How can we Escape Insanity? BY Charles W. Page, M.D., Assistant Physician, Retreat for Insane, Hartford, Conn. Repainted from the Report of The State Board of Health, 1882. HARTFORD, CONN.: Press of The Case, Lockwood & Brainard Company. 1883. HOW CAN WE ESCAPE INSANITY? By CHARLES W. PAGE, M.D., Assistant Physician, Retreat for Insane, Hartford, Conn. [From the Proceedings of the State Board of Health.] HOW CAN WE ESCAPE INSANITY? Assistant Physician, Retreat for Insane, Hartford, Ct. CHARLES W. PAGE, M.D., The insane asylums in the United States accommodate in all about 40,000* patients, while there remains a still larger number scattered throughout the country, for whom no special hospital accommodations have as yet been provided. Such facts, coupled with the knowledge that new cases are not only rapidly swelling these numbers, but in an increasing ratio— out of proportion to the growth of the population, suggest a problem alarming in its import and difficult of solution. The history of insane asylums is a record of the earnest en,» deavors of large hearted men to understand this subject and to prevent or alleviate in some degree the immense total of human suffering involved. The circle of interest gradually enlarged until the financial as- pect of the question has become of sufficient importance to com- mand the attention of the whole State. When lunatic asylums were first provided, the insane were com- mitted to them as a matter of convenience or necessity, rather than from sense of duty, which resulted in the collection of a large proportion of acute and curable cases. With the advantages of hospital seclusion, discipline, etc., on such a class of patients, the early superintendents achieved a flattering success, and a high percentage of their admissions was restored to reason and to active offices in society. In their efforts to influence the public to provide more asylums, specialists, and other interested parties, made use of such facts as the basis of their appeals, and from this the idea came to prevail that lunatic asylums, if large enough to accommodate them, would * Journal Nervous and Mental Diseases, April, 1882, page 243. 4 cure nearly all who might become insane, and in some way largely prevent attacks of insanity in the future. In neither respect have such hopes been realized. It has been impossible for institutions to restore the large per cent, expected, and their power to prevent insanity can accom- plish little until they have the intelligent sympathy and hearty cooperation of the medical profession and the general public. If then the means for curing insanity are so unsatisfactory, cannot more be done in the way of prevention ? It is the invariable conclusion of those who study the subject, that very many who ultimately become insane, might have avoided the painful attack by the application of intelligent means at the suitable moment, and when the records of asylums are examined this conclusion is abundantly confirmed. The same exciting causes of insanity operate in all communities, in that degree at least to which various places correspond in social and political respects; if then for the sake of convenience and special application, the statistics of this State are examined, at the same time, the subject can be considered in its broadest sense and bearings. The last annual report* of the Connecticut Hospital for Insane, tabulates the exciting causes which led to the admission of 2,333 patients, the whole number received up to that date. Condensing the table for convenience, it reads as follows, viz.: Not insane, ....... 23 Causes unknown, . . . . . .957 Old age, brain disease, fevers, etc., etc., . . .263 111 health, . . . . . . .331 Connected with religion, the affections, domestic trouble, . 198 Dissipation and vice, . . . . .116 Intemperance, tobacco, opium, . . . .226 Over-work and over-study, . . . . .72 Anxiety in business, fluctuation of fortunes, etc., . . 147 Total, . . . . . .2,333 Nine hundred and fifty-seven cases, or forty one per cent, of all, could not be referred to a special exciting cause; yet, while no point of departure from the normal state could be decided upon, * Sixteenth Annual Report, Conn. Hospital for Insane, 1882. 5 no doubt the history of each case would reveal very many minor influences which had value in the sum total of causation, but so complex and evenly balanced the conditions that it would be un- just, as well as impossible with our present knowledge, to tabulate such cases under a single heading, or to decide how many were preventable. However, if to this class are added those not insane, and the 263 cases in which insanity followed natural, accidental, or unavoidable causes, as old age, injury to head, organic brain disease, fever, sunstroke, etc., the total is only 1,243, or little more than one half the whole number. In the other half of the cases insanity was brought about by such agencies as poor health, disappointed affections, vice, intemperance, tobacco, over study, over-work, anxiety from various causes, and loss of sleep—conditions largely under the control of man. In most cases attributed to definite causes, there can be dis- covered many previous lapses from a healthy standard not suffi- cient in themselves to dethrone the mind, but all leading up to the final overthrow of reason. And when insanity develops in individuals with an uneventful history, the same is usually true of them, but it is hard to allot responsibility to the several contributing causes, and the accom- panying physical debility is accepted as reliable enough to answer the requirements for ordinary statistics, and the cases stand on the books charged to ill health. In the table quoted 331 cases, or fourteen and eighteen one hundredths per cent., are so rated- In this connection, ill health is not a definite term, but signifi- cant. It conveys the idea that the final breaking down was the result of a long train of physical debility and suffering, com- mencing quite likely in a delicate constitution, feeble by inheritance, with subsequent over-work, anxiety, grief, want, neglect, or abuse, and insomnia almost invariably. Through such agencies, it is easy to trace the insidious advances of nervous invalidism to ultimate insanity, which on the whole is but the climax of a series of accumulating vicious influences attributable to natural heritage, and the enfeebling, disorganizing conditions to which from acci- dent or choice the individual is subjected. From the end, how easy to follow back along the lines of causation which in case after case are so direct and parallel that the unmistakable drift of such conditions ought to be better understood and more successfully antagonized. 