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ON  THE  SUPPOSED  INCREASE  OF INSANITY,


          BY £D\frARi7 JARVIS, M. »•
                 Dorchester, Mass.

  [riprinted from tub '-American journal or insanitt."
S^SS^SmSSSEmSSJS
£  14 W 7
h. 
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ON THE  SUPPOSED  INCREASE OF INSANITY.
   Dr. James C. Prichard, in his Treatise on  Insanity,
 page 236, says, "A very general apprehension has exist-
 ed, both in this country," Great Britain, "and France,
 that Insanity has increased in prevalence of late years,
 to an alarming extent, and that the  number  of lunatics,
 when compared with the population, is continually on the
 increase."
   A very similar  apprehension exists in America, and
 the known facts and the  public records seem to confirm
 it.  There are certainly more lunatics in public and pri-
 vate establishments; they attract more of popular sym-
 pathy ;  they receive more of the care and protection of
 the government; more and more hospitals are built; and
 the numbers of the insane seem to increase in a still more
 rapid ratio.
   Nevertheless, it is impossible to demonstrate, whether
 lunacy is increasing, stationary, or  diminishing, in pro-
 portion to the advancement of the population, for want of
 definite and reliable facts, to show,  how  many lunatics
there are now, and still less to show, how many there
have been at any previous period.  Wanting these two
facts, we cannot mathematically compare the numbers of 
6
 the insane or their proportions to the whole people at any
 two distinct periods of time, and thus determine, whether
 lunacy increases or retrogrades.
   It is but a recent thing, that any nation has enumerated
 its insane.  And I cannot  discover, that any nation has
 ascertained  and reported this  twice, and thus offered us
 data for the  comparison.
   Governments, political  economists and statisticians
 have made accurate enumerations of the whole people.
 Beside this, they have ascertained their ages, employ-
 ments and even their property, and many  other circum-
 stances respecting them.   But very few have attempted
 to determine the degree and quantity of vital force among
 the people, the numbers that come up to,  and the num-
 bers that fall short of, their full development  of strength
 and fulness of health, and enjoy  each and all of their
 days, through  their complete  term of years.  Still less
 have they enquired into and published to the world  the
 defalcations  and depreciations  of mental health and
 power, and shown, how many minds were  diseased, and
 how many were deficient,  or idiotic, or demented, in any
 degree.
   Several Governments have ordered this  investigation,
 but none have done it thoroughly and completely.  Most
 have been contented with estimates, or with such general
 enquiries as  were answered entirely or in  part by esti-
 mates or conjectures.  They have not gone from house
 to house, making diligent  and minute enquiry in every
 family, to  know, whether there were any insane, and how
 many of these there might be, and what were their form
 and degree of disease.
  The Government of the United States, in the decennial
 enumeration of the people, made this enquiry, in 1840,
and again  in 1850.   But the published report of the first 
7
census contains some of the grossest and most palpable
errors in regard  to the  distribution  of insanity.  There
was such a manifest carelessness and inaccuracy in some
of the officers or clerks, who had the management of, or
who performed the work of that enumeration and its pre-
sentation to the public, as to throw a doubt over the state-
ments of the whole of that document.
  The last census, that of 1850, has not yet been pub-
lished.
  We have the census of the insane in Belgium, taken
with great apparent accuracy and reliableness ; but  as
we have no other census of that nation of either a previ-
ous or subsequent date, it is impossible to make a com-
parison of the numbers.
  A census of the insane at Norway, was taken, by order
of the Government in 1825, and published in 1828, by
Dr. Hoist.   Esquirol published an analysis of Dr. Hoist's
document in the Annales De Hygiene, in 1830.  But we
have no account of any earlier or later enumeration of
the Norwegian lunatics, and consequently have no grounds
for determining statistically, whether they have increased
or diminished.
  These are all the nations which are  known to  have
made careful and thorough examinations of the numbers
of their lunatics; and as they have done this only once,
their single facts give us no ground  of comparison,  and
we are therefore compelled to wait until they shall take
and publish another census of their insane before we can
determine their comparative condition and progress.
