PREFACE.

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

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

H. P. S.

Hartford, Dec., 1882.

CONTENTS.

[CHAPTER I.]
PRELIMINARY.
PAGE.
Increase of interest in the subject of insanity, resulting from, first, more intelligent views concerning its nature; and, second, theobligation to make provision for the care of the insane in a larger measure than for other unfortunate classes—Resultsin the way of hospitals—Asylum attendants—Change in the modes of management, and care of the insane[3]
[CHAPTER II.]
INCREASE OF INSANITY.
Indications which point to the probability of its increase in a greater ratio than that of the population: (1) in relation to thegeneral conditions of society; (2) in occupations; (3) in the character or tendency of disease—Increased demand for hospitalsfor the insane not a conclusive evidence of increase of insanity; other reasons exist for this—Improvements in hospitals—Thechronic as well as the acute insane now provided for more generally than formerly—Accumulations in asylums—Statistics—Thoseof England and Scotland—Their character and import as presented in the yearly reports of the Boards of Lunacy Commissioners[11]
[CHAPTER III.]
INSANITY AND CIVILIZATION.
Prevalence of disease among savage nations—Conditions of life not such as to produce insanity—Definitions of civilization—Severalconditions attending civilization combine to increase diseases of the brain—Increase of brain activity—Over-stimulationof the brain in schools and by the use of alcoholic beverages—Acommunity of interests exists in savage life which is lost in civilized life—In the latter the strong thrive atthe expense of the weak—Monopolies in land and other forms of property—Inference to be drawn from the tendency of insanityto increase—The primary condition of insanity one of the brain—Investigations should relate to the nature and causes of this condition[33]
[CHAPTER IV.]
THE INSANE DIATHESIS.
The ideal human system—The actual human system—Physical and mental differences among persons in health—Periodsduring which there exist considerable changes in the character of mental action in the case of many persons while in a state ofhealth—Excitement and depression of mental activity—This tendency to unstable activity of the nervous system may be inheritedor acquired—Illustrations from the effects of over-exertion, “writer’s cramp,” chorea—A similar condition of thatportion of the brain which is concerned in mental operations may exist—Illustrations—The effects of sudden mental shocksand long-continued mental application—Recapitulation—The condition which we term the Insane Diathesis is the prime factor in the causation of insanity[53]
[CHAPTER V.]
THE INFLUENCE OF EDUCATION.
The higher conception of education—The ordinary course pursued in schools—Too many subjects studied at one time, andtoo large a number of scholars under the supervision of one teacher—Little opportunity to study individual characters andtendencies—Numerous subjects of study tend to confuse the mind rather than invigorate it—Illustrative cases—Teachersonly in part to blame—Courses pursued in colleges—The importance of avoiding over-stimulation of any portion of thesystem in the period of youth—Ball clubs; rowing clubs—A similar tendency to over-stimulation of the brain in studyprevalent in England—Over-exertion in the use of the brain tends strongly to create weakness and instability of action, anda condition which may be transmitted to children[73]
[CHAPTER VI.]
INDUSTRIAL EDUCATION.
Occupations of persons admitted to State asylums—Percentage of those having no education in industry, or regular occupation—Importanceof industrial education to the brain—Difficulty of obtaining it greater than formerly—Education of the brainhas taken the place of industrial education, and with unfavorable results—The education of the schools does not qualify themass of people to earn a living: it tends rather to unfit them for industrial labor—The interests of society require that thelargest number be educated to be self-supporting—To secure this it is necessary to begin early in life—The same principlesapply to education for domestic labor[95]
[CHAPTER VII.]
MORAL EDUCATION.
Examples of deficient moral education—It more especially pertains to the influence of home and relates to obedience—Respectand obedience toward persons in authority essential to any efficient system—This must be learned in early life if at all—Self-controlessential to the growth of mental strength and discipline—The tendencies in the modes of home and school education[115]
[CHAPTER VIII.]
HEREDITY.
Its importance as a factor in causing physical and mental characteristics in families and nations—Illustrations—Tendenciesto morbid action, both mental and physical, may also be transmitted—Insanity—Dipsomania—How may unfavorable tendenciesbe avoided?—The influence of heredity acts toward elimination of unfavorable tendencies when existing on oneside of the family—Importance of understanding this in relation to marriage—Education may do much toward aidingin the removal of unfavorable tendencies—Weak-minded children—Those born with peculiarities of physical and mental constitutions[125]