6 That the various exciting causes charged with producing one- half of all insanities are in constant operation upon millions, while comparatively few break down under the strain, clearly shows that for the greater number the subjects of insanity were predisposed; that such persons had suffered a diminution of the power of re- sistance, and in this sense hereditary or acquired weakness is at the bottom of most cases of insanity, a conclusion which signifies that the percentage of insanity in a state is an index of the degree of physical and mental degeneracy in that community. At this point then should commence the study of insanity and all practical efforts at suppression. Heredity is a biological law. The most careless observers rec- ognize the fact that insanity runs in certain families; yet not only is overt insanity liable to break out in a direct line of descendants; but acquired habits even which affect the constitution in one gen- eration may become diseased conditions in the next. Since no serious results follow immediately, individuals and whole communities are pursuing methods of both work and play quite at variance with nature’s laws of perfect life and develop- ment. They are subjecting themselves to deteriorating forces which eventually drive to the wall the weaker members, con- tinually involve fresh stock, and entail upon future generations that instability of the nervous system recognized as the insane diathesis.* And yet those most interested are entirely apathetic, or give little heed to the necessity for avoiding all those undermining in- fluences winch induce or accelerate the invariable tendency towards disastrous results. The question of hereditary bias is undoubtedly a very serious matter, although it has become too popular as an excuse for results, which through ignorance or design are often obscure. True, if the original defect was due to malign influences which continue to embarrass individuals in the same line of descent, a serious explosion can be safely predicted; but for the most part the * It is noteworthy that the great increase of insanity is among those cases in which the symptoms are obscure. “Out of the cases of insane murderers in Broadmoor, insanity had been recognized in twenty-nine before the act was committed, but the persons were regarded as harmless ; in thirty-three they were not regarded as harmless, but insufficient precautions were taken, and in seventy-live no one had recognized insanity at all.”—Tukes History of In- sanity in British Isles, page 282. 7 so-called hereditayy limitations are conditional, and need seldom evolve the worst or even bad results if only proper attention be given to antagonizing the inimical tendency; for the law of hered- ity, if unimpeded, is most marked in the effort to eliminate de- fects, and to bring back a species from accidental errors to the normal type. Predisposition is by no means synonymous with predestination. A vastly more important element for individual good or ill is the subject of environment, the moulding influences of instruction, associations, example, and habit. The offspring of virtuous, healthy parents, if early subjected to vicious influences and corrupt train- ing, are pretty certain to swell the ranks of the diseased and immoral classes; while on the other hand, by removal from dis- orderly homes, with timely and wholesome instruction, the children of the depraved are often bred to careers of usefulness and honor. Such results are so commonly illustrated, that all are obliged to acknowledge the supreme importance of pure associations, wise discipline, and judicious physical and mental education to develop the best side of human nature, to counteract inherited evil traits, and to hasten on the work of elevating mankind. Every strong emotion, or train of thought, temporarily affects the nutrition of the nerve centers, and if such excitations are fre- quently repeated, there results an organic physical condition which becomes the basis of habit and character. This is especially true of the susceptible brains of children; which suggests reason enough why in the young every laudable thought and emotion should be fostered, and those which are corrupting or excessive be smothered or controlled. Nor should such precautions be neglected in later years, for what we are pleased to call the accidents of life are seldom the visitation of mere chance. Careful watch is incumbent upon the fortunate possessors of a constitution free from ancestral taint, and whose high duty it is to preserve and transmit the priceless boon; but doubly important is it for that other large class, whose advance in life is trammeled by the incubus of diseased pro- genitors, for it is possible, through prudent direction in early years and subsequent self-control, for such even to prevail over infirmi- ties and to rise superior to the “tyranny of a bad organization.” The springs of action should rise from a code of strict morals— self-discipline is to be encouraged, and self-feeling repressed. An education should be planned on the broadest grounds—not the 8 sort which is mere book learning, but that which cultivates the If natural powers of observation, comparison, and judgment; en- gaging the attention and stimulating interest in many channels and a wide variety of subjects. Other things being equal, breadth of base always contributes stability, and as concentration of the faculties obtains, the possibility of fatigue and strain increases, and the more difficult it becomes to regulate mental hygeine when there is impending insanity