  The French Government in 1843 published  a large
folio volume, the " Statistique De La France" respecting
the condition of the people of that nation.  Seventy pages
of this document are devoted to the insane, and their con-
dition, numbers,  residence, situation, professions, cost of 
8
support, causes of disease, and mortality during the seven
years from 1835 to 1841 inclusive.
  This is a State document; it is prepared and published
by the Minister of Agriculture and Commerce; it comes
with all the authority of the Government;  and,  without
doubt, it contains all the facts that were then known in
regard to the lunatics of France.   Yet there is an appa-
rent want of completeness in its statements.
  This report gives accounts of the lunatics in hospitals
and hospices, in  poorhouses, and prisons  and all other
public and private establishments for their cure or custo-
dy.  It includes those lunatics who  were kept at home
with their own friends, or were boarded in  other private
families, and also those who were wanderers, in vaga-
bondage, strolling about the streets  of the towns  and
country.
  There are eighty-six departments in France. In sixty-
seven departments, there were, in 1843, one hundred and
nineteen public and private establishments for the insane,
leaving nineteen departments without any provision within
themselves for this purpose.  All of these  nineteen de-
partments sent their lunatics to others, except three which
reported no lunatics  in any  condition belonging to them
during these seven years.
  Only twenty-one departments are reported to have any
lunatics at their houses or in private families, leaving
sixty-five departments with all of their insane in public
or private  establishments especially devoted to them, or
in prisons, or in vagabondage.
  Only twenty five departments are reported to have any
vagabond lunatics, wandering or strolling abroad, leaving
sixty-one departments, all of whose patients of this sort
are at their houses, or in other families, or in some insti-
tutions for their cure  or custody. 
9
  Fifty-four departments are stated to have all of their
lunatics in some public or private institutions, and none
at their homes, or in any private families,  or in vaga-
bondage.
  So important a department as the Seine, which includes
the city of Paris, and about a million inhabitants, reports
no lunatics at their houses, or in any private families, or
as strollers  in the streets, while there are stated to be
2,407 in the public and private institutions.
  The department of Bouches de Rhone,  including  the
city of Marseilles, according to this report, has all of its
insane in public and private institutions.
  Eleven departments had no lunatics in either place, or
class of places, on the 1st of January, 1841,  according
to this document.
   There seem to be remarkable omissions and imperfec-
tions  in this report.   That eleven  departments  should
have  no insane among their population at any moment—
that fifty-four departments, including so large cities as
Paris and Marseilles, should have none at their homes, or
boarding  in other private  families,  or  strolling abroad
during these seven years, is too improbable to be believed.
The best that can be said of these reports, is  that they
contain the record of all  the insane that were then heard
of; and we must not infer from the blanks, that no luna-
tics existed, but that none were reported.     <
   These explanations must be considered  in estimating
the value of the following table, which is taken from the
369th page  of the " Statistique De La France :"-^-
b 
10
Year.	Population.	Number of Lunatics.	Number of Lunatics in 100,000 People.
1835.............	33,540,910 33,540,910 33,540,910 33,540,910 33,540,910 33,540,910 34,213,929	14,486 15,314 15,870 16,892 18,113 18,716 19,738	43 46 47 50 54 56
1836.......................			
1837.......................			
1838.......................			
1839.......................			
1840.......................			
1841.......................			58
			1
   Here is  shown an  apparent increase of insanity  in
 France, during these seven years.  Yet as this document
 has the appearance of a collection of partial  enquiries
 and estimates from the several departments, rather than
 the results of careful investigations in all the districts, and
 towns,  and families, this table is to be taken rather as a
 probable than a certain account of the progress of lunacy
 in that  country.
