From the Third Annual Report of the State Board of Health of Wisconsin. 
SOME OF THE PREVENTABLE CAUSES OF 
INSANITY. 
By WALTER M. D., 
Superintendent of the Northern Hospital for the Insane, at Oshkosh. 
David Atwood, Printer, Madison, Wis. SOME OF THE PREVENTABLE CAUSES OF 
INSANITY. 
By WALTER KEMPSTER, M. D., 
Superintendent of the Northern Hospital for the Insane, at Oshkosh. SOME OF THE PREVENTABLE CAUSES OF 
INSANITY. 
By WALTER KEMPSTER, M. D., 
Superintendent of the Northern Hospital for the Insane, at Oshkosh. 
The old adage, that an ounce of prevention is better than a pound 
of cure, appears to have taken forcible hold upon the thinking mem- 
bers of the community. Individual effort and advanced ideas in cer- 
tain communities have given preventive measures an impetus un- 
known heretofore, and with results which could not have been 
predicted in the “ good old times ” when the adage was a proverb 
only. 
To-day, the. efforts of the advanced members of the medi- 
cal profession the world over, are in the direction of the prevention 
instead of the cure of diseases; and the success thus far attend- 
ing this departure is such as to warrant the furtherance of this 
object, if need be, by the power of the law. 
Just where the line is to be drawn ultimately between those 
diseases which may be prevented, and those which may not, it is 
impossible to predict; but one fact is apparent and that is sufficient 
for our present purpose; it is, that wherever prevention has been 
thoroughly and completely tried, no matter whether the effort was 
directed against small-pox, diphtheria, scarlet fever, yellow fever 
or typhoid fever, there the disease has been stayed in its progress; 
these diseases can not find lodgment where there is no filth. The 
time has arrived in the progress of civilization, when it is necessary 
to impress upon communities the importance, and indeed the nec- 
essity, of keeping clean bodies, clean houses and clean cities, if they 
would enjoy freedom from disease; that cleanliness will yield 
healthfulness; that diiffiness will beget disease. 
This much may be predicated of disease in general, but wbat has 4 
this to do with the subject of this paper? Whatever diseases are 
to be ultimately considered non-preventable, insanity is certainly 
not to be so regarded. 
Insanity is a disease which may be prevented in a largo percent- 
age of cases both by individual effort, by wiso and wholesome laws 
by a proper training of the mental faculties, and a sound education. 
To the proper training of the faculties, not so much perhaps 
in classic literature as in the laws governing mankind, and 
to individual effort, self control, etc., we are to look for the 
most perfect results to follow. Ignorance and apathy are the 
congeners which favor the spread of disease; these must be re- 
moved; the people must be made aware that either or both will 
spread misery and death in their wake, that universal cleanliness 
of body, home and town, and a close guardianship of health, will 
prevent insanity as well as other forms of disease. 
Upon what facts are these statements based? If any one inter- 
ested in the matter will turn to the statistics found in nearly every 
report issuing from hospitals for insane the world over, they will 
find in the table of causation a large proportion of cases of insanity 
caused by some circumstances which may bo averted or controlled. 
Taking at random from among the reports of hospitals for insane 
for 1878, thirteen reports from as many states, it appears from the 
table mentioned that 1,236 persons became insane from causes 
clearly within the power of the individuals to have prevented, this 
being 28 per cent, on the whole number of admissions. And this 
is limited to causes, as before said, clearly within the power of the 
individual to prevent. 
This estimate is too low, as the reports themselves indicate, for 
many were not included in the list who might have been placed 
there with propriety. Without entering further into a discussion 
of the general subject, let us for a moment examine some of the 
assigned causes enumerated and see whether they are preventable 
or not. The list of causes to which we refer are capable of indefi- 
nite division, but they can be just as well grouped and treated 
together. Among the most pronounced causes we may mention 
over-work; want of proper food; intemperance and dissipation, and 
disregard of the ordinary laws pertaining to health. Many cases of 
insanity may, and doubtless do, have as factors, several of the 
conditions enumerated above combined; thus, over-work and 5 
■want of nourishment generally attend each other perhaps as 
cause and effect; while intemperance, so far as it relates to the 
abuse of alcoholic stimulants and tobacco, may and often does 
lay the foundation for either or both the above named causes 
with many others, for the effects of intemperance are far-reaching, 
extending even to the third and fourth generations of the descend- 
ants of those who are addicted to the habit; not that each success- 
ive generation will be necessarily drunkards, but they will suffer 
the penalty which invariably follows the prolonged disregard of a 
general law. How does over-work produce insanity? Over-work 
of any kind, protracted fora length of time, may eventually produce 
insanity; but to avoid generalities and endeavor to benefit by the 
examples we meet with daily, let us examine briefly the kind of 
over-work that brings to our state hospitals those persons who 
have been been classified as insane from over work. 