or actual aberration. When by undue self-examination subjective feelings are magnified into morbid states and false proportions, it becomes impossible for the individual to control the habit by direct force of will, whether it be attempted through personal fears or by professional advice. The remedy in such cases is to completely occupy the atten- tion in other directions—a course which if successful promises most, be the object to prevent or cure insanity. When other means have completely failed in such attempts, the moral treatment of the insane asylum frequently succeeds, and the whole secret consists in presenting marked contrasts to former surroundings. The fascination which comes from observing other patients, or perhaps the substitution of a genuine annoyance or subject of anxiety for trivial or imaginary trouble, is often the first step which leads to gratifying results in treating mental disease. In the table which forms the basis of this paper, there are 198 cases, about five and a half per cent., placed under the moral causes, religion, the affections, and domestic trouble. That senti- ments of unalloyed religion will derange a sound mind is very improbable. On the contrary, a well grounded religious faith is calculated to keep at a minimum the influence of many mind- destroying agents, and to safely tide its possessor over the natural or accidental emergencies of life. It serves the practical advantage of withdrawing the mind periodically from the tiresome circle of care and business, affording a necessary break in the exhausting concerns of life, and permitting not only true rest, but a renewal of duties, with a clearer mind and fresh vigor. As a means of con- serving human energy, the benefits of the Sabbath-day rest are inestimable. Then too the wise Christian should of all men be a true philosopher, and hold the favors of this world in such estima- tion that their acquisition or loss would not seriously disturb his equanimity. There are, however, extra emotional minds in every community, 9 apt to take on irregular action through wrapt attention on any subject appealing to the emotions, and who are often crazed through the excitement incident to some forms of religious fervor. For this rather numerous class, the gospel of common sense would be a much safer doctrine than theories of personal infalli- bility, leading to less mental disease and more practical Chris- tianity. But it is minds of quite another order that are liable to serious injury through the affections. It is a law of nature that intensity is opposed to permanency. So when those very demonstrative, overmuch persons are disturbed or thwarted in their love plans, there may be an explosion quite out of magnitude with its cuticu- lar shallowness, but the first sweet zephyr usually clears up their heaven, while the retiring, amiable, sweet-natured ones may be mentally wrecked for life, on account of dismay, regret, or the rude shock accompanying the disappointment of fond hopes and expectations. That pure, absorbing love often witnessed between members of a family or particular friends, is a sacred influence, inspiring and beautiful to behold, but it may promote unsymmetrical development, and become a source of emotional or mental strain. Especially is this true when such affection for a deceased rela- tion or friend is unduly cherished and magnified as the months or years roll on; a morbid mental condition results, reacting upon the physical organization until a burden of sickness or lunacy is superadded to the original affliction. In the sad history of all those who become bankrupt in sound sense through unfortunate bestowal of the affections, a time can be pointed when a knowledge of the truth and discipline, self imposed or otherwise provided, might have averted deplorable results. Likewise with the victims of domestic trouble; a mutual effort towards duty or forbearance, the kind office of a mediator, or the stern hand of law and justice, should necessarily be tested in their behalf, before classifying such cases as unavoidable. One hundred'and sixteen cases, about five per cent., are returned as due to dissipation and vice. That such cases are largely pre- ventable in a moral community, ought not to be questioned. The number credited to intemperance is 218—about ten per cent, of all cases. This is below the per cent, attributed to the same cause, in the average returns of other institutions; while some good authorities claim that fifty per cent, of all cases of 10 mental disease, result directly or indirectly from the excessive use of alcoholic liquors. The lack of uniformity in such reports may depend upon the predominant class of the population, and their habits respecting the use of stimulants, as they vary in the several localities of the different observers. Then perhaps the theoretical bias of some leads them to strain every point to sustain a favorite theory; but without question intemperance occupies the first place among the physical causes of insanity. Dr Carpenter asserts that “ twenty-five per cent, would be small enough an esti- mate for Great Britain.” In such returns and estimates, temporary madness and delirium tremens are not included, only cases of marked insanity, though many have a distinctive alcoholic character. The sensitive brain tissue which presides over mental manifestation is shocked and blunted by the presence of alcohol in the blood, and when its long- continued use has resulted in a profound disturbance of nutrition in the nervous system, the patient exhibits symptoms of partial paralysis in both mind and body—as judgment and will-power are impaired, an emotional, childish disposition becomes a prominent feature of the case. Hallucinations, delusions, or suspicions fill the otherwise vacant mind, and there results a permanent loss of the finer feelings and higher development of character. There are many others, however, which have not these special aspects of “rum cases,” but classify under the common terms for the differ- ent phases of insanity. They represent a large class who by in- herited, accidental, or acquired causes are predisposed to mental derangement, and in whom mental balance is overpowered before the nervous system becomes saturated to the destructive point with the irritating poisonous fluids. In official reports such cases may be assigned to other classes; still intemperance was no less the exciting cause, and to it is chargeable all the suffering, personal and family-wise, besides the financial burden thus imposed upon self, friends, or the State. Even habits of moderate drinking, especially in the lower classes, produce a considerable crop of insanity. The money squandered for the worse than useless liquor, nine-tenths of which is not what it purports to be,* amounts to millions,f the most of * Encyclopaedia Britannica—Adulteration. t Careful estimates make the amount for whole country not less than $600,000,000, and for Connecticut not less than $15,000,000.”