   The  British  Metropolitan Commission of Lunacy, in
 1844, made a most valuable report as to the lunatics and
 lunatic  establishments  in Great Britain and Ireland.   So
 far as their report relates to hospitals and to all sorts of
 public and private institutions  for the insane and to the
 patients contained in them, and to the pauper lunatics in
 poorhouses and elsewhere and to the private self-sustain-
 ing lunatics who were under commission, it is doubtless
 correct, for it is based on record and observation.
  They report  20,893 lunatics, of  every sort and in every
 condition in England and Wales; 16,821 of these are pau-
 pers, and 4.072 are private or self-supporting patients.—
 All of these private or self-supporting patients  are in asy-
 lums or hospitals, or licensed houses especially devoted
 to them, except two hundred  and eighty-two who were
 under commission.  No mention is made  of any pay pa-
 tient who is not in some institution, or under commission,
 none of any retained at their  houses, or boarded else-
 where in private families, and  supported by  their own
property or by that of their friends. 
11
   Without  doubt,  these  are all  the pauper  lunatics,
 wherever they may be.  It is very certain, that here are all
 the pay-patients who were under commission.  But it is
 not probable, that there were no others,—none supported
 by their own or their friend's property out of hospitals or
 licensed houses, and not  under commission.  Nor is it
 probable, that there were only two hundred and eighty-
 two pay or private  lunatic-patients in  all  England and
 Wales, out of public and private establishments especially
 devoted to them.

   We must therefore conclude, that this is  an imperfect
 census of the insane of England and Wales, especially
 when the commissioners themselves say, on page 182 of
 their report, that  "of patients who have been under pri-
 vate care, for shorter periods than one year, no return is
 required, so that a large class of insane persons, under
 certificate exists, in respect to whose number there are no
 materials for calculation."  Again they say, " as regards
 those of whom return ought to be made, it is believed,
 that in a very small  proportion  of instances is the law
 complied with."  " We have not taken the class last
 mentioned, [certificated single patients] into the account,
 in our estimate of the present numbers of the insane.—
 Even if these returns were complete and all certificated
 single patients were comprised in them, there would still
 remain a considerable class of insane persons of all ranks
 of life, under the care of guardians or relatives, without
 certificate, of whose probable number we have no means
 of forming an estimate."
  We have then no enumeration  nor any complete  esti-
 mate of the insane in even England and Wales.  Still
 less have we two enumerations taken at different times
by which we may make any comparison. 
n
  The marshals of the United States enumerated and
reported 627 self-sustaining, and 644 pauper  lunatics in
the State of Massachusetts, in 1840.  The government of
that State, in the year 1847, appointed a large and respect-
able commission to ascertain the number of the insane in
the Commonwealth at that time. Instead of going them-
selves or sending suitable agents to every house to learn
the sanity of its inmates, these commissioners  sent circulars
to the mayors and aldermen of the several  cities, and to
the selectmen of the several towns asking them to obtain
and give this information.  These public authorities,  in
their answers to the commissioners,  gave  them such
knowledge as they possessed in regard to these matters.
They returned the names of all the insane persons they
Jsnew.   These municipal officers could return the num-
bers of the pauper lunatics in their respective towns and
cities for they were subjects  of public record; but they
have no more knowledge of the domestic condition of pri-
vate families than any other men of their respectability
and range of acquaintance.  Consequently this commis-
sion, through this mode of enquiry ascertained and re-
ported<one thousand  one hundred and fifty-six lunatics
who were paupers, two hundred and ninety-one who or
whose  friends were able to support them, and sixty-five
others  whose pecuniary  circumstances could  not be
learned.   These made  one thousand,  five  hundred and
twelve lunatics of all classes within the  State of Massa-
chusetts, in the year 1847.
  The best commentary on the incompleteness of this re-
port is  the fact, that at the  very time, when the commis-
sioners made their enquiry, there were,  in the  various
hospitals of Massachusetts or the neighboring States, three
hundred and twelve lunatic patients belonging to Massa-
chusetts, who were able to support themselves or were 
lo
supported by their friends, beside a probably larger num-
ber who were kept at their homes or boarded In private
families, and yet this public commission discovered only
two hundred and ninety one in all conditions both in pub-
lic institutions and in private houses.
