INQUIR Y 
INTO THE 
CAUSES OF INSANITY 
With Especial Reference to Prevention 
and Treatment, 
BY 
CHARLES P. BANCROFT, M. I)., 
Superiuteudeiit Hew Hampshire Asylum. 
[Reprinted from Annual Report of New Hampshire State 
Medical Society.] 
MANCHESTER, N. H. 
PRINTED BY JOHN B. CLARKE. 
1884. INQUIRY 
INTO THE 
CAUSES OF INSANITY 
With Especial Reference to Prevention 
and Treatment. 
BT 
CHARLES P. BANCROFT, M. I)., 
Superintendent New Hampshire isyluin, 
[Reprinted from Annual Report of New Hampshire State 
Medical Society.] 
MANCHESTER, N. H. 
PRINTED BY JOHN B. CLARKE. 
1884.  INQUIRY INTO THE CAUSES OF INSANITY 
WITH ESPECIAL REFERENCE TO PREVENTION AND 
TREATMENT. 
CHARLES P. BANCROFT, M. D., CONCORD. 
In no class of disease has modern scientific investigation done 
more to assist the physician and ameliorate the condition of the 
patient, to overthrow old barriers of superstition, and to develop 
a rational and intelligent treatment, than in insanity. The his- 
tory of insanity and its treatment from earlier times down to the 
present day is exceedingly interesting. Its pages are filled with 
the records of the grossest superstitions and the most absurd and 
childish fancies. For centuries insanity was not considered a 
disease; but the patient was supposed to be possessed of some 
evil and unclean spirit that had taken up its abode in the unfor- 
tunate person. Nothing short of exorcism could therefore relieve 
the patient, and hence the study and treatment of insanity did 
not properly belong to the province of the physician, but was 
relegated to the mummeries and incantations of magicians and 
witches who were oftentimes half crazy themselves, and who were 
supposed to be in some way invulnerable to the antics of these 
demons, and could thus deal with them with impunity. 
In the early centuries of the Christian era the aid of the priest- 
hood was invoked for the cure of insanity. Mental aberration 
being considered to be the result of a demoniacal possession, 
mankind very naturally were led to believe that the powers of 
good possessed some potent charm over the evil spirit world. 
Hence the earlier prescriptions for mental disease were composed 
of a curious mixture of popular drugs, holy water, and prayers. 
I give one such prescription in full, as it illustrates perfectly the 4 
vague, uncertain notions about insanity in those early days: 
“Take the ewe hop plant, wormwood, bishopwort, etc.; put 
these worts into a vessel, set them under the altar, sing over them 
nine masses, boil them in butter and sheep’s grease, add much 
holy salt, strain through a cloth, throw the worts into running 
water. If any ill-tempting, occur to a man, or an elf or goblin 
night visitors come, smear his forehead with this salve, and put 
it on his eyes, and where his body is sore, and cense him with 
incense, and sign him frequently with the sign of the cross; his 
condition will soon be better.” Another prescription for “ Devil- 
sickness,” as it was called, was as follows : “A mixture, com- 
pounded of many herbs and clear ale, was to be drunk out of a 
church bell, while seven masses were to be sung over the worts or 
herbs, and the lunatic was to sing psalms, the priest saying over 
him the Domine, sancte pater omnipotens. ’ ’ 
For many centuries these superstitious and very unscientific 
views concerning insanity obtained. This dark cloud of igno- 
rance was only dispelled in very modern times. As you all 
know, Pinel was among the first to declare that insanity was a 
disease, and that it should be treated intelligently, like any other 
disease ; that incantations, chains, and punishments were as un- 
reasonable as would be the same treatment for rheumatism or 
pneumonia. It is singular to witness, however, how slowly the 
human mind parts with the gradually acquired traditions of the 
past, and how difficult a thing it is to obliterate the most mani- 
fest errors which have been transmitted from generation to gener- 
ation, and have become incorporated, so to speak, in its very 
texture. Even at the present day traces of this same incompre- 
hension of insanity still exist, and many find it difficult to under- 
stand that it is disease, governed by the same laws as other 
disease. They wonder why they cannot argue away a delusion, 
although they know well enough that the pain in a rheumatic 
joint cannot be dispelled by such sophistry. Some, less humanely 
inclined, think that the changed and perverted character is mere- 
ly a general state of “cussedness,” and that a good whipping 
would effect a cure, although they well know that such a course 
would not cure a cough proceeding from pneumonia. As a result 
of these erroneous ideas of the past, a tendency still exists to 5 
separate insanity from the general category of disease, to place it 
in a sphere by itself, and to consider that when it does come, it 
is a misfortune not caused or controlled by the same laws that 
influence disease in general. 