—Conn. Temperance Union. 11 which comes from those who at their best can scarcely make suita- ble provision for themselves and those dependent upon them. The theory that lager beer is a comparatively harmless bev- erage. and could wisely be substituted for distilled liquors, is a gratuitous fallacy, judging from the experience of the Connecti- cut Mutual Life Insurance Company.* Because of this waste of funds whole families are deprived of clothing, food, shelter, and medical care in sickness, to an extent which is destructive of all principles of wholesome living; leading to malnutrition, over-work, beggarly idleness, cankering care, or dull despondency, which glide into insanity in many weak systems, and involve in all some degree of physical or mental degeneracy—an indebtedness to nature which must be liquidated sooner or later at the expense of human well-being. To a large extent the increased consumption of alcohol is symp- tomatic of the increased prevalence of neuropathic constitutions— of a rapidly increasing class who feel an insatiable nervous craving for some excitant or stimulant, and lack the will-power to triumph over the weakness. But alcohol, when adopted, is no remedy for such diseased conditions; it only accelerates the same evil in a vicious circle. The abuse of alcohol as it affects the user is worthy the most serious consideration, but the stupendous total of suffer- ing and disease descending upon the innocent children of hard drinkers would be appalling if generally recognized in its extent and menacing import. The heredity of dipsomania is insisted upon by all authorities. They are agreed that parents enslaved to stimulants always bestow upon their posterity inherent defects, ex- ceedingly liable to develop alcoholism, insanity, or idiocy; at times skipping a generation to break out later as a distressing malady. This wide-spread disease, the result of moral and physical vice, is not self-limiting; by inheritance and example, fresh recruits are daily augmenting this inglorious army, who for the sake of a temporary “ fool’s paradise ” thus hazard every honor in life, both for themselves and their posterity. Most certainly some measure * “ What beer may be, and what it may do in other countries and climates I do not know from observation. That in this country and climate its use is an evil, only less than the use of whiskey, if less on the whole—that its effect is only longer delayed, not so imme- diately and obviously bad, its incidents not so repulsive, but destructive in the end I have seen abundant proof. It is 'peculiarly deceptive at first: it is thoroughly destruc- tive at the last.”—Colonel Jacob L. Geeene, President Conn. Mutual Life Ins. Co—Hart- ford Daily Courant, Nov. 29, 1882. 12 should be projected to counteract this immense evil, and a large share of the responsibility would seem to rest on physicians. The effect of intemperance in its immediate and remote relations upon families, and a succession of families, should be traced and recorded. Already some institutions work on this scheme, but the general practitioner must do a large share of the work, for who else is trained, and has opportunity for such public service. The State Board of Health, a modern institution of great power for good, is ready to give the widest publicity to all reports and statistics on subjects affecting the public interest as this does. Waiving personal sentiments respecting temperance, the physician ought to take a vital interest in this subject, for he is con- fronted daily with the pernicious influence of this king of dis- eases: moreover, cultivating broad views in any field of knowledge assists wonderfully in cheering and stimulating one’s labors in individual routine. Then there is open to the profession a grand opportunity to shape public opinion on this subject, which at present is far from settled, else settled very erroneously. Cold science must furnish the facts and argument for the work, but kind-hearted philanthropy must take a new, earnest departure on this subject. Instead of threatening tracts and glittering gen- eralities, the unpleasant truth must be brought home to the unfor- tunate, the mistaken, and the vicious, in a spirit of kindness, thus disarming antagonism with friendly sympathy and assistance. The use of tobacco is another method of satisfying the abnormal sensations of the nervous system, so destructive to physical well- being if not regularly fed, when once the appetite is recognized or has become a habit. The injurious effects arising from excessive use are too masked or remote to admit of numerical expression, and the conclusions warranted by statistics, but it is the common belief of those who see much of nervous disease that tobacco as used by many is a serious detriment. Of the 2,333 cases, only one is reported as due to the opium habit. As a prolific source of insanity, and results injurious to health and constitution, next to*alcoholic intemperance comes “intemperance of work; ” that intense, unremitting application which leads to mental and physical strain, directly conducing to insanity or systemic 13 defects which may reappear in succeeding generations. Every one admits that the ambitious, intense haste characteristic of the present day is too fierce for general good. Still