A large part of the population in the northern portion of this 
state is composed of persons who have sought a residence in the 
new world. Elated with the prospect of establishing a home and 
owning it, they settle in the forest. Ax in hand, their sturdy work- 
manship opens up a clearing in which crops are to be produced 
for the sustenance of life and for the accumulation of future wealth. 
Vigorous health, with prospects of emolument, lends strength to the 
arm of the young emigrant, and for a time he laughs at prolonged 
toil, frontier hardships and privations. Through wet and dry, cold 
and heat, from early dawn until latest dark, hard work, involving the 
active exercise of almost every muscle in the body, characterizes 
the laborious daily toil of a class of people who are unceasing in 
their effort to own the land they settle upon, at no matter what 
cost to the powers of physical endurance. The few hours of sleep 
snatched from the daily toil (and this begrudged) is not sufficient 
to rest the body from the fatigues of one day before another begins, 
and the process of wearing out exceeds the process of building up, 
long before nature intended that it should be so. 
For a while all is well, and the draught upon the system is not 
noticed; but slowly, quietly, this drainage of strength, this over- 
work, begins to make its mark; the subject not being acquainted 
with the troublesome hindrances which prevent him from accom- 
plishing as much work as usual, ascribes the difficulty to something 
else, and keeps on his way until, at last, when his farm is cleared 6 
and paid for, he finds, alas! that he is broken down, and 
his incessant hard work, his disregard for the laws of health, 
his long defiance to the needfulness / of rest, of sleep, now 
deprive him entirely of the latter, and he sinks into a profound 
melancholy or hopeless dementia, in which unhappy state he ends 
his days. 
If to this condition we add want of the absolute essentials for 
the proper maintenance of healthy bodies, by lack of nourishment, 
another element enters into the case, an element which is even 
more potent for harm than hard work, and the break down will be 
more certain and the wreck more complete. 
This is not an overdrawn picture — there are now many men and 
women in our hospitals whose history corresponds almost identi- 
cally with the conditions above enumerated, who have been brought 
to their present state by over-work, and want of proper rest and 
food. It may be asked why this should be so, considering that 
the life of a farmer is regarded as the healthiest of occupations. 
Doubtless the farmer’s life, so long as it is pursued in accordance 
with the laws governing life, is one of the very healthiest of occu- 
pations, but pursued as described, without proper rest, with no 
regard to the requirements of the body, disregarding wet and cold, 
no wonder that rheumatic affections attack the individual and pre- 
pare an easy way for the advance of uther diseases usually con- 
nected with impaired circulation of the blood. It is not the occu- 
pation, but the ignorance of how to preserve health, that breaks 
down the individual. 
Each individual is endowed with a certain amount of power ; 
that power or force is maintained by properly balancing all the 
bodily functions, and this condition is maintained by performing no 
more work than can properly be done without making a draft upon 
the system. As surely as the force called upon to accomplish a 
certain object no matter what, exceeds the amount the individual 
can properly yield, just so sure does it take away from the power 
to resist encroachments of disease ; indeed, it hastens disease, and 
hence shortens life. 
The power possessed by each individual is a limited quantity; if 
the demand exceeds the limit, by just so much is health impaired 
and life shortened. 
Exposure to cold and wet, to excessive muscular strain, and pro- 7 
tracted hard labor, predisposes the individual to diseases of the 
circulation, to “ heart disease ” and to “ nervous diseases,” which 
frequently ends in insanity of a chronic type. The laws governing 
health and life are immutable and can not be ignored. Every 
one who imagines himself possessed of greater powers of endurance 
than his fellow man, deceives himself — he has already opened the 
door through which disease shall soon stalk, and his boasted prowess 
makes him an easy prey. Eight hours of hard muscular labor is as 
much as can be borne properly out of the twenty-four without 
damaging health. Eight may be spent in light work and amuse- 
ment, and the balance must be spent in sleep. He who seeks to 
set aside the rule which time and experience both proclaim to be 
the best, does so with the positive assurance that he is shortening 
his own life, by bringing upon himself disease in some form. 