Until very recently it has not been thought necessary to intro- 
duce its study into the curriculum of our medical schools, and 
hence even our physicians have been led to believe that disease of 
the mind was a special province that did not concern the general 
practitioner. On the ground, however, that insanity is a disease 
of somatic origin, it becomes at once a subject of vital impor- 
tance to the practitioner. For, by an intelligent understanding 
of the causes of mental disease, he may do much to prevent the 
appearance of the same. As a proper understanding of the causes 
of diphtheria and typhoid fever led to the prophylaxis of those 
diseases, so a correct knowledge of the causes of insanity may 
teach us how to prevent the most unfortunate calamity that can 
befall a man, viz., the loss of those higher faculties which are al- 
most more to him than life itself. For these reasons I wish to 
discuss, as briefly as possible, a few of the principal causes of 
insanity, feeling that when the disease is approached from this 
etiological standpoint, we may arrive at a somewhat rational sys- 
tem of prophylaxis and treatment. 
In glancing over the list of assigned causes of insanity in the 
admission book of any hospital, or at the table of causes in the 
asylum reports, one is impressed with their great variety and 
number. One sees in this list, overwork, overstudy, disappoint- 
ment, grief, excessive joy, fright, anxiety, and almost every con- 
ceivable factor, social and moral, in the daily life of man. But 
it is also evident that these are not causes per se. Some other 
element must necessarily exist in the individual which renders 
him susceptible of being influenced. In estimating the above 
factors as causes, we have only half reached the truth. For if 
these were actual causes of mental alienation, then the entire 
population of the civilized world would become insane: for 
every man and woman is subject during a greater part of his life 
to these adverse influences, and yet how small a proportion are 
made insane by them. What, then, is this underlying and pre- 
disposing influence which renders one man liable to become in- 6 
sane on the appearance of circumstances which upon another 
man seem incapable of producing any effect? I think we find, in 
large measure, the answer to this question in the law of heredity. 
But it is necessary to consider heredity in the largest sense of the 
word. Insanity itself, as a special morbid entity, is not necessa- 
rily inherited, but a certain constitutional vice is transmitted, 
which may lead to such an alteration of nerve force that insanity 
may be a result. And this is the one important point that I wish 
to emphasize : the causes of insanity lie deep down in the inner- 
most life of the individual; they exist in the blood that circulates 
in his veins, and in the very structure of his nervous organism ; 
they are incorporated in the very foundations of his physical and 
animal life, and only become apparent, perhaps, after years of 
dormant existence. In this respect, therefore, insanity is inti- 
mately related with all disease, and hence is a subject of as much 
concern to the general practitioner as other diseases which he has 
thought belonged more exclusively to his province. 
The laws of heredity have been closely studied in the lower 
order of animals, and it is well known that the virtues and the 
vices of the parents are transmitted to the offspring. So in the 
human race good and bad qualities are transmitted. Vices of 
constitution tend to reproduce themselves in the children. All 
those factors which tend to lower the physical stamina of the in- 
dividual, which tend to diminish the normal resisting power of 
the nervous system to shock and disease, all these factors are 
transmitted to the children. And it is especially those factors 
which tend to depress vitality, to disturb the healthy flow of 
healthy blood to different parts of the body, that are most apt to 
bring about in the descendants diseases of low vitality, such as 
scrofula and consumption, and also diseases damaging the normal 
and regular display of force in the nervous system, such as chorea, 
epilepsy, hysteria, and insanity. 