the most marked exponents of this impolitic fashion push on, wrapped in the delu- sion of personal exemption from the universal reign of law. The youngest members of the community are soon involved, for our school practice conforms to the general high pressure system. Encouraged by parents, enterprising teachers impose a multi- plication of tasks; a complex course of study is blocked out, and all comers, regardless of capacity, or ultimate ends in life, are hastily crowded through'the rigid machine. During the years of tender life, when the physical growth is of prime importance, the brain is overtaxed to memorize a mass of dry disconnected facts and generalities, for the most part to be early forgotten, and of little practical importance beyond the dress parade of the exciting, injurious examination day. Such practice may be teaching, but it is not educating in the proper sense or healthy way. Nearly all for whom public schools are designed will succeed in life only by personal application to some form of labor, and that which they can make use of alone constitutes the graduate’s true knowledge. Running superficially through the whole field of science and history, and inculcating often ideas of talent, merit, and promise, which are mere conceits when the material limita- tions of the individual are considered, are among the errors often charged to our public schools, but of much graver mischief is the antagonism which over-study precipitates between brain growth and body-growth. When mental preoccupation absorbs the whole energy of the young scholar, the powers of nutrition are chiefly expended upon the nervous system, in response to the local brain stimulation, and in efforts to recuperate the perpetual nervous exhaustion which must follow. The result of such perverted physiological activity is unsymmetrioal development. The nutrition and functions in one set of organs are excessive, while in others they are retarded, and this eventuates in refinement, delicacy, and intensity of the nervous system at the expense of stamina and reserve power. It produces subjects inclined to headache, backache, and the never- 14 ending variety of nervous disturbances which go to make up the modern disease, American Neurasthenia.* When the ordinary school requirements have such a depressing tendency, what can possibly excuse the folly of grafting fashiona- ble society excitements and frivolities upon our public school system, thus doubling, without prospective benefit, the risks of mental over-work and strain. At a season when the legitimate school tasks require for their mastery the fullest and calmest mental attention of the pupils, subjects stirring up scheming, pride, envy, and excitement are forced upon them in a manner so alluring that imprisonment of the mind must become a second- ary consideration. At an age when the judgment is unformed, social privileges and equalities are so meted out that the heads of some are completely turned—erroneous ideas of rank and future possibilities are formed; the correct, modest beginning, requisite for final success in life, is slighted, and years, perhaps a life-time, may be wasted struggling along on a plane to which the individual is unfitted by circumstances of life and fortune. Of the many who, by genius and personal efforts, have raised their position from lower to higher stations in life, none have made the advance through such channels, nor in accordance with such artificial standards. As a consequence of the mental and nervous strain from these causes, how many scholars, brilliant according to school test, dis- appoint all expectation by making no mark in after life. But the obscure character of the mischief is its worst feature. If exhaustion is noted, a rest is prescribed, with the expectation that a few days of idleness will obliterate' all traces of harm; and since there are no certain means of comparing the subsequent life with what might have been, it is hard to demonstrate the import- ance of this factor in diminishing good health. Yet how many go through life crippled in energies, suffer as chronic nervous invalids, or become downright lunatics, through this fruitful source of degeneration. In the conflict between mental tension and physical development, the female system suffers greatest, injury through refinement of * During the last school year twenty-five per cent, of the girls in the Cleveland High School withdrew, from one cause or another. Of these seventy-five per cent, left, wholly or in part on account of ill-health, and thirty-three per cent, of those who left were compelled to do so on account of physical trouble. The health of more than half the children drops below the level when attending school.— The Medical Becord, Nov. 12, 1881. 15 organization and delicate harmony of physiological functions, upon the integrity of which depend both individual well-being and race progression, for “ if any class of organs become predominant in their development, it conflicts with the great law of increase.”* Such one-sided modifications as the excessive nervous temperament represents, become more and more difficult to rectify or sustain. Nature has appointed woman to bear the strain of perpetuating the species, and the quantity and quality of animal life in the mother largely determines the character of the offspring, for “the first requisite of a gentleman is that he be a good animal,” a con- clusion of the philosophical Emerson, so recently quoted and em- phasized by Herbert Spencer. “ So commonly do I find ill health associated with brilliant scholarship,” writes Dr. Goodell, “that one of the first questions I put to a young lady seeking my advice is, ‘ Did you stand high at school?”’ That undue brain work will undermine the health of girls cannot be denied.