be in
the future. The stronger in body and mind will rise above and triumph over
the hardnesses and roughnesses of life, becoming stronger by the very
effort of so doing. To him that hath shall be given, and he shall have an
abundance of the possessions of life, but that abundance is drawn from him
that has but little, and he falls out by the way, as the fruit untimely
falls from the tree. Many of these poverty-stricken ones are the
psychological windfalls of society.

Christianity has taught us to pick them up and try to nurse them to
strength for further battle. She has built hospitals and asylums of refuge
from the storm, into which these weaker ones drift, and here, at least for
the present, lies the field for her efforts toward ameliorating their
condition. It was true thousands of years ago that the poor were
everywhere and always present in all conditions of society. It has been so
since, and probably will always continue to be so, so long as society
continues; and we have no reason to expect other results from the
conditions of poverty hereafter than heretofore. Only as the number of its
victims may become fewer, through the influence of an education which will
enable persons to be self-supporting, will the grand total of mental
disease and the misery caused by it become less.




CHAPTER XIV.

RELIGION.


Two facts relating to the history of religious belief stand out with
clearness and prominence in the past. The first is, that man's belief in
his relation toward and responsibility to a Supreme Being has been one of
the most important and influential factors in guiding his conduct, and
leading him on and up in the pathways of civilization, since his history
began. Indeed, it has been the foundation on which governments and
societies have been built up, and the relations and obligations of man
toward man have been established.

The other, which is no less clear and important, is, that this belief has
been made an instrument, in the hands of designing men, of vast suffering
to thousands of the human race, and its history, under the influence of
fanaticism, has been too often written in suffering. The most gigantic
wars have been instituted, and the most cruel wrongs have been
perpetrated; the advancement of science and liberty has been retarded, in
too many instances, by those claiming to be the ministers of religion.
Perhaps it is not too much to allow that some of the most bigoted
cruelties which have ever disgraced the human race have been done in the
name and under the garb of religion.

These things, however, have not resulted directly from the character of
religious influence, but rather from an absence of such influence upon the
conduct of men; and in some cases from the darkness of misconceptions and
only partly realized truths.

If, then, religious belief has exerted so powerful an influence for good,
and indirectly for ill, on human character and conduct while in health, we
are prepared to appreciate the fact that, when weakened by the influence
of disease, it still manifests itself, and that, in some cases at least,
the mind is tinged with morbid views concerning it. When the brain is
under the influence of disease, or when the will-power is much impaired,
thought runs in channels long used, or where deepest impressions have been
made during some former period of life, and hence it would be expected
that the disordered mind, in some cases, would dwell more or less
continually on such a subject as religious experience or a lack of it; and
accordingly, we find in most asylums patients whose thoughts are occupied
more especially on their failures in the past in relation to religious
obligation and conduct.

In my view, however, it would be a mistake to conclude in these or other
cases, that the insanity has been in any wise occasioned by any form of
religious belief, or by the absence of it, unless in consequence, the
individual has been more ready to violate the laws of health by courses of
conduct which he would have been hindered from had he been under the
restraint of such belief. That these religious sentiments have become
excessive is a result of the disease of brain, and has no relation to
_cause_; and, if the mind did not dwell upon this subject with a morbid
anxiety and intensity, it would be sure to do so on some other. The fact
that it happens to be upon religion, rather than on some other subject, is
a mere accident, or rather is probably due to the past experience of the
individual, or lack of it in this respect.

The truth is, that religious ideas and beliefs are innate in man. We find
them in some form or other among all tribes and races, from the lowest
South Sea Islander up to the representative types of the race; all alike
realize, imperfectly it may be, and yet distinctly, that they are both
feeble and ignorant, in the midst of the infinite variety and extent of
the universe about them, and they instinctively look, in their feebleness,
toward a Power above and superior to them, as naturally as the child looks
to the parent for support and protection.

There is a law operative among all creatures, that every instinct of the
being has something answering to it from without, toward which it turns in
its periods of need and helplessness. The breast of the mother answers to
the instinctive action of the hungry infant; the strength of parents to
the feeble clinging of the child; the atmosphere to the outstretched
moving wing of the bird; the water to the waving fin of the newly hatched
fish; and these instincts would not exist except for the answering reality
outside and about them, which calls them into activity.

So it must ever be, as to religious belief in the human race. Man realizes
at times, and will always continue to do so, that he is a very helpless
being in the midst of a stupendous system, a relentless on-going of
nature, silent as the tomb and terrible as fate, and from which there come
to him no voices of assurance and no gleams of hope. It cannot otherwise
be, than that he should feel, even in the fulness of his strength and the
highest realization of his powers, that he stands as on a grain of sand
only; that the longest ranges of his vision are soon enveloped in
darkness; that his knowledge is as ignorance when compared with that
wisdom which is manifested by the greatness of worlds which look down upon
him from the depths of space. He must always realize how feeble are his
highest conceptions or imaginations, when he tries to push them out among
the systems of worlds which are so much larger and grander than his own,
or when he undertakes to change or regulate a movement or operation of
nature.