We have, then, reached this first point in our inquiry into the 
causes of insanity : Mental disease and physical disease are close- 
ly related in their origin and development; both are transmitted 
from parents to children; and both are mutually interchangeable. 
A vicious constitutional taint may be transmitted, but not neces- 
sarily in its original form, it may appear in the form of any one 7 
of these allied diseases. Thus phthisis may appear in several 
members of one generation; but in the next generation this form 
of disease may disappear entirely, and in its place insanity ap- 
pear. The records of our insane hospitals present many cases 
which illustrate this. In some of these cases a faulty diathesis is 
established by the alliance of bad elements, and then we see 
phthisis and insanity appearing at the same time in one genera- 
tion. I will mention, as illustration, two cases taken from our own 
state hospital records. 
Case i. A young man developed hysterical melancholia at an 
early age. He was seized with a morbid desire to destroy his 
life, but felt he must do it in a peculiar way. He wished to die 
in some place where his body could not be found, and hence 
would run away from home and climb trees with the wish that he 
might starve to death in that position and not be discovered. As 
he grew older, this same morbid desire persisted, and at the same 
time a destructive tendency developed itself. He would destroy 
his handkerchiefs, collars, and neckties, but rarely more than one 
article would be demolished in a week. He seemed to be pos- 
sessed of a morbid fancy that during each week some one thing 
must be destroyed. At one time it showed itself in an impulse to 
break hens’ eggs and kill young chickens. He always acknowl- 
edged that he did these things, regretted the fact as much as any 
one, would promise to do better, but seemed powerless to control 
himself when the impulse fairly seized him. Physically he was 
not strong; he was of slight physique, inclined to anemia, diges- 
tion extremely poor, and lost his teeth from decay at an early age. 
His whole appearance indicated a lowered and depressed vitality. 
Any physician on seeing him would express the opinion that his 
was a constitution possessing feeble resistance to disease. Inquiry 
into his family history elicited the following interesting facts ; 
His grandmother was insane and died of phthisis, she had a sister 
also insane; this grand-aunt had two children both of whom were 
insane. His grandmother had four children; viz., two males, 
one of whom had consumption, the other consumption and epi- 
lepsy, and two females, one of whom had consumption and the 
other, the mother of our patient, also had consumption. The 
patient, though delicate, has never developed phthisis, but at an 8 
early age developed a weakened and disordered mind. In this 
case we see phthisis and insanity existing at the same time in one 
individual; we see the phthisis transmitted through one entire 
generation, and then, after lying dormant, as it were, in the race 
for a long period, we see insanity reappear without the phthisis. 
Probably at this point the race is extinct, for I have many doubts 
if the patient possessed the procreative power. Returning to this 
grandmother’s generation again, we find that she had an insane 
sister, and this sister had two insane children, and the line is ex- 
tinct at that point. It is also interesting to note that in one of the 
patient’s uncles epilepsy appeared in addition to phthisis, thus 
showing the close relation that exists between diseases which are 
the result of low vitality and unstable tissue growth. The one 
disease reacts upon the other. Phthisis and insanity are both 
diseases of malnutrition; in both the great nervous centers are 
poorly nourished; and oftentimes one result of such defective 
nutrition is irregular and spasmodic action of these centers. 
Sometimes this is seen in marked and unusual eccentricity. The 
crank, so called, is a type of this class. Again this unstable 
condition of the higher nerve centers is seen in hysteria, which 
condition often involves the motor center as well as the more 
purely intellectual centers, and then we have hystero-epilepsy. 
The same condition extended a little farther produces real epi- 
lepsy, as in this patient’s uncle. He suffered from a poorly organ- 
ized and feebly nurtured brain, as well as a delicate constitution, 
and, as a result, epilepsy and phthisis both appeared. Fortunately 
for the human race, nature, by a wise provision, allows this dete- 
rioration to go only about so far, and at a certain point stamps 
all such vitiated blood with sterility. 