  If this investigation had been thorough, and its results
complete,  there might have been some plausible ground
for  comparison  of numbers, and determining the differ-
ence of the proportion of lunatics to the entire population
in 1840, and in 1847.  But as the last statement certainly
is, and the first probably is, incorrect, all inferences from
them would be useless and worthless.
  The reports of the  number  of lunatics in other States
and Nations are taken from still looser  data than even
these.  They are generally founded on  the number  of
patients resident in the lunatic hospitals.  The  various
writers on this  special subject, whose works, articles, and
reports I  have seen,  go to this  source  and give the
ratio of the hospital patients to the whole population  in
several countries, districts, and cities, as  evidence of the
comparative  prevalence of insanity.  Dr.  Pliny  Earle,
quoting from the American Journal of Medical Sciences,
gives the  proportion of lunatics,  as one in 3,350 inhabi-
tants in Madrid, one in 4,879 in Italy,  one in 7,181  in
Spain, and one in 30,714 in Cairo, because these are the
several quotients of their respective populations divided
by the number  of the lunatics in their hospitals.
  The number of patients in the hospitals must bear some
relation to the numbers of the insane in the countries  to
which  they respectively belong:  that is, they cannot have
inmates unless  there are insane  among the  people, and
these inmates cannot  exceed  the whole number of the
lunatics in the country or district unless they come from
abroad. 
14
  But there are so many other elements to be taken into
the calculation, that as yet the hospital population is no
indication of the  prevalence  of mental disease  in any
community.  It is rather an indication of the degree  of
civilization, and of general intelligence, especially in re-
spect to mental disorder, of public generosity, and  of
popular interest, in behalf of  the afflicted.
  Thus we find, that whenever the seeds of this interest
are once sown, and allowed to germinate,  and grow, it
spreads continually thereafter.  Whenever the attention
of the people of any country is called to this subject, and
a hospital is built, there follows a remarkable increase of
the cases of insanity revealed to the public eye, and seek-
ing for admission.
  In the year 1832, when the McLean Asylum at Somer-
ville, Massachusetts, contained 64 patients, the State Lu-
natic Hospital was established at Worcester, for 120 pa-
tients.   This was as large a number as was then supposed
would need its accommodation.  In 1836 one new wing,
and in 1837 another new wing, and rooms for 100 more
patients were added to the Worcester Hospital, and  at
the  same time the McLean Asylum contained 93 lunatic
inmates. In 1842, the Worcester Hospital was again en-
larged by the addition of two new  wings, and now these
are  all filled to the over flowing, having 450 patients in
May 1851,  while,  at the same  time, there were 200 at the
McLean Asylum,  204 at the City  Lunatic Hospital,  at
Boston, and 115 in the county  receptacles for the insane
at Cambridge and Ipswich, beside 36 in the jails, making
1,015 lunatics in the public establishments of Massachu-
setts in 1851, instead of the 182 which were there in 1832.
  Beside these, there is now so great a demand for the
admission of patients who  cannot be accommodated  in
these establishments already built, and there is so much 
15
 interest excited in their behalf, and the friends of the lu-
 natics are so alive to the necessity of providing means of
 relief for all of these sufferers, that the legislature has
 just now authorised the erection of a new hospital suffi-
 ciently large to receive 250 patients.
   The State Hospital at Augusta, Maine, was opened in
 December 1840, with only 30 patients.  In 1845, it was
 so crowded that the trustees  asked for more rooms.  In
 1847, the building was enlarged, and 128 patients  were
 admitted.  In 1848,  the house was all filled,  and  more
 were offered than could be accommodated, and  the su-
 perintendent asked the  Legislature to build still another
 wing to enable him to meet the increased demand.