This being so, it must be that man will, in the future as in the past,
look toward and seek help from some Power above and beyond himself. The
instinct is and must be as true to the reality as is that of the hungry
child when it turns to its mother, or that of the fish which leads it to
move when in the water; and, as the water answers to the instinct of the
fish, as the breast of the mother to the calling of the child, and the
atmosphere to the wing of the bird, so, too, must there exist a Being
responsive to that instinct which leads man to pray and trust.

That this quality or faculty of his nature has been unwisely used, that it
has been greatly abused; that it has been mis-educated, and often
mis-directed, and too often turned into an instrument for inflicting
suffering and ill, history, alas! makes only too clear; but so have other
faculties of man's mind, and so will they continue to be, except they are
trained and educated toward higher and better purposes; and the problem in
reference to religious belief is, not how to ignore or blot it out, or
ridicule it as a monument of superstitious belief, or explain it away,
but rather how to so educate and strengthen it, that it shall conduce
toward endurance and stability of the brain, and thus render it better
able to bear up under the strain, labors, and harassing disappointments of
life. It appears to me that religious belief may be made one of the most
potent of agencies in this direction, and the following suggestions would
seem to strengthen this view.

First, the laws of health and those of religion go hand in hand; the two
fundamentally agree. There exists a broad basis in the very nature of
man's system, on which to build up religious belief and practice.
Temperance, honesty, obedience to parents, truthfulness, chastity,
recognition of sacred times, and brotherly kindness are no less in
accordance with the laws of bodily and mental health, than they are with
the laws and ordinances of the Christian religion, and when man sins
against one he does also against the other. The two are in harmony with
the constitution of his system, and their observance can conduce only
toward his highest health and consequent happiness. On the other hand, a
failure in their observance, or intemperance, licentiousness, and
dishonesty, no less surely war against the nature of his mental
constitution, and tend toward ill-health.

Again, a religious belief and practice conduce largely toward sustaining
the mind in the experience of suffering and misfortune, and thus are
indirectly of very essential service toward securing and preserving
integrity of mental action.

Account for the fact as we may, the conditions of society are sadly out of
gear. The vast majority of the human race now are, always have been, and
are always likely to be, in a condition largely of dependence. The most
sanguine optimist must admit that long ages will pass, ere that time shall
come when the superior in physical and mental ability shall not use that
superiority for his own advantage, as against that of his less-favored
brother. In the later phases of civilization, this has passed somewhat
from the manifestation of muscular force, but it has only gone over into
that of mental force. Brain now rules where formerly muscle did; and the
man of superior brain, to-day, under the forms and protection of law, and
by virtue of his intelligence, rules over others, and secures his
purposes, as surely as formerly the man of greater physical strength did.

So long as such conditions continue, so long will ignorance, disease, and
misery exist, and consequently there will exist in the human system needs
of the consolation and hope which can come to man only from the teachings
of religion. And he will not only require the teachings of religion by
which to be guided and its admonitions to influence, but also such hopes
and anticipations as it alone can offer as to a higher and better
condition of existence hereafter. The expectation that, some time in the
ages of the world, some of those who are to come after him may possibly be
in a more favored condition of existence on earth, will afford too little
comfort to him in his ofttimes-condition of suffering and ignorance. If
the present is to end all, and there may be no to-morrow for him in which
he may hope for some adjustment and anticipate a higher plane of
existence, then the darkness and mystery of life itself become profoundly
inexplicable. But the expectation of a condition of existence hereafter,
wherein he shall be released from the companions of disease and want,
which now so often haunt his every year of life, will stimulate hope, and
consequently tend toward health of mind.

Again, man requires that which religion alone can bring to him to satisfy
the aspirations of his higher nature. The press and throng of daily life,
in its many-sided avocations, satisfy only as to material things and for a
brief present. Science, in its numerous phases and advancing strides, has
done something, and there can be no doubt will in the future do still
more, for man's happiness and material gain; but these are not all, nor
sufficient for his greatest needs. They deal only with things observable
and physical.

Science unfolds some of the mysterious processes which are constantly
going on in man's system; it demonstrates or photographs for the eye the
approximate structure of nerve-cells or globules of blood; it has traced
out some of the mysterious mechanism of cerebration, and delineated with
more or less exactitude some of the great chemical activities which are
forever going on in organic bodies. It has gone farther, and revealed some
of the hitherto wonderful mysteries in the earth and in the worlds above.

But, after all, its sphere is circumscribed, and mystery still surrounds
us with an impassable wall. The greatest and wisest of its votaries have
at last to confess with confusion of face that they have arrived only on
the brink of an ocean which is infinite--that they know but little.

Science is good and its study ennobling, but it does not suffice for man's
highest aspirations, nor for the development of his moral nature. It has
never explained the mystery of a single act of his will, and can never
ascend into the region of the spiritual. Man may press onward and upward
in its paths never so far, and there still remains the infinite beyond.
His imaginations may invade the furthest circle of planetary motion, and
yet we know there remain system after system of worlds, and suns shining
with ineffable light, still beyond. His questions are never answered; his
longings are never satisfied, and never can be until they reach The
Infinite One--the object of his worship,--the Source of light and all
knowledge.

