Chapter I: Preface

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

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

H. P. S.

HARTFORD, _Dec., 1882_.

CONTENTS.

CHAPTER I.

PRELIMINARY.

PAGE.

Increase of interest in the subject of insanity, resulting
from, first, more intelligent views concerning its nature; and,
second, the obligation to make provision for the care of the
insane in a larger measure than for other unfortunate classes--
Results in the way of hospitals--Asylum attendants--Change in
the modes of management, and care of the insane 3

CHAPTER II.

INCREASE OF INSANITY.

Indications which point to the probability of its increase in a
greater ratio than that of the population: (1) in relation to
the general conditions of society; (2) in occupations; (3) in
the character or tendency of disease--Increased demand for
hospitals for the insane not a conclusive evidence of increase
of insanity; other reasons exist for this--Improvements in
hospitals--The chronic as well as the acute insane now provided
for more generally than formerly--Accumulations in asylums--
Statistics--Those of England and Scotland--Their character and
import as presented in the yearly reports of the Boards of
Lunacy Commissioners 11

CHAPTER III.

INSANITY AND CIVILIZATION.

Prevalence of disease among savage nations--Conditions of life
not such as to produce insanity--Definitions of civilization--
Several conditions attending civilization combine to increase
diseases of the brain--Increase of brain activity--
Over-stimulation of the brain in schools and by the use of
alcoholic beverages--A community of interests exists in savage
life which is lost in civilized life--In the latter the strong
thrive at the expense of the weak--Monopolies in land and other
forms of property--Inference to be drawn from the tendency of
insanity to increase--The primary condition of insanity one of
the brain--Investigations should relate to the nature and
causes of this condition 33

CHAPTER IV.

THE INSANE DIATHESIS.

The _ideal_ human system--The _actual_ human system--Physical
and mental differences among persons in health--Periods during
which there exist considerable changes in the character of
mental action in the case of many persons while in a state of
health--Excitement and depression of mental activity--This
tendency to unstable activity of the nervous system may be
inherited or acquired--Illustrations from the effects of
over-exertion, "writer's cramp," chorea--A similar condition of
that portion of the brain which is concerned in mental
operations may exist--Illustrations--The effects of sudden
mental shocks and long-continued mental application--
Recapitulation--The condition which we term the Insane
Diathesis is the prime factor in the causation of insanity 53

CHAPTER V.

THE INFLUENCE OF EDUCATION.

The higher conception of education--The ordinary course pursued
in schools--Too many subjects studied at one time, and too
large a number of scholars under the supervision of one
teacher--Little opportunity to study individual characters and
tendencies--Numerous subjects of study tend to confuse the mind
rather than invigorate it--Illustrative cases--Teachers only in
part to blame--Courses pursued in colleges--The importance of
avoiding over-stimulation of any portion of the system in the
period of youth--Ball clubs; rowing clubs--A similar tendency
to over-stimulation of the brain in study prevalent in
England--Over-exertion in the use of the brain tends strongly
to create weakness and instability of action, and a condition
which may be transmitted to children 73

CHAPTER VI.

INDUSTRIAL EDUCATION.

Occupations of persons admitted to State asylums--Percentage of
those having no education in industry, or regular occupation--
Importance of industrial education to the brain--Difficulty of
obtaining it greater than formerly--Education of the brain has
taken the place of industrial education, and with unfavorable
results--The education of the schools does not qualify the mass
of people to earn a living: it tends rather to unfit them for
industrial labor--The interests of society require that the
largest number be educated to be self-supporting--To secure
this it is necessary to begin early in life--The same principles
apply to education for domestic labor 95

CHAPTER VII.

MORAL EDUCATION.

Examples of deficient moral education--It more especially
pertains to the influence of home and relates to obedience--
Respect and obedience toward persons in authority essential to
any efficient system--This must be learned in early life if at
all--Self-control essential to the growth of mental strength
and discipline--The tendencies in the modes of home and school
education 115

CHAPTER VIII.

HEREDITY.

Its importance as a factor in causing physical and mental
characteristics in families and nations--Illustrations--
Tendencies to morbid action, both mental and physical, may also
be transmitted--Insanity--Dipsomania--How may unfavorable
tendencies be avoided?--The influence of heredity acts toward
elimination of unfavorable tendencies when existing on one side
of the family--Importance of understanding this in relation to
marriage--Education may do much toward aiding in the removal of
unfavorable tendencies--Weak-minded children--Those born with
peculiarities of physical and mental constitutions 125

CHAPTER IX.