   The New Hampshire Hospital was opened in 1842,
 and received 22 patients : these were all that were offer-
 ed.   In 1843,  these were increased  to 41;  in another
 year, 1844, there were 70;  in 1845, there were  76;  in
 1846, there were 98;   and in 1S50, they reached the
 number of 120. In  the meantime additions have  been
 made to meet this  growing demand for more and more
 accommodations.
   The number  of patients in the Eastern Virginia  Asy-
 lum, at Williamsburgh, has increased more than 200 per
 cent in fifteen years,—from  60 in 1836 to 193 in 1850.
 Those in the Western Virginia Asylum, at Staunton, have
 increased more than 800 per cent in twenty-three  years,
 —from 38 in 1828 to 348 in 1850.
   The average number of patients  in the Ohio State Lu-
 natic Asylum, at Columbus, was 64 in 1839, and  328 in
 1850, being an increase of more than 400 per cent  in
 eleven years.
  Now, no one  would imagine, that the populations  of
these several States, have increased in these ratios of the
increase of the lunatics in their asylums, within these 
16
 respective periods. But it will readily be supposed, that
 the opening of these establishments for  the  cure or the
 protection of lunatics, the spread of their reports, the ex-
 tension of the knowledge of their character, power, and
 usefulness, by the means of the patients that they pro-
 tect and cure, have created, and continue to create, more
 and more  interest  in the subject of insanity, and  more
 confidence in its curability.   Consequently, more and
 more persons and families, who, or such as who, former-
 ly kept their insane friends and relations at home,  or al-
 lowed them to stroll abroad about the streets  or country,
 now believe, that they can  be restored, or improved, or,
 at least made more comfortable in these public institu-
 tions, and, therefore, they send their patients to  these
 asylums, and thus swell the lists of their inmates.

  For the same reason,  the people  in the vicinity of lu-
 natic hospitals send more patients to them than those at
 a  greater distance.  Thus, the county of  Worcester,
 Massachusetts, has sent  one lunatic out of  every 116
 of its population, while the most remote counties of the
 State have sent only one  in 361  of  their people to the
 State Hospital, since its first establishment.
  In New York, the county of Oneida  has  sent one in
 361, and the remotest counties sent only one in 1,523, of
 their people to the  State Lunatic Asylum at Utica.
  In Kentucky, the people of Fayette county  sent one in
89 of their people to the Lunatic Hospital at  Lexington,
while the farthest counties sent only one in 1,635 of their
population to that institution.
  Similar differences, in the use of  the public hospital,
are found in Maine, New-Hampshire, Connecticut,  Ohio,
Maryland, Tennessee, and, doubtless, in other States the
same will be found on investigation.
* 
17
  If we assumed the principles by which the numbers
of the insane are determined or estimated by some wri-
ters,  in Spain, Ital}r, Cairo, &c,  assuming the  hospital
population as the basis of calculation,  we  should  infer
that the numbers of the insane, in proportion to the whole
numbers  of the people, had  multiplied more than five-
fold in Massachusetts in twenty years, five-fold in Ohio
in ten years, and more than four-fold  in Maine in the
same period.  We should  also conclude, that  insanity
was more than three times as prevalent in Worcester as
in Barnstable and Berkshire counties, in  Massachusetts,
four limes as  frequent in Oneida  as in Cattaraugus and
Chatauque counties, in New York, and eighteen times as
frequent in Fayette as in Macracken and  Hickman coun-
ties, in Kentucky, in proportion to their respective popu-
lations.  These deductions would be manifestly absurd.
  In the year 1806, a committee of the British House of
Commons, appointed for the purpose, made an inquiry as
to the number of lunatics in the kingdom,  and discovered
and reported  there to be 2,248,  in all.   Another com-
mittee,  in 1S15,  reported these patients to be twice as
many.
  Dr. Burrows, in 1819, found 4,041  in  the asylums of
every sort, and estimated that there were 2,000 more in
private families, making about 6,000 in all.