\ The popular out-cry against stair- climbing for school girls indicates public alarm over some grave evil; nevertheless it repeats an old error by mistaking the symptoms for the disease, and fails to recognize one of the original causes, and a grand remedy for the prevalent lassitude of young women. Not that schools deserve all the blame in this matter; in truth, if the days of the young were well ordered in every other respect, school duties would make a less serious impression; but as part with, and akin to the mistakes of the school system, is the com- mon home practice of forcing children ahead of their years—a most unfortunate American custom. No other device would so well serve to keep the mind and emotions in that constant exercise which alters character and depresses vitality. The various accom- plishments are attempted; too much time may be devoted to music, painting, and dancing; and such excesses, with reading sensational novels, and participating in exhausting pleasures, cer- tainly help the young to understand the ways of the world, but do not contribute abundant health, length of days, nor strong links in the chain of evolution. *Dr. Nathan Allen, Popular Science Monthly, Nov., 1882. f If woman’s health must he sacrificed upon the altar of a higher education, the time may come when, to renew the worn-out stock of this republic, it may be necessary for our young men to take the hint thrown out hy another, and make matrimonial incursions into lands where educational theories are unknown.— The Banger and the Duty of the hour. Wm. Goodell, A.M., M.D., 1881. 16 Two marked, local, cases of ‘•over-study” are thus explained: “ One of our girls who graduated in very delicate health read from the Institute Library one hundred and ten bound novels in six months, while she was attending school. Another young lady who came near breaking down the last half year of her high school course, saw company, either at home or elsewhere, every night during that winter. She said she never commenced to study her lessons until after eleven o’clock at night, and seldom went to her bed before one o’clock.”* Aside from the “ society claim ” cases, over-study is most liable to harm those who become anxious or worried about their success in reaching imposed standards, or their own ambitious aims, and the same rule holds good in professional or commercial life, for over-taxing the mind and strength, in the sense here used, covers the cares and anxieties of business. It is not so much that a man conducts business on a large scale, as the too frequent haste, anxiety, and worry about it—the strife and fret for greater success, or the conjuring into prominence of uncertainties, actual risks, or possible reverses, which lead to exhaustion or premature decay. When every thought is given to business, as to any other one object, by exclusion, capacity for interest and enjoyment is gradu- ally narrowed, and when too late it is found that the whole atten- tion gravitates in one channel, direct attempts to arrest its course in view of foreseen danger are as futile as planning to obliterate a stream by constructing a dam—the power behind accumulates until the barrier is thrust aside, having served the mischievous purpose of adding volume to the flood which follows. There is much corporeal over-work, particularly in the agricultural districts. Severe and constant manual labor leaves little time for cultivating the cheerful and better sentiments, or that education which contributes power and stability to mind and character. Years of constant drudgery combined, as is quite commonly the case, with innutritious food, improperly selected or poorly cooked, are so destructive of vital economy that exciting causes, harm- less under other circumstances, are sufficient in these to derange the mind. The frequency with which insanity breaks out in farm- ers’ families best illustrates this. The lot of a farmer’s wife in many instances is exceedingly hard. In addition to the demands upon ♦Letter.—Joseph Hall, A.M., Principal Hartford Public High SchooL 17 her strength and system incident to rearing a family, she usually performs all her housework, including family sewing and manag- ing a dairy. Her efforts to please her husband and children, and to do her part in paying off a mortgage or depositing a few dol- lars in the savings bank, become so absorbing that she labors on in earnest, unselfish devotion; in pure country air, to be sure, and with a plenty of wholesome food obtained from the farm, perhaps, but with no restful moments, only a short sleep when exhausted to interrupt the grinding, wearying toil; heeding no admonition, she accumulates burden after burden, undermining strength and health until the human machine collapses; if sooner or later de- pends upon the constitution inherited. “ Only think of it,” said a farmer’s wife in the Retreat happily convalescing after an attack of insanity. “ Dr. Butler is keeping me here and I have six children and fourteen cows to take care of at home.” “ Twenty excellent reasons for you remaining here until cured,” was the timely answer.* Injurious to mind and body as overwork is, idleness on the whole works greater havoc in deteriorating the race. Those who possess abundant physical vigor seldom adopt indolent habits, but the delicate and emotional, especially if in wealthy circumstances, often neglect all occupation which would require healthy attention or interest, and in luxurious ease read light literature, build air castles, and imagine the most fascinating personal romances. They selfishly dwell upon subjective feelings, developing more and more complete egoism ; they magnify sensations into symptoms, and symptoms into diseases, until nervous invalids result by the hundred. With emotional or intellectual capacity cultivated at the expense of physical development ; with serious, sensible views of life re- pressed by the engrossing cares of an artificial society life ; with wills untrained through perpetual indulgence, and with theories of human nature imbibed from French novels, French plays, and French operas, what wonder the middle ground between positive health or disease, sanity or insanity, is occupied with so large a class. Admitting such to be exceptional cases still, while well supplied tables, lager beer, and cod liver oil are successful in maintaining a ♦First Annual Report Conn. State Board of Health, 1879. 