His questions have ever been, whence am I? and whither do I go? and it can
never satisfy his aspirations, to reply that he is from the ape, and goes
to the ground, and that this ends all. There still remains to him a
longing for immortality; a craving for something above and beyond what he
now sees and knows, and only in the hope of this something hereafter, does
he have a realization of his highest possibilities.

I believe that thus far in man's experience he has been the loser, not by
too much religion, but rather by his unbelief and misconceptions as to its
true nature and the extent of its obligations. The plan should therefore
be, for a broader, higher, and more pervading religious influence, which
can come only from an intelligence educated as to his relations toward and
responsibility to God, and his fellow-men. As the tendency of the laws of
health and religion are in the same direction, it is not easy to
understand how a religious belief, or the influences which legitimately
flow from it, can be otherwise than for the highest interests of society,
and the mental health of its individual members.




CHAPTER XV.

INSUFFICIENT SLEEP.


We learn the most important lessons from observing the facts and studying
the operations of nature, and it is largely by such a course that we may
hope to learn the true method of either understanding or practising such
courses in life as will conduce to health.

From the time of birth until the body finally rests in its last sleep, the
human system requires periods of repose under the conditions of sleep. The
child, during the first few months of its existence, passes the larger
portion of the time in this state. While in it, the brain and nervous
system develop more rapidly, grow in stability, and attain capacity for
activity more surely than is possible in any other.

It is true that we do not yet understand precisely in what the phenomenon
of sleep consists; we do not know fully what change in the operation of
the brain occurs for its induction. It may be from deviated or lessened
currents of blood in certain portions, or from the opposite condition.
Both these theories have been advocated by men more or less eminent as
physiologists; some maintaining that while in sleep the brain contains a
larger amount of blood, that there exists a diminished action of the
vaso-motor nerves which control the coats of the vessels of the brain, and
that in consequence they become more fully distended than when the brain
is in a conscious state of activity.

On the other hand, others become equally positive, from observations made
on portions of the brain which have become exposed through the effects of
injuries to the skull, that these vessels contain less blood during sleep
than when in other conditions. I think these observations are conclusive,
and that there can be no doubt as to the fact that there exists a
diminished quantity of blood in the vessels of the brain in sleep; but
that this is the cause of the occurrence of that condition of the brain
which constitutes sleep does not appear to be so certain. It is quite
possible that this diminished quantity of blood is rather a _consequence_
than a _cause_. I am more inclined to think that sleep is primarily caused
by a diminution, or cessation, of some of the electrical currents which
constantly are passing through portions of the brain while in a state of
consciousness, and which are probably necessary to a condition of
consciousness, and that the anæmic condition of the brain which is
observed during sleep is a result of such change in these currents.

But from whatever primary cause it may occur, we know that it is only when
there are frequent periods for this condition of the brain in the case of
the child, that its nervous system develops and becomes strong in the
largest measure. And on the other hand, when, for any cause, whether it be
pain or artificial excitement, sleep is prevented, the whole system
speedily becomes deranged, and manifests its sense of indignation by
irregular or imperfect development and suffering.

The necessity of sleep for the system might be illustrated by the
presentation of many remarkable and curious facts, such as those of
persons who are greatly exhausted sleeping during surgical operations; of
physicians sleeping while walking to or from visits to their patients, or
while sitting beside them when in conditions of great suffering. I have
myself, when greatly fatigued from excessive professional labor, slept
through a considerable portion of a disagreeable and somewhat painful
dental operation. The torture resulting from the deprivation of sleep for
long periods is said to be greater than that of hunger or thirst, or from
the infliction of the severest bodily injury.

Accounts received from persons who have been shipwrecked, or exposed in
open boats upon the water in situations of great personal danger, and
where, in consequence, no sleep could be indulged, go to confirm this
view; and, though these accounts may have been somewhat exaggerated, and
reporters have drawn somewhat upon their imagination in their efforts to
depict these experiences, yet those who have been long deprived of sleep,
and have been obliged to struggle against its mastery day after day, may
easily imagine how terrible must be the suffering under such
circumstances. And yet, how little this imperative demand of nature and
the importance of this great necessity of the brain have been understood,
especially in reference to children.

When a young man and a student, I well remember hearing some lectures from
a person calling himself a physician, in which he took the ground that
fifteen minutes was ample time in which to take a regular meal, and that
all time spent in sleep in excess of four or five hours at most, was so
much lost time; that if persons slept only five hours instead of eight,
they would gain more than six years of time in the course of fifty;
therefore, every person who was so much of a sluggard as to sleep eight
hours instead of five, was responsible for wasting six years in fifty.
That ambitious insect, the ant, was held up by the doctor as an example of
industry and lofty enterprise, worthy the imitation of everybody who
expects to do much in life--as if he knew how many hours that creature is
in the habit of sleeping every year.

He might almost as well have put his case stronger, and argued that it was
everybody's duty to sleep only two of the twenty-four hours, because,
forsooth, we would gain more than twelve years in the fifty by so doing.

