Insanity: Its Causes and Prevention

CHAPTER X.

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.

TOBACCO.

CHAPTER XI.

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.

SEX IN RELATION TO INSANITY.

CHAPTER XII.

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, dysmenorrhœa, or amenorrhœa. 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.

POVERTY.

CHAPTER XIII.

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.

RELIGION.