Nature is a strict accountant. You may draw upon her resources, 
if you will, but she will demand back everything she gives ; if 
she is not paid in regular installments the demand will come in 
bulk, and then only death will satisfy her. 
With over-work of body there is usually another troublesome dif- 
ficulty; it is worry of mind. Although seed time and harvest have 
continued almost uninterrupted since the world began, there is, 
nevertheless, among a large class of people a feeling that, perhaps, 
it will fail this year; if the worry is not about the crops it is about 
something else. Indeed, there seems to be a growing tendency to 
worry about everything that concerns life in any of its phases, no 
matter whether in the walks of the husbandman, or in the depart- 
ments of commerce or the professions. Worry and fret, needless 
anxiety irritate every fibre in the brain and prevents nature from 
accomplishing her usually even course, so that her work can not be 
smoothly done; the result is always detrimental to healthfulness, 
inducing “ nervousness,” loss of sleep or horrible dreams, and in 
the end melancholy and insanity. 
With many in our community over-work is attended by another 
fertile cause of insanity; that is, underfeeding. By this term (un- 
derfeeding) we not only understand want of sufficient food but 
also improper food, no matter what quantity is eaten; or, again, 
improperly cooked food, which was originally good and whole- 
some. It may appear paradoxical to say that there are many in- 
stances of a break down in physical and mental health, occurring 8 
among people who live on farms, because they do not have enough 
to eat, but Buch is nevertheless the fact; among a certain portion 
of the community, the haste to got rich leads to little less than 
starvation in the household. I speak from actual observation, in 
asserting that insane people are brought to this hospital from largo 
farms which they own, who have denied themselves the requisite 
nourishment to sustain a healthy body; living upon the most parsi- 
monious diet, that the last grain of wheat may bo sold. This is 
not true of the entire community, but there are people in the com- 
munity who are accounted “ well fixed,” of whom it is true. Such 
cases not unfrequently recover at once, by simply supplying that 
which they have been deprived of — good food. Food, again, 
spoiled in cooking is not much better than a limited supply; in- 
deed, is not so beneficial as a limited supply of good food well 
cooked. 
The average stomach in an agricultural community is treated 
with little respect; it is often made to do duty which would ruin a 
grist mill or a soap vat, and it is made the receptacle for morsels 
never intended by nature for the human economy. “ Hard bread,” 
and salt pork fried till it is as tough as sole leather, and swimming 
in clear fat, which is used as a lubricant to the throat, making swal- 
lowing a possibility, the only apparent object being to get the 
mass into the stomach as rapidly as possible; and this continued 
three times a day, year in and year out, is not a method likely to 
strengthen the digestive apparatus, and it certainly does not sup- 
ply all that the system needs to maintain health. Pork requires a 
longer time to digest than any other meat when cooked in a proper 
manner, and when floated into the stomach, a cinder on a wave of 
fat, the fact is that it does not digest. 
Fried meat of any kind is less easily digested than broiled or 
boiled — but it will not do to digress from our subject, although 
a chapter might with propriety be introduced ou the part played 
in the production of insanity by unwholesome and improperly 
cocked food. 
A single fact may be mentioned upon this subject, which is, that 
the great majority of insane people, when brought to the hospital, 
have some difficulty with the stomach — generally called dyspepsia 
by the friends, but it often yields to the kindly influences of a 
generous diet of well cooked food. 9 
It is no unimportant part that this matter of improper diet plays 
in the production of all diseases. When badly nourished muscles 
are called upon to do an amount of work which the well fed would 
fail to do, another element enters into consideration; an element 
which a little elfort, a little knowledge rightly applied, would ex- 
clude entirely from the list of causes. No engineer would expect 
his engine to do full duty upon a half supply of fuel; then if his 
fuel was green it would seem hopeless to expect any result. Yet 
there are men, engineers of their own bodies, who require results 
just as impossible from the human economy, and wonder when the 
machine breaks down; the wonder is, that it should hold out so 
long. 