Unfortunately for society, this man has not been alone in advocating such
views. There have been others who, in their teachings, have greatly
underestimated the importance of an abundance of sleep as a means of
securing and maintaining a high standard of health. I think that most
persons, especially of the laboring classes, in cities as also in the
country, sleep too little. This is true as to adult persons, but to a much
larger extent of children, and it is hardly possible to over-estimate the
good effects arising from an abundance of sleep upon the brain of the
child.

There are certain physiological and anatomical conditions existing which
tend to show why this is true.

1. The brain at an early age attains a size out of proportion to other
organs and members of the body. This is especially true of that portion of
the brain supposed to be concerned in mental operations, while those
portions whose office is connected with the organic life of the system are
less advanced. After twelve or fourteen years of age, the relative
rapidity of development as to size becomes changed, and other portions of
the system increase more rapidly.

2. The cells of the hemispheres of the brain contain a considerably larger
amount of water during the younger periods of life than they do during the
adult period. One of the results of this condition of the brain is that of
less stability of character, and a larger measure of susceptibility. It is
more sensitive and easily disturbed by external surroundings, while the
influences which act upon it, in connection with its daily experiences,
tend to create a much more rapid metamorphosis of its tissues.

The nerve tissue of the brain in adult life is the most unstable in its
elemental composition of that of any organ, but in childhood and youth the
change resulting in degeneration and restoration of tissue is much more
rapid than at any other period. Hence the importance of frequent and
considerably long-continued periods of sleep and inactivity of this organ.

Now, my observation and experience lead me to believe that young children
in our cities sleep far too little to enable the brain to receive the
largest benefit from it; that they are out on the streets, or employed at
tasks, long after they should have been in bed. In many portions of our
large cities there exist excitement and noise, which are quite sufficient
to prevent sleep, until the system is very greatly fatigued, and the
nervous elements exhausted. Parents are frequently thoughtless and
careless in this respect, and the children are left out on the street or
visiting at neighbors' houses until too late an hour.

A teacher in a public school informs me that one of the greatest
hindrances in the advancement of some of her scholars, lies in the fact
that one or two nights of every week these children are out at musical or
dancing parties, or attending some place of public amusement, so that the
period of sleep is greatly abridged, and the brain has not recuperated its
energy so as to be able to study. The sensitive tissue is in a condition
of too great weakness to be much used, and in consequence the difficulty
of learning lessons is greatly increased.

Again, children are often called in the morning, long before enough sleep
has been secured to refresh the brain, and employed in different ways,
perhaps in attending to some piece of machinery in a large factory, which
is filled with dust and the noise of thousands of wheels, and kept there
ten or twelve hours a day; and the brain is not allowed to sleep for
sixteen or seventeen hours.

Now, one of the effects of these long periods of wakefulness and
over-activity is to check the normal development of the brain, to stint
its growth, and give it a twist from which it never recovers. This habit,
formed in childhood, frequently extends into adult life, and becomes so
fixed that it is difficult for the brain afterward to change its custom.
The period of wakefulness tends to increase so that sleep is limited to
six or seven instead of eight or nine hours.

That man who regularly and soundly sleeps his eight or nine hours a day
should be the man capable of large physical or mental work; moreover, he
is the man who lasts longest; his system becomes daily recuperated, and he
has the largest prospect of reaching his threescore and ten, while yet his
system is in a degree of health; while his neighbor, less favored in this
respect, becomes old at sixty if he chances to live so long.

It is not intended to imply that there may not be exceptions to this rule.
There have been some who could do with four or five hours' sleep for many
years and do good work, and there are probably such men to-day, but they
are using up the nervous energy and strength with which they have been
endowed far too rapidly; and they are exceptions to the mass of people,
who require much more sleep in order to enjoy good mental health.

Sleep is to the brain what rest is to the body:

  "Sleep, that knits up the ravelled sleeve of care,
  The death of each day's life, sore labor's bath,
  Balm of hurt minds, great Nature's second course,
  Chief nourisher in life's feast."

No words could paint more beautifully or effectively the office of sleep,
than these of England's greatest poet. But we need not turn to the writers
of prose or poetry in the past for instruction in this matter; all nature
teaches the importance of sleep. Every tree, and shrub, and vine, has its
period of sleep, and, if stimulated into ceaseless activity, would soon
die; and every portion of the human system is subject to the same great
law of necessity.

The stomach must have its periods of inactivity and rest; and there are
periods during every twenty-four hours when the kidneys secrete very
little, if any, urine. It is sometimes said the heart is an exception to
this rule; that its beat never ceases from more than six months before
birth until nature's last great debt is paid in death. But, in truth, it
is at entire rest nearly if not quite one third of the whole time. Its
action consists of a _first_ and a _second_ sound, covering the
contraction of right and left auricles and ventricles, and then a
rest,--and so far as we know a perfect one. Reckoning this at one third
the time occupied in each full action of the heart, and we have more than
twenty years of perfect quiet out of the threescore and ten.

The same is true to even a larger extent of other involuntary processes
and movements; for instance, that of respiration. The muscles concerned in
this operation are at entire rest during more than one third of the time,
and if the process of respiration be much quickened in frequency for any
considerable period of time, weariness and languor ensue.