CONSANGUINEOUS MARRIAGES.

Different views in relation to the influence of consanguinity--
The customs of the ancient Egyptians, Syrians, and others--
Experiments in the inter-breeding of cattle--Popular
impressions as to its effects--Opposite views explained by
understanding the laws of heredity--Favorable as well as
unfavorable tendencies are increased--Hence unfavorable ones
may be eliminated 145

CHAPTER X.

ALCOHOL.

General considerations concerning its effects upon the nervous
system--Its use at the present time as compared with that of
the past--Society now reaping the effects of its use in the
past--Physiological effects of alcohol upon the system--
Experiments of Dr. Parkes and Count Wollowicz--Its effect upon
the action of the heart--Its effect upon the circulation of the
brain, the blood-vessels, and cells, resulting in a less
sensitive condition of these parts, and ultimately in organic
changes--Its effect upon the character of mind; upon the
electrical currents of the brain; upon other portions of the
body; upon the brains of children and young persons--The
alcoholic diathesis likely to be transmitted 153

CHAPTER XI.

TOBACCO.

Opposite views as to its general effects upon individuals--The
physiological effects upon the mucous membranes, the heart, and
the nervous system--Nicotin--Its elimination from the system by
the lungs, skin, and kidneys--Its effects those of a narcotic
and not of a stimulant--Its effects upon the brains of children
and young persons--The use of tobacco by children should be
forbidden by law--Its general effects upon society, socially
and politically, as presented by M. Fievee--It is not directly
responsible in any large degree for producing insanity--Creates
a diathesis which causes a diminution of intellectual and moral
power 173

CHAPTER XII.

SEX IN RELATION TO INSANITY.

Relative frequency of the occurrence of insanity in the sexes--
The sexual system in the female exerts a larger influence upon
the nervous system in certain ways than that of the male--
Sexual derangements dependent upon the debility of the nervous
system--They are generally _consequents_ and not causes of
nervous debility--Functional derangements of sexual organs rare
among the insane--A tendency to recovery in case they do
exist--Other conditions not favorable to mental health 187

CHAPTER XIII.

POVERTY.

Physical labor one of the largest promoters of health--Sudden
increase of wealth often results most unfavorably--Too constant
application to labor and household cares--A case illustrative--
In the contests of life the weaker go to the wall--They are
often surrounded by most unfavorable sanitary surroundings,
impure air, poor tenements--They become the psychological
windfalls of society--Have been and will continue to be
dependent when stricken down by disease 199

CHAPTER XIV.

RELIGION.

Influence of religious belief upon man--Not a cause of
insanity--Religious belief natural to man--It is found in all
nations--Man instinctively looks up to a Superior Power in
hours of suffering and need--He needs such a belief to sustain
and give hope--The laws of health and a religious life are in
harmony--A religious belief tends toward health--So long as the
present conditions of life exist, man will require its
sustaining influence 211

CHAPTER XV.

INSUFFICIENT SLEEP.

Conditions of the brain which are supposed to produce sleep--
Congested state of the blood-vessels--An anaemic state--
Suffering when a person is for any cause deprived of sleep--
Persons usually sleep too little rather than too much--
Physiological reasons why children require more sleep than
adults--They generally sleep too little, especially when living
in cities--The importance of sleep for the brain learned from
its universality in nature and especially from the functions of
other portions of the body--In this state it recuperates its
exhausted energies and stores them up for use when in a state
of activity--Inability to sleep a precursor of insanity 223

CHAPTER XVI.

CONCLUSION.

The primary causes of few diseases are fully understood--
Prevention of insanity must come mainly from education received
at home and in the school--Difficulties in the way of securing
any efficient preventive measures--Educational processes may be
improved in several ways: (1) by securing a larger degree of
_individuality_; (2) more attention to industrial education;
(3) more efficient home education--Changes in certain habits;
(1) in reference to the use of alcoholic beverages; (2) in the
use of tobacco; (3) the importance of longer periods of rest
and recreation; (4) improved sanitary surroundings in those
portions of cities occupied by the poor and laboring classes
of society--The importance of systematic measures toward the
prevention of insanity 237