18 good standard of physique, it is a growing conviction that ‘‘women in the New England Family, are being gradually modified in physical organization, instincts, and character.”* True, healthy living requires both labor and recreation, and is best obtained by a systematic variety in subjects examined or under- taken, and by diversifying the channels of thought and action to combine exercise, change, rest, and amusement, thus strengthening the mind and character and affording the best preparation for success in any department of life. The professional man should follow a course of investigation or labor that would, through interest, not self-discipline, break into sedentary habits with regu- larity and profit. The business man and the farmer should adopt some course of reading or study which might be found most agreeable, or best educate the faculties for personal success, or the assistance that could be unselfishly rendered others. With children the same scheme of recreation and amusements must be employed if the happiest results are desired. It is not enough to declare a holiday, but judicious plans and careful supervision should attach to the entertainment of the young. Impressions leading to habits are so easily fixed that silly and vicious associations should be discountenanced, and those en- couraged which stimulate interest in all things pure and refining, while giving rise to physical development, innocent mirth, and buoyancy of spirits. Our native population inherited from the sturdy settlers of New England a coldness and austerity of manner, and there is great necessity for more methods of infusing warmth and sweetness into the lives and homes of our honest, strong-willed people. Much, therefore, remains to be done in educating the public in practical ways for rational enjoyment. Whatever customs evoke extreme sentiment, insipid or tart, and lead to apathy or frenzy, should be avoided. Unrestrained indulgence in exciting, frivolous pastimes is dissipation, and fond parents who provide for their children a ‘Nathan Allen, M.D., L.L.D. The Law of Human Increase.—Popular Science Monthly, Nov., 1882. The New England Family.— The Neui Englander, March, 1882. The Danger and the Duty of the Hour.—Wm. Goodell, A.M., M.D. Incompatibility of the Higher Education with the Duties of Motherhood.—Henry K. Palmer, M.D. The Transitional American Woman.—Kate Garnet Wells. Atlantic Monthly, Dec., 1880. Editorial.— Scribner's Magazine, Feb., 1881. continuous round of intoxicating gaieties, all unconsciously, per- haps, are substituting a trifling, artificial life for one of true dignity and worth. It is little realized how the young are being unfitted by this process for the sober realities of life. Again the wear and tear inseparable from some popular forms of amusement—the Fourth of July celebration, for instance— are greatly in excess of any possible benefit. Such play-spells supply recreation with a vengeance, and are “better honored in the breach than the observance ” Holidays and festivals which lead to cheerful, healthy recreation should be multiplied and util- ized by all classes. Families and local communities could well afford to spend more time in salutary fellowship. The plan of village improvement societies so successfully inaugurated by Secre- tary Northrop of the State Board of Education, was well con- ceived, and suggests the happiest possibilities in the way of variety and entertainment in localities where it is extremely difficult to vary the monotony of life. More should be done in providing opportunities for recreation and amusement for the large classes who, if unassisted, have neither means, time, nor inclination for securing their own best interests. The English plan of public coffee club-houses might well be adopted in all thickly settled com- munities. Such places when conducted with sense, made attractive by music and games, supplied with books and current literature, would promote social improvement, and might rival even the public schools in spreading practical education among those not likely to find at home sufficient cheer and variety to satisfy the natural taste, and who, if neglected, would gravitate into associations and habits certain to diminish the powers of both body and mind, and verge toward pauperism, crime, or insanity. But more important than all else in building minds and charac- ter is the family influence. Here rest the foundations of society, and here, in gentle patience, are engaged daily more heroism and grander virtues than are celebrated in the annals of military warfare. The laws of complete life are grounded on principles which must be indelibly impressed on the very young, and in faith, through example and precept, the parents must sow the moral seed. Truth, obedience, love, and industry should be thoroughly taught as cardinal points, and with such foundations, knowledge and wisdom such as books of themselves can never teach, will gene- rate spontaneously with the growth of the person, enriching and 20 perfecting individual character—the safeguard for future human progress. The nurture and admonition for such training need not be irksome. In those families when the actual motives in life correspond to such doctrines, principles do not require formulation. Instruction is possible without a schoolmaster. There can be dis- cipline without drilling, and correction without antagonism. Who has not been admitted to family circles where such a system prevails without friction or discord; where correction with love, and firm- ness with sympathy is so mingled, that the bestower with each instance is rewarded by stronger ties of endearment on the part of the recipient. One is always charmed in contemplating such har- monious promising family groups, where unselfish love and devo- tion to each other is the ruling motive of all, and feels assured of the safety of the race, so long as our land is filled with such homes and such families—the most sacred institutions on earth. The prominent causes of insanity have been discussed, but underlying and largely accounting for them, as well as detected in numerous other directions as responsible for much actual disease and race degeneration, is the common fierce desire