Now the brain is no exception to this same law. During every moment of
consciousness this is in ceaseless activity. The peculiar process of
cerebration, whatever that may consist in, is taking place; thought after
thought comes forth, with no volition on our part; long trains of
meditation come forth unbidden, one after another, from the hidden
recesses of the brain; sometimes things supposed to be long since
forgotten, which have for years been consigned to the rubbish lumber-heap
of dead plans and disappointed expectations, rise up suddenly, like a
frightened bird before the hunter. Then, again, the sound of some voice,
or the strain of some music long unheard, or the glance of an eye, will
call up the memories of some bitter and suffering experience with its ten
thousand harrowing associations, which go marching forward and backward
through the trackless channels of the brain like a vast army of ghosts.

All this when the brain has no set task to perform, no intent purpose to
follow out, and the body is at ease; and it is only when the peculiar
connection or chain of connection of one brain-cell with another is
broken, and consciousness fades away into the dreamless land of perfect
sleep, that the brain is at rest. In this state it recuperates its
exhausted energy and power, and stores them up for future need.

The period of wakefulness is one of constant wear; every thought is
generated at the expense of brain-cells, which can be fully re-energized
only by periods of properly regulated repose. It not unfrequently happens,
however, that sleep is only partial; that the brain still continues in
some degree of activity, and when we wake, we have dim memories of
sub-conscious thought, which has been moving through the brain. Such rest,
for the brain, is imperfect, and we are conscious of the conditions of
fatigue, which shows how imperative is the necessity for sound, healthy
sleep; and if this is not secured, if the brain, through over-stimulation
and thought, is not left to recuperate, its energy becomes rapidly
exhausted; debility, disease, and finally, loss of power supervene.

Hence the story is almost always the same in the history of the insane;
for weeks or months before the active indications of insanity appear, the
patient has been more than usually anxious about some subject or other,
and worried and wakeful, not sleeping more than four or five hours out of
the twenty four. The trains of thought have been left too long moving on
in certain channels of the brain, some experience has made too profound an
impression, and the effects of what we call the will have been unable to
control it; or there has been perhaps some source of eccentric irritation
which has been reflected; or it may be that the blood, upon which every
organ depends for nourishment and strength, has been poisoned, or its
nutrient properties impaired; and the poor brain, unable to do its
constant work under such influences, begins to waver, to show signs of
weakness or aberration; hallucinations or delusions hover around like
floating shadows in the air until, finally, disease comes and

              "Plants his siege
  Against the mind, the which he pricks and wounds
  With many legions of strange fantasies,
  Which, in their throng and press to that last hold,
  Confound themselves."




CHAPTER XVI.

CONCLUSION.


It has been my aim to conduct the preceding discussion in so plain and
direct a manner, that its lessons of instruction and warning, if it has
any, shall be readily appreciated by the reader. It will not, therefore,
be necessary to add chapters filled with specific directions how to avoid
insanity.

Some remarks, of a somewhat desultory character, concerning some branches
of the subject will comprise this closing chapter.

There are few diseases the conditions of whose existence are so clearly
and fully understood that they can in every case be avoided, and in
reference to the ultimate causes of many we know little or nothing. It is
true that, within a few years, we have more clearly recognized the
relations of hygiene to the prevalence of some forms of disease, and by
this means have done much toward limiting their progress, thus achieving
some of the grandest triumphs of medical science in recent times.

In doing this, however, we have not always, or even generally, known the
exact nature of the primary causes of these forms of disease, but have
simply learned, from observation, their relations to hygienic conditions;
but the knowledge of this relation has put society on vantage-ground in
all efforts to maintain the public health, so far as it relates to certain
forms of zymotic disease; and to the extent of our progress in
understanding these relations to most other forms of disease, shall we be
in a condition to avoid them.

The existence or the prevalence of insanity, however, does not depend on
any such conditions as relate to zymotic diseases, at least in the vast
majority of cases. Our study of its causes, therefore, has been in other
directions; and if our views of the influences which lead to degeneration
of nerve tissue are correct, these are even more easily appreciable than
are the causes of some other forms of disease, and consequently may be
avoided.

This must come largely, primarily, from the education of home and school
life, and from the regulation of daily conduct in its relation to the
brain; and, as the nervous system presides over and controls the body and
its several members in the discharge of their functions, an understanding
of its physiological action, at least in some degree, is of great
importance to everybody. While we cannot do much to lessen the amount of
brain-work or check the ambitions of adult life, as they have become so
intensified by modern modes of living and the requirements of business,
yet we may hope to do something by the judicious training and education of
the young.

That this may be effectually done, we must study the action of the brain
and nervous system when under the influence of different external
conditions and agencies. We have been accustomed to draw up long lists of
experiences and occurrences in the lives of those who have become insane,
as _causes_, such as _shock_, _grief_, _loss of friends_, _fever_, etc.,
etc. but it should be borne in mind that the vast majority of persons pass
through these or similar experiences, and yet do not become insane. It
becomes necessary, therefore, to go back of these experiences or
antecedents, and inquire as to the causation of that peculiar condition of
the nervous system which renders it susceptible of the effects of such
secondary causes.