I have already said that we sometimes see two persons united, 
one of whom comes from a race containing a record of insanity, 
and the other from a race presenting a history of phthisis or other 
disease of low tissue change. From what we know of the laws of 
heredity we should infer that the issue from such unions would be 
unhealthy, that they would present either phthisis or insanity to a 
marked degree. The facts in the following case, taken from the 
hospital records, fully sustain our supposition; 
Case 11. A man fifty-eight years of age, a very active mer- 9 
chant, broke down from overwork. He became depressed, and 
finally suicidal. He was possessed of an exceedingly nervous 
temperament and a very delicate constitution. He was asthmatic 
when well, but during the violence of his mental disturbance this 
neurosis disappeared. He presented the following family history: 
His maternal grandmother died of phthisis ; she had two chil- 
dren, a son who became insane, and a daughter (the mother of 
our patient) who possessed all the elements of the phthisical 
constitution, seeming to be continually on the verge of consump- 
tion, and in addition was an extremely nervous person. She 
married a man (the patient’s father) who was asthmatic, who 
became insane, and finally died from some organic disease of the 
nervous system involving paralysis. These two persons had thir- 
teen children, four of whom only are living. As far as could be 
ascertained, four died of phthisis, one was epileptic, and a sixth, 
our patient, became insane. What a commentary is this upon the 
inevitable working of the great law of heredity ! It shows us 
how surely nature places her seal upon whatever is faulty in the 
race, and protests against the continuance of diseased and un- 
healthy germs. Here is the record of the union of two diseased 
races, both of which should have been kept entirely separate ; 
one tainted with insanity, the other with phthisis. In the 
issue of such a union we see appear phthisis and insanity and 
also an allied neurosis epilepsy. Somewhat contrary to the usual 
law, the first result of such a marriage was remarkably prolific: 
thirteen children, and yet how soon nature set her veto against 
the continuance of such a race. Out of this large family of 
children only four are living, and of these four one has been twice 
insane, and is in constant danger of death from insanity or 
phthisis. Another interesting point was developed in this case : 
during the height of his mental alienation his habitual asthma 
disappeared, and as his mind regained its normal balance, the 
asthma reappeared. In this case the asthma was undoubtedly a 
pure neurosis, dependent upon a faulty nutrition of certain ner- 
vous centers. When this evil influence was transferred to the 
centers of ideation in the brain, the former neurosis subsided for 
awhile only to reappear as the cerebral irritation ceased. We 
thus see how closely related is brain disease and constitution a 10 
weakness,— the two being so closely allied that the one condition 
may alternate with the other in the same individual. 
The records of the hospital contain many illustrations of this. 
One patient, a man of delicate habit, a sufferer from hip disease 
in childhood, passed into an incipient phthisis in adult life; as a 
last resort he was sent to a warmer climate where he completely 
recovered from the lung disease, but shortly afterward succumbed 
to an attack of insanity, which at last account bade fair to merge 
into organic brain disease. Another patient, a young-woman, 
ceased menstruating at the age of thirty, shortly after developed 
insanity, and remained in that condition for over a year. She 
then contracted pneumonia which passed into phthisis, and while 
in this state her mind recovered its normal balance, but it is evi- 
dent that her lungs are hopelessly diseased. Still another case; 
a man of middle life, in whose family there had been a record of 
insanity, had for years been afflicted with asthma. His mind 
finally became deranged; he suffered from an exceedingly severe 
attack of mania, and was actively homicidal under the influence 
of his delusions. During the period of his insanity, which lasted 
over a year, he was entirely free from asthma ; he made a good 
mental recovery, but it was remarkable to observe how each day 
of mental improvement was accompanied by increased difficulty 
of breathing. When he left the hospital he was perfectly well in 
mind, but was scarcely able to walk or lie down on account of 
excessive dyspnoea. His insanity never returned, but he died 
within two years of phthisis. The records are full of such cases 
as these, in which mental disease and constitutional or neurotic 
weaknesses of some sort seem to vie with each other for the su- 
premacy in some one individual. I merely mention these three 
cases at the present time to illustrate how intimately related is 
insanity to constitutional disease, and how often we must look 
for the real causes of insanity deep down in the very life-springs 
of the individual. The real cause of final mental disturbance in 
this or that person may be therefore incorporated in his very tis- 
sues, and increase with their growth. We often hear it asked of 
one who has become insane, “ How could such an event have 
happened to Mr. A? he always seemed so well-balanced, his 
u dgment so excellent, that he was the last person in whom I 11 
should have looked for such an issue.” The answer to this ques- 
tion is too often to be found in the long record of hereditary and 
constitutional weaknesses which do not at first sight appear. 
