INSANITY:

ITS CAUSES AND PREVENTION

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

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

Copyright by
G. P. PUTNAM’S SONS
1883

Press of
G. P. Putnam’s Sons
New York

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

PREFACE.

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

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

H. P. S.

Hartford, Dec., 1882.

CONTENTS.

PRELIMINARY.

CHAPTER I.

PRELIMINARY.

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

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

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

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

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

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

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

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

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

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

INCREASE OF INSANITY.

CHAPTER II.

INCREASE OF INSANITY.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In 1869 there were under observation:

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

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

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

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

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

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

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

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

In 1879, there were:

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

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

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

In relation to the general population it was as follows:

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

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

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

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

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

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

INSANITY AND CIVILIZATION.

CHAPTER III.

INSANITY AND CIVILIZATION.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

THE INSANE DIATHESIS.

CHAPTER IV.

THE INSANE DIATHESIS.

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

Now, the actual human system approaches toward this ideal one in a greater or less degree. It possesses all the faculties, both physical and psychical, but they are tainted with imperfections, and their health varies from the highest state attainable, down to some assumed standard, below which we say that a diseased condition exists. It will, however, be observed, and hereafter more definitely appear, that this border-line is merely one of assumption. No definite standard can be applied to all persons, and a condition which would be normal for one person may not be so for another. Besides, the actual condition of many persons is one of changing stability, both in respect of the body and the mind, and this may depend upon causes which operate from either within or without.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A few illustrations may serve to make this more clear:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

THE INFLUENCE OF EDUCATION.

CHAPTER V.

THE INFLUENCE OF EDUCATION.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

INDUSTRIAL EDUCATION.

CHAPTER VI.

INDUSTRIAL EDUCATION.

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

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

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

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

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

In these statistics I have included those persons who, in the reports, are classed as domestics, laborers, and persons of no occupation. I have not included wives of laborers, or persons whose occupation was “unknown.” I think it may fairly be assumed that, in the case of laborers, those who dig and shovel and labor on the public works, or in other places, under supervision, and in the case of domestics generally throughout the country, not one in ten has ever had any training or education in any special line of service before they undertook to earn a living in following these avocations; that, in fact, they could not do any thing else.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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