  In  1844, the  Metropolitan Commission discovered
11,272 lunatics in  the asylums  of all  kinds,  besides
9,621 in workhouses  and  elsewhere, without including
" a considerable class of insane persons  of all  ranks of
life, under the care of guardians  and  relatives."  The
comparison of the results of  these estimates  and inqui-
ries shows an  increase of near 200 per cent in  the asy-
lums, and  about 250 per cent  of all in twenty-five years,
and almost 900 per cent in thirty-eight years. The popu-
            c 
18
  lalion increased, in the shorter period, about 37 per cent,
  and in the other period, about 78 per cent.
    The number of lunatics reported to exist in  tne hospi-
  tals in France was 1,070 in 1801, and 2,145 in  1821, and
  13,887 in 1841.   This would indicate an increase of 100
  per cent in  the first twenty years, and 547 per cent in
  the next twenty years.
    Thus we  see that, except in Belgium and Norway, and
  perhaps in the United States,  we have no  positive  and
  reliable means of knowing the numbers of  the insane in
  the whole  population at any point of time ; and in no
  nation have we these facts satisfactorily given at differ-
  ent times, by which any comparison would  be  made.
    We see also from the very great difference of hospital
  accommodations, and of the use  made  of them  by  the
  people of different nations, and at different periods by
  the same nation,  that we  have no  means  of knowing
  what number of lunatics abroad those in these establish-
  ments represent.
    The statistics,—the ascertained and enumerated facts
  — then, are not sufficient to enable us to determine this
  question satisfactorily.  For although we might compare
  the number of lunatics ascertained to exist in Belgium in
  1841, and in the United States in 1840, with the numbers
  found in the hospitals, or calculated from conjectural an-
  swers to general  inquiries, to exist at any previous or sub-
  sequent  period, yet this comparison of an enumeration,
»  which is supposed to be all fact, with a  computation,
  which is part fact and part conjecture, would be, at least,
  unphilosophical, and might lead to error, and, certainly, it
  would lead to no reliable truth.
    To compare the estimates of the proportion  of insanity
  among the people, founded on the number of the lunatics
  in the asylums in England, or in France, or in Egypt, at 
                          19

 different periods, would be a still more unsafe method of
 reasoning, and lead to still more unsatisfactory results.
   To infer the number of lunatics in the community from
 the number in the hospitals, is about as unsafe as to infer
 the number of births from the number of children in  the
 schools.  The first element here is wanting ;  that is,  the
 proportion of all  the children that are sent to school.
 Now as this is very different in Massachusetts, and Eng-
 land, and Spain, and Egypt, and  Siam, no  reasonable
 man would venture to  compare  the number of births in
 these several countries  by the population of their school-
 houses. The provision for the cure and the custody of the
 insane in these countries  differs as widely as their pro-
 vision for  the education of children;  and yet, writers
 have given us the comparative numbers on this ground,
 as, in London one in 200, because there were 7,000 in
 the metropolitan Hospitals, and in  Cairo one  in  30,714,
 because there were 14 in the hospital of that  city.
   It must be farther considered, that many of these state-
 ments that were put forth as positive facts, are given in
 such round numbers, as to afford good reason for suppo-
 sing that they, or their  elements, are estimates, rather
 than actual enumerations.
   Thus, in some works on this subject, there are stated
 to be 32,000  lunatics in France; 16,000 in the  United
 States ; 7,000 in London ; 4,000 in Paris; 2,000 in Penn-
 sylvania;  and 1,000 in Massachusetts.  Millingen  says,
 the proportion of lunatics to the  people, is one in 1,000
 in England, and in France, one in 1,000.