To properly sustain all the functions of health, there must be a 
variety of healthy foods — the bones require one kind of nourish- 
ment, the muscles another, and the nervous system still another, 
and each will deteriorate unless it obtains the particular kind of 
food adapted to its wants. Some years ago, a very severe form of 
“ nervous fever ” broke out in Massachusetts, and afterwards in 
Michigan. It was fatal in its effects, the fatality apparently being 
due to severe spasms; for a long time the cause of this nervous 
fever baffled every one; but at last it was traced directly and un- 
mistakably to the use of flour made from grain which was spurred, 
and from what is sometimes called “ musty ” grain, both unmarket- 
able products — hence used in the household; a disposition of unsal- 
able farm products not unknown at this time. 
It is not supposed that the persons who used this kind of flour 
knew what the consequences would be, but unfortunately ignor- 
ance does nfit exempt mankind from the penalties attached to 
broken laws. It is our duty to know how to avoid the causes which 
lead to unfortunate results. Pork often contains the germs of dis- 
eases which are loathsome to contemplate; measly pork is another 
name simply for pork containing tape worms; and the deadly 
trichina finds within the muscles of pigs a lurking place, waiting 
only until it reaches the stomach before beginning its work of de- 
struction and death. These latter conditions are not perhaps direct 
precursors of insanity, but they are precursors of forms of diseases 
which, if they do not kill outright, leave the system in a condition 
which favors the development of any disorder which may seek en- 
trance, ending sometimes in insanity. 10 
There is no necessity for this to be so; that it is, can bo made ap- 
parent to any person sufficiently interested to make peronal exami- 
nation. 
We come now to the consideration of a cause which, for wide- 
spread energy, must be regarded as the great cause of insanity. 
I refer to the habitual use of intoxicants. Without entering into 
a discussion of the moral considerations pertaining to this subject, 
it is sufficient to say that the habitual use of intoxicants has caused 
more wide-spread misery, more revolting crime, more disease and 
wretchedness in every form than any other agent; without moral- 
izing, however, it becomes us to consider the question in a candid 
manner, unbiased by personal feeling, and accepting results based 
upon scientific deductions in precisely the same manner as we re- 
ceive demonstrations on any other subject, and for like reasons; 
that is, because they are true. 
To start with, it may be necessary to ask whether the prolonged 
use of alcohol really does have any effect upon the various organs 
of the body; if so, upon what organs, and how they are affected. 
To those familiar with the literature of this subject, it is “ thrice 
to slay the slain,” to assert that the prolonged use of alcohol has 
a direct effect upon the organization, and that its effects are dele- 
terious; indeed, it has been called the “genius of degeneration,” 
so marked are the pernicious effects of the continued use of alcohol 
in any of its forms upon the organs of the body. 
Alcohol is the base upon which all intoxicants in ordinary use rest; 
no matter whether the beverage is beer, wine, or whisky, it is 
only a mixture in which alcohol exists in a greater or less quantity 
according as it is diluted with more or less water. 
What, then, are the effects produced by the introduction of alco- 
hol into the system? 
We will suppose a healthy man who has never used alcohol in any 
form. The first symptom noted after the introduction of alcohol, 
is more rapid action of the heart; this fact has been established 
over and over again, both on man and the lower animals, and up to 
a certain extent the rapidity of the heart action increases propor- 
tionately with the increase of the quantity of alcohol drank. As a 
result, the heart is overworked, and when the alcohol is withdrawn 
the heart flags — does not beat as fast or as forcibly as in health, 
and exhibits signs of weakness. When the heart beats fast the 11 
blood is sent more forcibly through the blood vessels, giving color 
to the cheeks, indicating that the blood vessels have been filled up 
fuller than usual; the condition observed in the cheek is only an 
index of what is going on elsewhere; if it were possible to see the 
brain and spinal marrow, the same appearance would be noticed, 
that is, all the vessels are distended beyond their usual size, and 
by the process they are to a certain extent impaired. This effect 
is not brought about by the direct action of the alcohol on the heart 
or blood vessels, but because of its influence on the brain and 
nervous system first; and the brain being, so to speak, excited by 
the stimulus, causes the increased action of the heart. So that, 
(and this is the particular point to which direction should be called), 
alcohol exerts its power first upon the nervous system. This is 
well established, and has been confirmed over and over again by 
repeated experiments; it is a scientific fact, and stands apart from 
all moral bearings of the question. 