These factors have been silently at work, sapping and slowly ex- 
hausting his nervous system, until finally after some undue strain 
—a strain indeed which may have produced little or no effect on 
a constitutionally stronger individual the crash comes, and in 
this especial instance it is the brain, and not the lungs or the 
knee-joint or the lymphatic glands that suffer. 
We have seen how very intimately related are insanity and 
those diseases which proceed from states of constitutional weak- 
ness ; how insanity, phthisis, epilepsy, hysteria, and other dis- 
eased conditions seem to become incorporated in the cell-growth 
of the individual, and are then transmitted from parents to chil- 
dren. I now wish to call your attention to a remarkable case 
which illustrates the close relationship of insanity to cell-growth 
and its variations, and which shows how a morbid element intro- 
duced into the cellular structure of an individual life may develop 
and be transmitted from generation to generation, and finally so 
modify and vitiate the original stock that it can scarcely be rec- 
ognized. 
Case 111. A woman aged thirty-eight became feeble in health 
and finally depressed ; at length delusion and typical suicidal 
melancholia developed itself. By referring to the family history 
we find the following facts which have been kindly furnished by 
one of your number. The maternal grandfather descended from 
old Puritan stock noted for its longevity ; he himself and another 
brother attained the age of one hundred years. At eighteen 
years of age this grandfather contracted syphilis; he was very 
sick, and his health became much impaired ; he had several at- 
tacks of corneitis which resulted in marked ulceration of cornea, 
and almost total destruction of eyesight. Notwithstanding the 
somewhat severe ravages made upon his system by this disease, 
his wonderful recuperative forces carried him to the advanced 
age of one hundred years and five months. He had eight chil- 
dren. No. one died from injury to head in childhood ; Nos. two 
and three died young, and their history cannot be obtained ; No. 
four, a female, died childless at seventy-eight years of age, of 12 
malignant disease of breast and axilla ; No. five, a male, eighty- 
four years of age, but has always been very feeble ; No. six, a 
female, died of malignant disease of cervical and mammary re- 
gions ; No. seven, a female, the mother of our patient, has had 
malignant disease of jaw and angle of mouth which has yielded 
to caustic treatment, and she is alive at present; No. eight, a 
female, is still living, but has carcinoma of face, and also of left 
breast. We observe that in this generation the members died 
somewhat younger, although the tendency to long life still per- 
sists ; we also note a remarkable perversion of cell-growth in 
the tendency to malignant disease seen in four members. Now 
let us glance at the issue of this second generation ; numbers five 
six, seven, and eight, alone had children. No. five had three 
male children, viz., one male who had corneitis, and died of 
phthisis at forty years of age ; another male who had recurrent 
chorea ; and a third male who had chorea, and died of phthisis. 