   One department in France, Ariege, gives 300 vagabond
 lunatics, for four successive years  without  change, but
 these suddenly, in the fifth year, diminish to  250,  and,
in the seventh year disappear entirely.  Another depart-
ment, Seine Inferieure, reports 200 lunatics for seven sue- 
30
cessive years, and another 300 for three successive years
in private families ; Saone Haute  reports none either in
private families or as vagabonds for two years, when sud-
denly in  one year there appear to be 193.  Sarthe reports
273 lunatics in families in 1837,.and then they all disap-
pear, and are reported no more.  Mayenne reports eight
in families, and as vagabonds in  1835.  These  are  in-
creased to 209 in 1837, and  diminished to 21  in 1S38,
and to 8, the original reported number, in 1841.  There
are so many of these apparent inaccuracies, such full and
round numbers, and such unvarying totals, where there
must be  some change,  and such  sudden  and  violent
changes, out  of all relation to the ordinary changes in
disea.se, or the circumstances of society, that we are com-
pelled to look with distrust upon the whole and consider
it as but  little better than mere guess work, with more or
less  foundation in fact.
  Even if these statements were all accurate and com-
plete, they are of such different nature, that they do not
enable us to determine with any certainty the number of
the insane of the same  country at different periods, nor
of different countries at the same period.
  Nevertheless, as all enumerations, estimates, and com-
putations, from whatever source, give larger numbers of
the insane at each succeeding  period, and as  none of
them give less, except the enquiry in Massachusetts, by
the State Commissioners in L847, and as, in almost all
states  and countries,  the  history of  whose hospitals
through several years has come to us, there are more and
more that ask  for hospital accommodations, and they in-
crease as fast as rooms in the hospitals increase, and in
some places faster, there is plausible ground at least for
the supposition that insanity has been increasing for the
last half century, and is now on the increase; and there 
21
 is certainly a manifestation of more and more lunatics in
 these  communities, if not  a development of more and
 more insanity, among their individual members.
   Not finding the facts of history and statistics sufficient
 to determine, whetheHnsanity is an increasing, or dimin-
 ishing, or stationary disease, we may derive some  addi-
 tional light  from an examination of the origin and  sources
 of this class of diseases, and see whether the causes  are
 more or less abundant, and act with more or less effi-
 ciency now than formerly, and are likely to produce more
 or less lunacy.
   Esquirol  says,  that  "insanity is  a disease of civiliza-
 tion and the number of the  insane is in direct proportion
 to its progress."   " The progress of  civilization multiplies
 madmen  (fous.)"  So certain is he, that this progress of
 society causes this disorder, that he asserts,  that the in-
 sane have a right to demand that civilized society should
 remedy the evil which it  causes.   "It  is  not pity, nor
 benevolence, but justice  that should restore madness."
 "If it is true, that madness has a direct relation with civil-
 ization, it is the duty of society not only to ameliorate the
 lot of the insane, but  it is right even to compel it to  di-
 minish their number."*
  Nothing can be more positive than this opinion  of one
 of the ablest and most learned writers on diseases of the
 mind ; and he sustains it at length by various observations
 on the proportion of lunatics in countries of different de-
 grees of  civilization.   " There is less insanity in Spain
than in countries where civilization  is more  advanced."
" There are fewer insane in the northern parts of Norway
where civilization is the lowest, than in the southern pro-
vinces where civilization is the highest." t

 * Esquirol in " Annates De Hygiene," tome iv. p. 348-9.   i Ibid. p. 34. 
22
  Humboldt made diligent enquiry and found none among
the Indians of America.  Travellers find none in Africa,
and the general opinion of writers, travellers, and pt^si-
sicians is, that this disease is seldom found in the savage
state, while it  is known to be frequent  in the civilized
state.
  We are then led to examine the causes of lunacy, and
see how far they are necessarily connected with, or grow
out of, the improving condition of civilized society.
  On analyzing the  causes  of the cases  of insanity
which are reported in the several hospitals of the  United
States and Great Britain, we find 184 different names of
causes given, but rejecting  8 which are known to be sy-
nonyms, there are 176 different causes  stated in these
reports.   But these are  not all the causes that may pro-
duce mental disease.  They are manifold, almost as nu-
merous perhaps as the diseases of the nosology,  as the
accidents and injuries that may happen  to  man, as the
temptations to overwork the mind, as the causes of ex-
citement that may provoke the evil passions or the sensual
appetites, as the chances and varieties of fortune, and as
the evil influences that may fall upon humanity.