The fact being established that alcohol acts directly upon the 
nervous system, it remains now to ascertain what results from its 
continued use. Without attempting to show the successive steps 
by which the brain and nervous system are affected by alcohol, it 
is sufficient to say, because of easy proof, that with every potation 
of alcohol the blood vessels within the brain, and they are to be 
numbered by the thousand, are distended; this distension con- 
tinued, causes the vessel to lose its naturally elastic condition and 
it becomes permanently enlarged, and in time its walls are thick- 
ened. After a longer time the tissue of which the wall is made 
changes into a fatty state, which renders it comparatively soft and 
easily torn, and it then happens that we have apoplexy and death, 
or life long paralysis. 
Not only does it affect the walls of the vessels, but it changes 
the very fibre of the brain itself and in much the same way, that is, 
by rendering the nerve cells fatty, or by shriveling them and wast- 
ing away the brain substance. 
It must be admitted by every candid mind not biased by a pre- 
conceived idea, that an agent, no matter what its name, capable of 
producing such effects must give rise to disease of some kind. 
What those diseases are can be shown by statistical evidence. 
Still further proof that alcohol enters into the nerve tissue directly, 
is found by experimentation upon lower animals; the brain being 12 
subjected to examination during life, while the animal is under the 
immediate influence of alcohol. The conditions already enumerated 
so far as they relate to the circulation of the blood in the brain, 
then become visible; in several instances the same condition has been 
observed upon the human subject. Dr. Richardson, a celebrated 
English authority, once had an opportunity to examine the brain of 
a man within a short time after death. Ho says: “ A man in a 
paroxysm of alcoholic delirium cast himself under the wheels of a 
railway carriage. The brain, instantaneously thrown out of the 
skull by the crush, was before me within three minutes after the 
accident. It exhaled the odor of spirit most distinctly, and its 
membranes and minute structures were vascular (full of blood) in 
the extreme; it looked as if it had been recently injected with ver- 
milion injection. The white matter of the cerebrum [the large 
brain] studded with red points, could scarcely be distinguished 
when it was incised, it was so preternaturally red; and the pia- 
mater or membrane covering the brain resembled a delicate web 
of coagulated red blood, so tensely were its fine vessels engorged.” 
When large doses of alcohol have been given to animals and 
then the animals killed, the brain has been found saturated with 
the alcohol. Dr. Maurice Perrin says that “ thirteen ounces of the 
brain tissue of dogs killed during alcoholic intoxication, triturated 
with seven ounces of water and submitted to distillation, gave 
nearly a drachm of alcohol. The same quantity of the blood sub- 
mitted to the same experiment gave rather less.” These experi- 
ments of Dr. Perrin confirm researches originally made by Dr. 
Marcet in I860 and 1862. Another proof, should more be needed 
to establish the fact that alcohol acts directly upon the brain, is the 
condition known as delirium tremens, in which the affected indi- 
vidual sees sights and hears sounds, when there is no cause for 
either sight or sound except in his own disordered brain — disor- 
dered because of the presence of alcohol in the uerve tissue, 
creating hallucinations of the senses. 
Again, the blood which carries the life-giving particles selected 
for the nourishment of the brain is disordered and disorganized by 
the use of alcohol, so that it can not supply the brain with proper 
food in proper quantities. The blood of confirmed drinkers, ex- 
amined by the microscope, shows that it has undergone changes in 
its make-up which renders it to a certain extent incapable of prop- 13 
erly performing its duties; hence the brain suffers doubly — first 
from the fact that the alcohol finds its way directly into the nerve 
tissue, and secondly, because it is not properly nourished by 
the only agent capable of conveying nourishment to it, the blood 
which is impaired by the alcohol. 
Another fact, based upon strictly accurate data, concerning the 
susceptibility of those persons who habitually use alcohol, to all 
forms of disease, is found in a series of figures taken from “ Neison’s 
Vital Statistics,” where it appears that intemperate persons have 
much greater mortality from head and digestive diseases than any 
other class of people, while the influence upon life itself is very 
great. Thus the average duration of life in a temperate person 
At 20 years of age is 44 years. 
“ 30 “ “ “ 36 “ 
“ 40 “ “ “ 28 “ 
“ 50 “ “ “ 21 “ 
“ 60 “ “ “ 14 “ 
While in the intemperate the chances of living are as follows: 
At 20 years of age it is 15 years. 