This I have endeavored to do, more especially in the chapter on the Insane
Diathesis. I have sought particularly to draw attention to the delicacy
and great susceptibility of the brain while in childhood and youth to
external influences and impressions, and to show that if much in the way
of stimulation of any kind is added to its daily experiences, the effect
upon its future development and character may prove to be most
unfavorable. We have seen how at this early period of life it is moulded
and changed in no small degree by its experiences, and that if these are
of a disturbing character from any cause whatever, there can but result
such an influence on the brain-cells as will be incorporated into their
growth, and manifest itself in after-life in uncertainty and liability to
irregularity of brain-action.

Again, I have proceeded, in discussing the subject, on the supposition
that the nervous system is a unit; that, though the functions of the
several parts are of diverse character, such as motion, sensation, and
thought, yet the same laws of healthy activity pertain to all portions
alike; and that we could safely reason, in reference to the effects of
unfavorable influences, from the observed and known to the less known,
from the simple to the more complex processes of nerve-function; that what
is known to be injurious to the one must be so to the other. I have
endeavored to show that as too great or too little activity of the various
portions of the nervous system result in irregular activity or in failure
of activity, so, also, too much stimulation to the brain, as well as too
little exercise of function, both result in failure in some degree; that
through these two channels, and also from the effects of poisons acting on
the brain, comes the largest danger to its integrity of activity.

While some of the causes of insanity, however, are of such a character as
has been pointed out, and consequently preventable, yet it will readily be
perceived how difficult it will be to educate society so that it may be
avoided. The conditions of its existence pertain in many cases to all
classes of society, and ramify in the customs and habits alike of the rich
and the poor. In many other forms of disease there exists some degree of
unity in etiology, and we are able to discover their immediate hygienic
conditions with considerable certainty, and these conditions can in many
cases be avoided without much inconvenience; but those of insanity are so
multifarious, they are so interwoven with the very texture of our modern
civilization, that any warning which we can give, any words of help, or of
caution even, all are only too likely to fall on ears which are dull of
hearing. The ruling tendencies in our modes of living and of conducting
the great business enterprises of life, some of which are inherited, and
others learned in the years of early life, lie directly athwart its path.

Again, in many other forms of disease, we approach toward their nature and
causes by examination of the secretions and excretions of the body; we use
our chemical tests; we percuss and auscultate; we reason from the
pathological conditions existing after death, to those which must have
existed prior to death; but in cases of insanity, these modes of procedure
have so far availed us very little. While we find slight degrees of
difference in the secretions of the insane at times, yet these changes do
not appear to be pathognomonic. They may be found to exist equally with
the sane and insane, and therefore avail little or not at all in
determining any change which has taken place in the brain. Nor can we
determine the nature of those vibratory movements which are supposed to
take place during the processes of reasoning or the experiences of
sensation.

In examinations after death of the brains of those who have died while
insane, we find certain morbid changes in the cells and connective tissues
in many cases, and a few years since we were indulging large expectations
that we had at length arrived on solid ground, and thenceforth could
proceed to more perfect knowledge and definite results. But, so far, there
has very little of positive value, in determining the "_fons et origo_" of
insanity, been brought to light through pathological researches. The
changes in brain tissue found after death in the insane are degenerations
in various stages of progress, and in no essential respect differ from
those which may be found in some cases after death from injury and
disease, where no insanity has existed.

Indeed, if we ever should be able to definitely determine the connections
between morbid changes in the brain and the various modifications of
thought and action among the insane, while we should be in a position to
frame more perfect classifications of the insaniæ, yet it is not easy to
perceive how we should be much the gainers in our appreciation of the
ultimate causes of insanity, or in its treatment.

Notwithstanding all these and other difficulties, however, we may hope for
progress in the future in our ability to appreciate at least some of the
causes of insanity more fully and be able to avoid them.

A few sentences in the form of a recapitulation will serve to recall some
of the more important points embraced in our discussion, and indicate
through what channels we may anticipate successful effort in the
prevention of insanity.


I.--_In Improved Methods of Education._

1. A larger appreciation of the importance of _individuality_ in giving
instruction. The teacher will have a fewer number of pupils, and find it
necessary to study the peculiarities and tendencies, both physical and
mental, of each one. Instead of having all together pass through a regular
routine of education, with little or no reference to mental constitution,
the system will be, in some measure, adapted to the present, and what may
appear to be the future, requirements of each scholar.

2. There will be less importance given to education of the brain by means
of books only, for all children, and a larger importance to _industrial
education_. Inasmuch as the large majority of the members of society must
obtain the requirements of living by industrial operations, society will
appreciate more fully the importance, not only to itself, but especially
to the individual, of so educating each person, that he may be
self-supporting, and consequently less liable to become a diseased and
dependent member of it.