for the acquisi- tion of riches. To give direction and tone to popular notions as to worthy objects in life, there is great opportunity and necessity in this country for a wealthy cultured class, for men willing to pursue scientific investigations free from all anxiety for maintenance or gain; for men who would undertake public duty for honor, secure above the temptations of bribes, and more men, in imitation of some noble examples, who would desire to earn renown through the practice of Christian philanthropy. But in accordance with the money-gauge of nobility, the better impulses are trampled down in the rush for financial gains, and- when favored by fortune, the grand climax of a successful life is claimed, even when to accomplish this, comfort, character, or life may have been ruthlessly sacrificed. Our interest in the agencies which cause insanity are broader than the field embraced by any single topic. Prom the same cen- ters radiate the malignant influences which cast upon society and its progress these great burdens—poverty, crime, and insanity. It is probably true of all these evils, that fifty per cent, is a low estimate for the amount due to gross ignorance or selfish disregard of known laws, and which might be largely prevented if the lead- ing causes were better understood and suitable provision for cor- 21 recting faulty living were at the command of an intelligent and interested public. Interested the public should be, for the unity of human interest is such that whatever affects the individual affects society. We prate of our independence and respect the rights (?) of others even in suicidal courses, but can we escape all responsibility? “Am I my brother’s keeper? ” was the unavailing ex- cuse of the man who invented murder. The diminution of marriages and the birth rate, and the frequency of divorces in the native New England population can be explained on this physiological theory* of the one sided development resulting from wrong methods in society, in study, and in business, though it is impossible to draw a line of demarkation between moral and physical influence in such connection. The unfavorable showing from statistics on these subjects, with the prevalence of poverty, intemperance, crime, and disease, and the frequency of shocking social explosions in quiet old orthodox districts in New England, indicate a decided undercur- rent, demoralizing and deteriorating in its tendency. The recogni- tion of such a state of things does not argue pessimism—it is but the diagnosis requisite for scientific treatment—and fortunately such conditions are the exception, for without doubt there is in the main an enlargement and progress in human affairs, but it is no less our duty, while retaining what is good, to detect, control, and remove what in modern life and manner is evil. Crying temper- ance in all things, and preaching the “gospel of relaxation” is not enough to stem the torrent of baneful influences. The moral law is always the ldw of progress, and public sentiment must be held to the highest standards. The results of noxious habits, errors, and vices must be undertood and taught, and correction suggested. That narrowness of attention and asymmetry of development, as exhibited in forms of amusement, systems of education and appli- cation to business, must be realized as likely to defeat the very hopes which prompt such courses by their direct tendency to physical impairment—a condition inviting disease either in the individual or descendants. From the limits of New England have gone out a great multi- tude distinguished for pure faith, pure aims, and pure blood. It has been an acknowledged center for the best moral and religious sentiments, but its honorable prestige may give place to a fame * New Englander Mar., 1882, p. 149—D. Allen. 22 quite undesirable, if the elements of decay and disintegration are not retarded in their onward march.* We are justly proud of our high state of civilization; but every civilization that has risen into prominence but to decline, has been sacrificed to internal processes of decay. When to appearances at the height of their glory the whole fabric of society was permeated with corrupting, disintegrat- ing habits and forces. Typical for all time of the false sense of security bred of hu- man pride, was that warning vision revealed to the king of great Babylon. “ Its brightness was excellent,” for as presented in his dream this remarkable human image was crowned with a head “made of fine gold.” But when the inspired prophet scanned the same apparition from head to foot, marking how successively materials of a retrograde quality entered into its composition, until an incoherent mass of iron and clay made up the fragile feet on which it rested; he proclaimed in dismay that “its form was terrible.” Man follows scientific laws in propagating and cultivating every species under his control, excepting only his own, and this indiffer- ence comes because the lines connecting cause and effect in the growth or decay of man are so attenuated—often through the years of several generations, that a single observer has personal knowledge of disconnected sections only; but if such vitally interesting panoramas could be focused within a single field of vision, to be known and read of all men, it is safe to assume that attempts to perfect man would be the first business of the State. No systematic attempts have as yet been made to prevent insanity, but with the clearer knowledge yearly accumulating, the enormous money considerations involved and the increasing general interest in the subject point to the inauguration at an early day of efforts in the right direction. Not that insanity can be stamped out except in an ideal State, but it can be largely obviated in a working, practical commonwealth. * Let us see to it that the New England idea which is creeping towards the far West and lengthening out its slimy trail towards our own home, which is breaking up house- holds and gnawing into the core of our national prosperity—let us, I say, see to it that this canker does not take root in our soil.”—Dr. Goodell, at Balt., Md., 1881.