“ 30 “ “ “ 13 “ 
(I U (( U « 
“ 60 “ “ “ 10 “ 
“ 60 “ “ “ 8 “ 
These deductions are based upon observations made on 357 per- 
sons, and is all that is necessary to establish the fact. 
It is correct, then, to state that the intemperate use of alcohol is 
a continued process of degeneration, affecting primarily the brain 
and nervous system and disorganizing the body, and that it directly 
shortens human life by many years, through the disorganization it 
produces of bodily organs. 
The organs it disorganizes most rapidly and effectually are the 
brain and those concerned in the circulation of the blood, the 
stomach, liver and kidneys, the latter all intimately connected with 
the proper nourishment of the body, and when diseased they be- 
come active agents in the production of disease ofttimes resulting 
in insanity. 
What are the statistics of institutions for the care of insane per- 
sons as to alcohol being a cause of insanity? Upon consulting the 14 
tables, it will be seen that quite a percentage of yearly admissions 
are attributable to the habitual use of intoxicants. 
Bucknill & Tuke, who are regarded as good authority the world 
over on the subject of insanity, in their last treatise on this subject 
give a series of statistics gathered with great care, relative to the 
causation of insanity from the habitual use of alcoholic drinks, and 
they quote from the reports of institutions in different places, thus: 
In York, England, Dr. Needham reports 22 per cent, of the as- 
certainable causes of insanity among men due directly to intemper- 
ance; Dr. Clouston, a high authority, gives 22 per cent, for men; 
Dr. Kirkbride, Philadelphia, gives 22 per cent.; Dr. Earle, Massa- 
chusetts, gives 20 per cent., but the most remarkable statistics re- 
main to be given. 
M. Lunier published an article in 1872 embodying the results of 
his observations in the several departments of France, showing 
how insanity increased with the increased production of alcohol. 
He states that, “ while the consumption of alcohol has nearly 
doubled between 1849 and 18G9, the cases of insanity from intem- 
perance have risen 59 per cent, with men and 52 per cent, with 
women.” 
In some of the departments where the proportionate increase in 
the manufacture of alcohol is known, and where accurate statistics 
are kep', the showing is remarkable. Thus, in those departments 
which produce alcohol, and where the annual consumption has in- 
creased in twenty years from four quarts per head to seven quarts 
per head, insanity from this cause has risen from 9 to 22 per cent. 
In another department, where the annual consumption of alcohol 
has risen from six pints per head to three quarts per head, insanity 
from this cause has increased from 7 to 10 per cent. 
In one department, where the annual consumption of alcohol has 
risen from one pint in 1849, and now (1872) is one quart per head, 
alcoholic insanity has only increased from 7 to 11 per cent. 
In the department of the Somme, where but little alcohol is 
drank, and scarcely so much in 18G9 as in 1849, the number of cases 
of insanity from this cause has remained almost stationary. 
M. Lunier also asserts that the increased number of suicides 
everywhere in France followed the increased consumption of al- 
cohol. 
Dr. Sheppard, the author of a work upon the subject of insanity, 15 
says of causes: “Without doubt the most frequent of these is 
intemperance.” In his report for 1876, he says : “ It is painful 
again to allude to the large part which alcoholic intemperance 
plays in the production of insanity. A careful analysis of the his- 
tory of the year’s admissions clearly establish a percentage of more 
than 28 as due to this cause. And I am persuaded from the char- 
acter of the individuals and the form of their malady in other cases, 
where the causation is not assigned or can not accurately be traced, 
that an addition of 12 per cent, may directly or indirectly be at- 
tached to the same origin. Thus we have an approximate record 
of 40 per cent, of the madness of Middlesex as due to a prevent- 
able cause, and that cause the growing passion for strong drink.” 
In a little work by Dr. H. Tuke, published this year, entitled 
“ Insanity and its Prevention,” the author states that among the 
causes intemperance unmistakably takes the lead. This is one of 
those facts which, amid much that is open to difference of opinion, 
would seem to admit of no reasonable doubt. “ Some years ago I 
calculated the percentage of cases caused by intemperance in the 
asylums of England, and found it to be about twelve. This pro- 
portion would be immensely increased were we to add those in 
which domestic misery and pecuniary loss owed their origin to 
this vice. Although tax-payers grumble about the building of 
large lunatic asylums, it is amazing how meekly they bear with the 
great cause of their burden, and how suicidally they resent any 
attempt made to remove by legislation the area of this wide- 
spread and costly mischief.” 
