Insanity: Its Causes and Prevention

CHAPTER XIV.

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.

INSUFFICIENT SLEEP.

CHAPTER XV.

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.”

CONCLUSION.

CHAPTER XVI.

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 ⅓?

b. What number is that to which if you add ²⁄9 of 11, the sum will be 44⅗?

c. What number multiplied by 11 will give 44⅗ for a product?

d. What number divided by 4²⁄7 will give ²⁴³⁄324 for a quotient?

e. What divisor will give 4²⁄7 for a quotient, 66 being the dividend?

f. What number is that ⁸⁄14 of which exceeds ½ by 4²⁄7?

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 ⅓ 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 7½ to 8½, did work. Studied from 8.30 to 8.55. From 9 till 1½ o’clock P.M., studied and recited. Dined at 2, and after dinner worked until 3. Then ½ hour for recreation. From 3½ till 5½ o’clock, study hours. From 5½ to 6, turns were taken by the pupils in preparing supper. Supper at 6. From 6½ to 7, recreations. From 7¼ to 9, Latin recitations and study.”

Other pupils need not have studied so much by 1½ 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.