3. A larger importance will be given, in methods of education at home, to
inculcating and enforcing obedience to laws and regulations. This is
essential, not only to the interests of society, but especially to those
of the individual in his relations to the laws of health. Man is endowed
not only with intellect, but with a will in the direction and use of it,
and it becomes his duty and essential to his interests to find out those
courses of conduct which will lead to health. In a considerable degree he
is capable of regulating his conduct so as to be in harmony with such
regulations. If, however, he is not taught the necessity of obedience
while young, and how to obey easily, the lesson becomes one very difficult
to learn in later life, and he is in great danger of never learning it.

4. A larger degree of importance will be given to education in relation to
physiology and heredity, especially so far as they relate to the
institution of the family. As the well-being of both society and the
individual depends so largely on that of the family, a knowledge of the
laws of heredity will be considered as essential to all persons who enter
into the relation of marriage, so that tendencies toward diseases may be,
at least in some measure, avoided.


II.--_In Reference to Certain Habits and Customs of Living._

1. One of the most important of these will relate to the use of alcohol,
in its various forms, as a beverage. Its stimulating and deteriorating
influence upon the brain will be more fully understood and avoided,
thereby removing one of the largest factors in the causation of insanity.

One of the astonishing facts which confronts the student of sociology, is
the unaccountable indifference, which has existed hitherto in society to
the vast evils of intemperance. When, however, the young become more
generally educated in reference to the physiological effects of alcohol,
and more fully appreciate the fact that they do not cease with those
primarily concerned, but pass over from the individual to his family and
to society; that the amount of disease and suffering to both, from this
evil, are so much greater than from any other--nay, I had almost written
from all others together,--extending in the family to the third and fourth
generations frequently in the forms of insanity and idiocy, and in society
to ignorance, poverty, crime, and a larger expenditure of charity than for
all other forms of evil,--why, it seems certain I shall be justified in my
prophecy, that the day cannot be far distant when society will proscribe
and limit the ravages of this enemy of human society.

2. The second refers to the excessive use of tobacco, especially by the
young, before the system attains to the maturity of its growth.

3. The importance of less stimulating and exhausting methods of conducting
business avocations in large towns and cities. A more full recognition of
the fact, that every brain is limited to its unit of power in activity--so
much and no more,--and that length of days and fulness of strength can be
expected only by the judicious care and expenditure of brain-force.

4. A more full recognition of the importance to the brain of _change_ and
longer periods of rest, both for adult persons when engaged in the usual
avocations of life, and especially for children in relation to the hours
of sleep.

5. The importance of improved sanitary conditions for all houses occupied
by the poor, especially in cities, and of all shops and manufacturing
establishments.

The kinds of avocations followed in-doors are not likely to be much
changed or lessened; indeed, I think they are likely to become even more
common; that larger numbers will be engaged in such occupations in the
future than in the present; but it is quite possible to realize more fully
the fact that the brain requires the effects of pure air, if it is to
remain in a condition of health, and that it is practicable to introduce
this to all places so occupied.

As will readily be perceived, the tendencies of the preceding pages have
served to point toward the importance of systematic preventive measures
concerning insanity. _Prevention_ is the watchword which is being
signalled along the line of the medical profession, at the present time,
concerning the management of disease. The importance of State Boards of
Health in many of the larger States has become so generally recognized,
that they are yearly appointed, and make regular reports, with more or
less full accounts as to the results of observations in reference to the
public health and the prevention of disease, which prove to be of the
highest value.

I would suggest the importance of appointing on such Boards one or more
physicians who are qualified for such a position, whose special duty it
shall be to ascertain and make public reports upon the prevalence of such
conditions as conduce to the production of mental disease. They should be
appointed by the State, so that they may have influence with school
teachers and school boards. In this way they may be able to point out the
dangers which lie in methods of educating and preparing the young for the
duties and responsibilities of life. Such persons should be able to wisely
direct in laying the broadest and most secure foundations on which to rear
the fabric of vigorous mental health.

That physicians appointed by the State, and operating in conjunction with
superintendents of public institutions and with teachers, would be able to
accomplish a most valuable work, in reference to the conduct of education,
and in instructing the public concerning those habits of life which are at
variance with mental health, I have no doubt. I may add that there can be
no question that a generous expenditure of money for such a purpose would
save many minds from the suffering and ruin which result from disease,
and, in the end, prove to be the wisest economy.


THE END.




FOOTNOTES:

[1] The whole number was 31,782.

[2] "The Past in the Present: What is Civilization?" by Arthur Mitchell,
M.D., LL.D., ed. 1880, p. 227.

[3] From "An Address delivered before the Graduating Class in the Medical
Department of Yale College," by the Author, 1875. Tuttle & Morehouse, New
Haven, Ct.

[4] As an example of what is required of young pupils, in addition to the
usual study hours in school, I herewith subjoin a list of what a lad,
twelve years of age, brought home from school, by direction of the
teacher, to learn during the evening:

1--_a._ From what incident is the phrase "passed the Rubicon" derived?

_b._ Why is the Archipelago southeast of Greece sometimes called the Ægean
Sea?

_c._ What poet is sometimes called the Ettrick Shepherd?

_d._ What is the largest bell in the world, and how much does it weigh?

_e._ What was the debt of the United States at the close of the
Revolution?