With what singular force these words of Dr. Tuke apply to the 
same state of affairs in our own country. From the facts I have 
been able to gather, and from personal observation, I am satisfied 
that the average as stated above is low enough' ; that is, for the 
direct effect of alcohol in the production of insanity. Statistics of 
the kind are not easily gathered, because the friends of those who 
are the victims are not always willing to tell all the facts about the 
intemperate habits of the patient. A curious confirmation of sta- 
tistics related to this subject is found in the report of Dr. Yellow- 
lees, superintendent of the Glamorgan asylum, Wales. In a recent 
report, he says, that during the second half of the year 1871 the 
admission of male patients to that institution numbered twenty- 
four, while there were forty-seven and seventy-three in the pre- 16 
ceding and succeeding half years. Tn 1873, during the first quar- 
ter, there were ten admissions, while in the preceding and suc- 
ceeding quarters there were twenty-one and eighteen. 
During the same period an experience precisely similar was no- 
ticed in the local prison; a less number of persons were admitted as 
criminals than there had been hitherto or subsequently in the same 
period of time. In seeking for the cause of this exceptional pe- 
riod, it was found that at that time the population, who were largely 
employed in coal and iron working, were engaged in a general 
strike, and that the miners and others having no money to spend 
for drink were obliged to be temperate, and there was a marked 
decrease of insanity and crime. 
Maudsley says, that if it were possible to strike out at once all 
insanity Irom off the earth, it would certainly be reproduced by 
intemperance in the use of alcohol. I cannot close the remarks on 
the influence that alcohol has upon the production of disease in a 
more fitting manner than by a quotation from Dr. B. W. Richard- 
son, in his Diseases in Modern Life. He says : 
“ There are times in the life of man when the heart is oppressed, 
when the resistance to its motion is excessive, and when blood flows 
languidly to the centers of life, nervous and muscular. In these 
moments alcohol cheers. It lets loose the heart from its oppression 
and lets flow a brisker current of blood into the failing organs; it 
aids nutritive changes, and altogether is of temporary service to 
man. So far alcohol may be good, and if its use could be limited 
to this one action, this one purpose, it would be amongst the most 
excellent of the gifts of science to mankind. Unhappily the bor- 
der line between this use and the abuse of it, the temptation to 
extend beyond the use, the habit to apply the use when it is not 
wanted ns readily as when it is wanted, overbalance in the multi- 
tude of men, the temporary value that attaches truly to alcohol as a 
physical agent. Hence, alcohol becomes a dangerous instrument 
even in the hands of the strong and wise; a murderous instrument 
in the hands of the foolish and weak.” 
From the foregoing we are enabled to determine from scientific 
data without appealing to the sympathies, or dwelling upon 
the moral side of the question, that a large percentage of the cases 
of insanity are avoidable from this one factor alone. Now com- 
bine this with the conditions which almost invariably follow the 17 
continued intemperate use of alcohol — domestic distress, poverty, 
want of food, unkindness, and, indeed, misery of every descrip- 
tion, and what a sea of wretchedness is created in which man- 
kind sinks, drowned in the depths of his own creation. Did it end 
here, it would be bad enough, but it does not; the habitual drinker 
invariably stamps his offspring with some form of bodily degen- 
eracy. And so on, the widening stream gathers within its murky 
Avaters the unhappy multitude, swept onward to inevitable death 
of body and soul. 
Another preventable cause of insanity is that of heredity. 
It is asserted upon the highest authority, based upon the sta- 
tistics of years, that insanity is transmittible from parent to 
child. Statistics, gathered in all parts of the civilized world, con- 
firm the general statement. England, France, Germany, Austria 
and America, each and all, have instituted enquiries of this kind, 
and each have arrived at the same results, although the percentages 
are not the same in each country, being modified by causes not 
necessary to explain here. 
The statistics of Bethlehem hospital show that thirty-two per cent, 
of the admissions had hereditary predisposition. In what is known 
as the Retreat in York, England, hereditary predisposition was 
traced in one-third of the admissions. Baillarger gives the results 
of his observation in France as nearly seventy per cent. 
Dr. Stewart, of Scotland, places the percentage of cases of 
heredity in the institution over which he presided at forty-nine 
per cent. The statistics of the Northern hospital at Oshkosh show 
that the percentage of cases admitted up to this time, who have 
inherited insanity, averages thirty per cent. 