[CHAPTER IX.]
CONSANGUINEOUS MARRIAGES.
Different views in relation to the influence of consanguinity—The customs of the ancient Egyptians, Syrians, and others—Experimentsin the inter-breeding of cattle—Popular impressions as to its effects—Opposite views explained by understanding thelaws of heredity—Favorable as well as unfavorable tendencies are increased—Hence unfavorable ones may be eliminated[145]
[CHAPTER X.]
ALCOHOL.
General considerations concerning its effects upon the nervous system—Its use at the present time as compared with that of thepast—Society now reaping the effects of its use in the past—Physiological effects of alcohol upon the system—Experimentsof Dr. Parkes and Count Wollowicz—Its effect upon the action of the heart—Its effect upon the circulation of the brain,the blood-vessels, and cells, resulting in a less sensitive condition of these parts, and ultimately in organic changes—Itseffect upon the character of mind; upon the electrical currents of the brain; upon other portions of the body; uponthe brains of children and young persons—The alcoholic diathesis likely to be transmitted[153]
[CHAPTER XI.]
TOBACCO.
Opposite views as to its general effects upon individuals—The physiological effects upon the mucous membranes, the heart,and the nervous system—Nicotin—Its elimination from the system by the lungs, skin, and kidneys—Its effects thoseof a narcotic and not of a stimulant—Its effects upon the brains of children and young persons—The use of tobaccoby children should be forbidden by law—Its general effects upon society, socially and politically, as presented by M.Fiévée—It is not directly responsible in any large degree for producing insanity—Creates a diathesis which causes a diminutionof intellectual and moral power[173]
[CHAPTER XII.]
SEX IN RELATION TO INSANITY.
Relative frequency of the occurrence of insanity in the sexes—The sexual system in the female exerts a larger influence uponthe nervous system in certain ways than that of the male—Sexual derangements dependent upon the debility of thenervous system—They are generally consequents and not causes of nervous debility—Functional derangements of sexualorgans rare among the insane—A tendency to recovery in case they do exist—Other conditions not favorable to mental health[187]
[CHAPTER XIII.]
POVERTY.
Physical labor one of the largest promoters of health—Sudden increase of wealth often results most unfavorably—Too constantapplication to labor and household cares—A case illustrative—In the contests of life the weaker go to the wall—They are oftensurrounded by most unfavorable sanitary surroundings, impure air, poor tenements—They become the psychologicalwindfalls of society—Have been and will continue to be dependent when stricken down by disease[199]
[CHAPTER XIV.]
RELIGION.
Influence of religious belief upon man—Not a cause of insanity—Religious belief natural to man—It is found in all nations—Maninstinctively looks up to a Superior Power in hours of suffering and need—He needs such a belief to sustain and givehope—The laws of health and a religious life are in harmony—A religious belief tends toward health—So long as thepresent conditions of life exist, man will require its sustaining influence[211]
[CHAPTER XV.]
INSUFFICIENT SLEEP.
Conditions of the brain which are supposed to produce sleep—Congested state of theblood-vessels—An anæmic state—Suffering when a person is for any cause deprived of sleep—Personsusually sleep too little rather than too much—Physiological reasons why children require more sleep than adults—They generallysleep too little, especially when living in cities—The importance of sleep for the brain learned from its universalityin nature and especially from the functions of other portions of the body—In this state it recuperates its exhausted energiesand stores them up for use when in a state of activity—Inability to sleep a precursor of insanity[223]
[CHAPTER XVI.]
CONCLUSION.
The primary causes of few diseases are fully understood—Prevention of insanity must come mainly from education receivedat home and in the school—Difficulties in the way of securing any efficient preventive measures—Educational processesmay be improved in several ways: (1) by securing a larger degree of individuality; (2) more attention to industrialeducation; (3) more efficient home education—Changes in certain habits; (1) in reference to the use of alcoholic beverages;(2) in the use of tobacco; (3) the importance of longer periods of rest and recreation; (4) improved sanitary surroundingsin those portions of cities occupied by the poor and laboring classes of society—The importance of systematicmeasures toward the prevention of insanity[237]