2.--Spell the following words and give the definition of them (being
prepared to write both the spelling and definition as they are announced
by the teacher):

Clarify, Pyrenees, judgment, leguminous, critique, pistachio, deceit,
scissors, superficies, idiom, anodyne, filigree, monody, cartouch,
committee, tobacco.

3.--Work out and hand in on paper solutions of the following problems:

_a._ What number is that from which if you take 8/14, the remainder will
be 1/3?

_b._ What number is that to which if you add 4/9 of 11, the sum will be
44-3/5?

_c._ What number multiplied by 11 will give 44-3/5 for a product?

_d._ What number divided by 4-2/7 will give 243/324 for a quotient?

_e._ What divisor will give 4-2/7 for a quotient, 66 being the dividend?

_f._ What number is that 8/14 of which exceeds 1/2 by 4-2/7?

_g._ What number is that to which if 8/14 of itself be added, the sum will
be 66?

_h._ What number is that from which if 1/3 of itself be subtracted, the
remainder will be 11?

I call attention: 1st, to the amount of labor and time it will require
simply to do the work of the above lesson, even supposing that a class of
children from eleven to thirteen years of age have the ability, and after
five hours in the school-room during the day; and 2d, to the character of
some of the requirements.

[5] Before this patient left the Retreat she gave me the following
schedule of her daily duties and mode of life while in school:--

"Breakfast at 7 A.M. From 7-1/2 to 8-1/2, did work. Studied from 8.30 to
8.55. From 9 till 1-1/2 o'clock P.M., studied and recited. Dined at 2, and
after dinner worked until 3. Then 1/2 hour for recreation. From 3-1/2 till
5-1/2 o'clock, study hours. From 5-1/2 to 6, turns were taken by the
pupils in preparing supper. Supper at 6. From 6-1/2 to 7, recreations.
From 7-1/4 to 9, Latin recitations and study."

Other pupils need not have studied so much by 1-1/2 hours.

Comment on the above is unnecessary.

[6] D. H. Tuke: "Insanity and its Prevention."

[7] Quoted by Dr. Tuke.

[8] Since writing the above, the following, in a newspaper published in
Chicago, Ill., has come to my attention:

"The chief cause of the 'lumping' system is that, owing to the
disappearance of apprentices, a good workman in any trade is becoming a
rarity. This leads to the lumping system in two ways: first, there are few
workmen who know how to do more than one or two things; second, a vast
army of inferior workmen are drifting about who cannot command good wages,
and consequently have to work upon the cheapest class of work, and these
are the only men whom the sub-contractor can afford to employ. According
to old master-carpenters and masons, the disappearance of apprentices
accounts for the new state of affairs. One of the best carpenters in the
city, who owns a shop and does a large business, said: 'It is scarcely an
exaggeration to say that the race of good workmen is dying out, and that
were it not for the immigration of foreign workmen we should be at a loss
for men to do even the commonest jobs. The best foreign workmen do not
come here at all, finding enough to do at home, so that those we do find
are not such workmen as we had twenty years ago; but at least they are
better than the men who have failed to learn a trade here. The newspapers
say that men do not know their trades nowadays because there is no such
thing as apprenticeship. There is no such thing as a legal apprenticeship
bond between a boy more than sixteen years of age and an employer;
consequently a boy who is taught something useful in a shop, will learn
where he can get half a dollar more a week in some other place. A boy will
not stay in a shop more than a year without pay; we have to pay them for
allowing themselves to be taught a trade. As boys are usually not worth
their salt in a carpenter shop, we do without them. The consequence is
that boys pick up a trade in a superficial way instead of learning it.'"

[9] "Heredity: A Psychological Study of its Phenomena, Laws, Causes and
Consequences," p. 1. Th. Ribot, 1875.

[10] Quoted by Ribot.

[11] "Illustrations of Heredity," by J. R. Dunlap.

[12] Quoted by Ribot.

[13] Ribot on "Heredity," pp. 86, 87.

[14] _Journal of Mental Science_, January, 1881.

[15] Dr. McGraw, "Address on Heredity and Marriage," pp. 12 and 15, quoted
by Dr. Miles.

[16] Quoted from "Diseases of Modern Life," by B. W. Richardson, M.D. D.
Appleton & Co., 1877, pp. 213 and 214.

[17] "A Sober View of Temperance," by Rev. Daniel Merriam, Bibliotheca
Sacra, Oct., 1831.

[18] "Diseases of Modern Life," by B. W. Richardson, M.D. pp. 228 and 229.

[19] The writer is here describing a personal experience.

[20] "After a short time the products of tobacco find a ready exit out of
the system. They are thrown out by the three great eliminatories--the
lungs, the skin, and the kidneys. The volatile matters exhale by the
lungs; * * * while both (nicotine and the bitter extracts), I believe,
are carried off by the kidney, the grand eliminator of all poisons of the
soluble type."--"Diseases of Modern Life," by B. W. Richardson, M.D., pp.
283 and 285.

[21] Quoted by John Lizars--"The Use and Abuse of Tobacco," New York,
1880, p. 21.