No. six had two children, viz. ; one female who was hysterical, 
then became epileptic, and finally died of encephaloid disease of 
ovary, at thirty-six years of age ; one male who had chorea for 
years, and finally recovered. No. seven had three children, viz.: 
a female who had hysteria which merged into hysterio-epilepsy, 
and finally into pure epilepsy, and who at last died at twenty-five 
years of age, of structural brain disease ; another female who is 
living, but who has hysteria of a grave character ; another female, 
the patient whom we have referred to as case three, and who was 
insane. No. eight had four children, viz.; one male who died 
of phthisis at thirty years of age ; one female who died of phthisis 
at twenty-one years of age ; a second female who died of phthisis 
at twenty-five years of age; a third female who developed chorea 
at ten years of age, and then epilepsy ; at thirteen years of age 
phthisis appeared, and she died at twenty-two years of age. We 
observe in this third generation that the original longevity has 
disappeared, and that a large number of the issue have died be- 
tween twenty and thirty years of age ; we also note that the 
general retrograde metamorphosis of cell structure has persisted, 
and instead of being confined to one or two types such as malig- 
nant disease and corneitis, we see that a more universal change 
has appeared, a general constitutional deterioration has taken place ; not only special organs and tissues have become impaired, 
but a constitutional vice has become established which is under- 
mining the nervous system as well as the physical health of the 
race. We see the corneitis reappear in one member, and malig- 
nant disease in another; but we also find phthisis in addition, 
and hysteria, chorea, epilepsy, and insanity. These last men- 
tioned diseases show that the vitiated germs have appeared in the 
nervous system, and the usual results follow, viz., irregular and 
incoordinated action of the nerve centers, producing hysteria and 
insanity in the intellectual tracts, chorea and epilepsy in the 
motor tracts, of the brain. We observe, also, that this race is 
gradually becoming extinct. Formerly a hardy, intellectual, 
long-lived family, they have gradually deteriorated through three 
generations, until now all that represents this once sturdy Puritan 
ancestry are four females, two of whom have had malignant dis- 
ease, one has grave hysteria, and the fourth has been insane; and 
two males, one a feeble old man eighty-four years of age, whose 
children are all dead, and one who for years was subject to 
chorea. 
It is a well-known fact that the virtues of the ancestors are often 
transmitted to the children, and that often certain especial quali- 
ties are transmitted, thus, a talent for music and painting, and 
an aptitude for mechanical work, or mathematical skill, reappear 
in the children. It is also a fact that certain especial vices are 
transmitted, and that the identical manifestation of disease seen 
in the parents may reappear in their descendants. This is un- 
doubtedly due to that natural tendency of the nervous system 
to develop a habit of action. Thus a patient who has once had 
mania is very likely to have a recurrence of the same, and it be- 
comes very easy for the recurrence to become an established 
thing ; so it is with suicidal melancholia. A marked periodicity 
of diseased action is very characteristic of neuroses of the brain. 
When certain morbid tendencies are once fairly established, it 
therefore becomes a very natural and easy thing for them not 
only to reappear in the individual, but for them to be transmitted 
to his descendants. This is perhaps the most striking feature of 
all the laws of heredity. It shows how close is the relation be- 
tween the psychical and physical life of man. Certain develop- 14 
ments of the cell structure of the brain are established ; through 
this development peculiar traits of mind appear, so subtle and 
purely spiritual in their essence that it seems hardly possible that 
they can have an organic origin. And yet so intimately related 
are they with the organized growth of the individual that they do 
not die when he dies, but reappear in the race which he has cre- 
ated. I will mention a case in illustration of this in which a ten- 
dency to suicide appeared in different generations and branches 
of one family. Some of the members of this family were insane 
and eccentric without being suicidal ; but at a certain age there 
seemed to develop a disposition to suicide, which tendency was 
transmitted from parents to children. 
The earliest progenitor in this family of whom we have any 
record was born in 1725. He married a woman who committed 
suicide. They had children, one of whom only has left any 
record ; this was a male and was himself healthy. But he left 
five children, viz. ; No. one, who committed suicide ; No. two, 
who committed suicide ; No. three, who was apparently healthy ; 
No. four, who was insane ; and No. five, who became insane. In 
this generation we see insanity or suicide appears in every mem- 
ber but one. Now let us see what appeared in their children. 
No. one, No. three, and No. four alone had children. No. one 
married and had one daughter; this daughter married and had 
one insane son. No. three had two children ; one son who com- 
mitted suicide, and one daughter who, though sane herself, had 
one son who committed suicide. No. four had four children 
whom we will designate A, B, C, and D. A was healthy, B 
committed suicide, C committed suicide, and D was insane. Now 
let us look at their children. A and D alone had children. A 
had four children whom we will call E, F, G, H. Of these E 
was mildly insane; F and G were very eccentric, so much so 
that many people called them insane; H was healthy, married 
well, and had a healthy child. This branch of the family there- 
fore seems to be gradually freeing itself from the morbid ten- 
dency. D, who was insane, had one child who was also insane. 