There is not a shadow of doubt that heredity plays a most im- 
portant part in the causation of insanity, the least calculation plac- 
ing it at from 25 to 30 per cent, on the whole number of persons 
admitted, and there are some exellent authors who make the per- 
centage much greater. The chances of insane offspring resulting 
from the union by marriage of persons who have been insane, or 
who inherit insanity directly, is as great, if not greater, than the 
certainty of transmitting almost any other disease. 
Cases almost innumerable may be cited, going to show evidence 
of transmissibility, if it were needed, but it is unnecessar}*-; the 
facts are generally known, the difficulty that presents itself is, 18 
how to make mankind heed them. It seems to he well established, 
that the mother’s influence in the propagation of this disease is 
greater than that of the father; hence, when men select wives it 
behooves them to be careful whom they select, at least so far as 
this terrible malady is concerned. I know it is the lover’s notion, 
that matches are made in Heaven; that is poetic, it sounds prettily; 
but there are those who believe that falling in love is a matter of 
taste, and depends upon the judgment (or want of it) of each of 
the contracting parties. The importance of securing, each for the 
other, a sound, healthful companion would be a great advantage to 
the world, and save a vast amount of sorrow and distress; but such 
things are unfortunately not often thought of. Just whore society 
may attempt to regulate this matter it is impossible to say, and, 
indeed, with this subject we have nothing to do. Our duty is to 
lay the facts before society, then if they suffer they do it inten- 
tionally; they do it in the face of experience, and must abide the 
consequences. 
To a reflecting mind one phase of modern civilization is peculiar. 
An unusual epidemic disease appears from some cause, probably 
filthiness, in some part of the country, which operates virulently 
for a time, and carries off a fifth part of all it attacks. At once 
assistance in the shape of money, sympathy, all that kindness and 
consideration can do, is done freely. Every device known to art 
or science is employed to stay the ravage; laws are passed, state 
and national legislatures make haste to establish strict rules, hoping 
to “ stamp out ” the scourge. This is as it should be. At the 
same time a scourge more terrible, a malady more dreadful, is 
fastening its fangs deeply in the vitals of the people; it progresses 
slowly but irresistibly; it is not confined to one locality, it is wide- 
spread as the earth, and where the scourge strikes down its tens, 
this malady strikes down its thousands, yea, its tens of thousands, 
and the stream is ever widening, ever deepening, and no strong 
hand of law is raised to stop its progress or make the attempt to 
keep it within bounds; the disease is insanity, of which it may be 
said that one-half the causes are apparently preventable. 
There are causes of this dire malady which may not be reached 
by law — the passions of men allowed full sweep, anger, vicious 
life, faulty education, hope deferred, ambitions crushed, all aid to 
bring about those states of body and brain which end in madness; 19 
these the individual must battle with alone, and conquer or be con- 
quered as God gives him the strength; these must be made the 
subject matter for individual education, of individual self-govern- 
ment and discipline. It must be made a part of that universal hu- 
man reason which Carpenter tells us is progressive, and by which 
we may hope to secure that watchful self-discipline which will bene- 
fit not only ourselves but those who are to come after us, by estab- 
lishing an intellectual and moral constitution which our children 
and our children’s children will inherit. 
There are, however, some things which it would seem might be 
done by legislatures to help stay the onward march of this disease. 
Intemperance in the use of alcohol gives us certainly 25 per 
cent, of all the cases of insanity; this is a low estimate, much lower 
than my experience would dictate. Heredity gives us, at the very 
lowest computation, as many more; there are then from these two 
causes alone, 50 per cent, of the cases admitted to hospitals for in- 
sane which might be prevented. Add to this the insanity induced 
by other causes, which we have not time to consider now, but which 
are certainly within the power of individuals or communities to 
prevent, and the aggregate would soon roll up a mighty army of 
men saved from a bitter experience. Who can compute the an- 
guish spared; who can estimate the misery, distress, sorrow and des- 
olation avoided; or the wealth accumulated, the happiness, peace 
and prosperity that would follow the prevention of any considera- 
ble part of the number made insane annually by preventable causes. 
To remove only a portion of the trouble, would cut away the 
roots of untold sorrow, would confer a boon upon mankind to be 
estimated only by Him who holdeth the destiny of the people in 
the hollow of his hand.