In this family, as far as we can get at accurate record, there were, 
in four generations, seven cases of suicide and six cases of insanity 
without suicide, and I am informed that there were several cases 15 
of suicide in the collateral branches of the family. Any com- 
mentary upon this remarkable race tendency is scarcely necessary. 
Certain morbid conditions of the nerve centers in the brain be- 
came established ; and then for several succesive generations 
these conditions were transmitted from parents to children. And 
so identical was the pathological state in all the individuals of 
this race that in the majority of cases precisely the same manifes- 
tations of disease appeared. 
It is hardly necessary to mention any more individual cases, 
although tha records of our own state hospital and many other 
similar institutions contain hosts of cases of like character. 
Now what are we to infer from such abundant records ? It seems 
to me simply this : That insanity is a disease of disordered and 
deteriorated nutrition of the brain, and that this condition and 
the tendency to it can be transmitted from parents to children. 
It is well understood that in the animal economy cell-structure 
tends to repeat itself: certain well-established forms of cell- 
growth reappear in the descendants from the original stock. 
It is in this way that certain configurations of the face and body 
reappear in members of the same family. The same law un- 
doubtedly obtains in the more intricate structure and devel- 
opment of the nervous system. On no other basis can we ac- 
count for identically the same traits of character, moral and 
psychical, reappearing in successive members of the same family. 
Now if a healthy and well-developed cell-structure is transmit- 
ted, it follows that a perverted and ill-nurtured cell structure 
must be repeated in the offspring. Among the lower orders of 
animals, breeders thoroughly understand this law, and are gov- 
erned by it; they select only the healthiest types, and propa- 
gate a sound and healthy stock from them. In the human race 
the same law exists, but as little or no selection is practiced, we 
do not always reach the same results. Mind disease is brain dis- 
ease ; and a poorly nourished and poorly organized cerebral de- 
velopment is sure to lead to weakened and perverted state of 
mind, and this is only another name for insanity. The condi- 
tions of insanity, therefore, exist in the cell-structure of the brain ; 
and this peculiar structure, whether it is the result of a malforma- 
tion of cell-growth (in the same way that we can have a club- 16 
foot or a harelip), or whether it is the result of a vitiated and 
deteriorated state of the blood, this peculiar brain structure can 
be transmitted. 
The records of our state hospital show that about fifty-one per 
cent of the cases admitted are referable to a vicious inheritance. 
Fully another twenty-five per cent are undoubtedly due to the 
same cause, but their family history cannot be ascertained. The 
remaining twenty-five per cent cannot be traced to any form of 
hereditary cause. These latter cases are generally acute in char- 
acter, and consist for the most part of attacks of acute mania, 
melancholia, and melancholia with stupor or acute dementia. 
These comprise, as a rule, those cases which terminate favorably, 
and form the majority of the thirty-three per cent of curable 
insanity. Insanity may, like any other acute disease, as pneu- 
monia, or pleurisy, attack a perfectly healthy individual, - one in 
whom there is no previous record of scrofula, phthisis, intem- 
perance, or any other depressing constitutional taint. Such a 
person under proper care and treatment generally recovers, unless 
exhausted with severity of the attack. And I think that care- 
fully collected records would show that such cases recover as fre- 
quently as do other acute diseases occurring in otherwise healthy 
individuals. 
If, then, nearly seventy-five per cent of the prevailing insanity 
of the present day is traceable to a hereditary constitutional 
taint of some kind ; if generations of phthisis, scrofula, intem- 
perance, and other depressing causes in the ancestry, have so de- 
teriorated the blood and weakened the normal energy and equi- 
librium of the nervous system that insanity is a possible result in 
the descendants, what is to be done in the way of prevention ? 
Many pessimistic writers might say, “ Nothing can be done to pre- 
vent the inevitable ; ” and so would hold an altogether discourag- 
ing view as to the possibility of the prevention of the increase of 
mental disease. But it seems to me that it is possible to do some- 
thing in the way of intelligent prophylaxis. 
Of course the most obvious method of prevention would be 
the prohibition of the union of two unhealthy individuals. But 
it is also equally obvious that such a variety of artificial selection 
in members of the human family is not attainable, at least in 17 
the present social status of the world. The passions and senti- 
ments of the human mind far outweigh any physiological consid- 
erations that might be brought to bear against them. Admitting, 
then, the fact that unhealthy individuals will come together, and 
that deteriorated bodies and brains will be propagated as a result, 
what can be done to prevent the appearance of insanity ? 
In the first place it is necessary to premise our inquiry with the 
statement that insanity per seis not necessarily transmitted. The 
predisposition only may be perpetuated ; the soil for its develop- 
ment may exist, but not necessarily so the disease. Herein lies 
our strong hope. Knowing the previous family record of the 
individual and his present constitutional temperament, we can so 
guide and warn him, cair so surround him with favorable environ- 
ments, and so repair a lowered vitality that we may avert an 
actual disease of the mind. We know the weak point, and we 
can fortify it against the disease itself. This is nothing more 
than the intelligent practitioner does in the case of other threat- 
ened disease. He gives the person threatened with phthisis 
tonics and fats, and sends him to a warmer climate ; the rheu- 
matically inclined person he bids dress warmer, avoid damp and 
wet and cold ; to him whose grandfather suffered with gout, 
irritable temper and a cane, he prescribes a nutritious but non- 
stimulating diet. 
In a very interesting and instructive book on “ Insanity and 
its Prevention ” Dr. Tuke says : 
“ If it is disheartening to know that, while some men are proof 
against the invasion of this calamity, whatever folly they may 
choose to commit, others have the seeds of insanity sown in their 
nervous system, only awaiting a favorable exciting cause to make 
them germinate, it is none the less but all the more important 
that we should know what are the circumstances, what the condi- 
tions, calculated to stir up the slumbering embers into flames 
There can be no doubt that, given in two cases precisely the 
same predisposition to insanity, the disease might in one case be 
kindled by an unwise, or averted in the other case by a wise, 
mode of life based on the principles I have endeavored to lay 
down. To this extent then, insanity is a preventable disease. 
Looking at the cases I have known, and regarding the causation 18 
of their attacks from this point of view, their preventability, 
I can see a large number, who, under more favorable circum- 
stances and a brighter sky, under judicious mental training, 
under a calm and regular instead of an irritating life, or free 
from habits and associations of a certain kind, might have es- 
caped the perils of their unfortunate mental heritage. 
I have seen this predisposition lighted up by speculation and 
consequent pecuniary losses and bankruptcy, by the misery of a 
homeless home, by a drunken wife, by the complete absorption 
of' the affections in a child, and that child dying, by a course of 
excessive study accompanied by competition for honors, by evil 
habits, and by many circumstances, the avoidance of which 
would have left a fair chance of escape.from an attack of insan- 
ity, had these individuals, conscious of the dangers into which 
they, with their proclivities, were running, shunned them. 
Familiar, therefore, with the physiognomy of temperaments, 
the physician accustomed to observe their relation to mental dis- 
order will not fail seriously to warn those who possess them, 
whether they betray signs of actually passing over the boundary 
line of sanity or not, to guard in an especial manner against 
overexcitement in some instances, much study in others, over- 
strain in all. He will often readily recognize the die in which 
this or that person is cast, and detect the peculiar mark on the 
metal, which the unskilled or unobservant fail to notice. He 
sees a combination, a grouping of mental and physical character- 
istics which experience tells him are apt to be associated with 
certain tendencies, only awaiting a sufficiently exciting cause to 
develop them, be it the exclusive search after gain, the indulgence 
in drink, and other passions, or in the absence of rational and 
healthy occupation.” 
This, then, is the conclusion at which we arrive : First, insan- 
ity is, in the majority of cases, a disease resulting from certain 
pre-established family conditions, certain proclivities and tenden- 
cies which operate as predisposing causes. Secondly, insanity is 
a preventable disease in just so far as we can remove these predis- 
posing causes, or by a previous knowledge of their existence we 
can guide and warn the individual of impending dangers.