  All of them may directly or  indirectly act upon the
brain  and disturb its operations.
  The following list includes the names of causes which
are found in the American Hospital Reports, and in some
treatises on insanity.
  For convenience of analysis, these may be reduced to
classes—the Physical and the Moral causes.
  The Physical causes are those which primarily act
upon the body and disturb the brain, and then its functions, 
                                   23

deranging thus the  mind or the moral affections.    These
are,
 Congestion of the Brain,
 Disease of      "
 Phrenitis,
 Epilepsy,
 Arachnoiditis,
 Apoplexy,
 Convulsions,
 Hydrocephalus.
 Nervous Irritation,
 Excessive pain,
 Neuralgia,
 Typhus     Fever,
 Nervous       "
 Bilious        "
 Scarlet
 Intermittent   "
 Yellow
 Gastritis,
 Measles,
 Gout,
 Dyspepsia,
 Dysentery,
 Erysipelas,
 Phthisis,
 Rheumatism,
 Bilious Rheumatism,
 Suppression of Hemorrhoids,
       "       Perspiration,
       "       Secretions,
       "       Eruption,
               Tumor,
               Fistula,
 Small Pox,
 Varioloid,
 Irritation of the Spine,
 Disease of      "
 Pregnancy,
 Parturition,
 Abortion,
 Puerperal,
 Cold in Childbed,
 Lactation,
 Sexual Derangement,
 Disease of Uterus,
 Irregular Menstruation,
Profuse        "
Suspended     "
Suppressed     "     at change of life,
Hysteria,
111 Health,
    "     and solitude,
    "     and perplexity in business,
    "     and family trouble,
    "     and pecuniary difficulty,
    "     and lawsuit,
Old Age,
Irregular decay of powers in old age,
Congenital,
Hereditary,

             Injuries,
  Concussion of Brain,
  Lesion of  Brain,
  Blow on the head,
  Fracture of the head,
  Burn on the head,
  Malformed head,
  Fall,
  Kick on the stomach,
  Surgical operation,
  Mesmerism,
Insolation,
Want of Exercise,
Sedentary life,
Idleness,
Insolation and drinking cold water,
Exposure to excessive heat,
Exposure to cold,
Bathing in cold water,
Sleeping in a barn filled with new hay,
Tight lacing,
Excess of Quinine,
Metallic vapor,
Prussic Acid vapor,
Charcoal vapor,
Carbonic Acid Gas,
Working in  White Lead,
Acetate of Lead,
Excessive labor,
Bodily exertion,
Loss of sleep.
           Dissipations.
Intemperance in spirit,
      "      in snutf,
      "      in smoking,
      "      in Opium eating,
Syphilis,
Vice and Immorality. 
24
   The moral causes affect the mind and  the moral affec-
tions  primarily, and  through them they  reach the brain.
These are,
Mental labor and excitement,
   "   fatigue,
   "   shock,
   "   perplexity,
Study Excessive,
Study of Metaphysics,
  "   of Phrenology,
Excitement of lawsuit,
Politics,
Political commotions,
Excitement of Mexican War,
    "        visiting,
Sea voyage,
License question,
Anti-rent,
Fourierism,
Preaching sixteen days and nights,
Blowing Fife all night,
Application to business,
Reading vile books,
Seclusion,
Suddeu joy,
Hope,
Faulty Education,
Day Dreaming,
Extatic admiration of works of art,
Death of Relatives.
    "    Husband,
    "    Father,
    "    Son,
Sight of death of a friend,
Sickness and death of friends,
    "     "     "    kindred,
Murder of a Son,
Anxiety,
Anxiety and loss of sleep,
    "   for absent friends,
Home-sickness,
Being lost in the woods,
Fright,
Disappointment,
       "       in love,
       "        in ambition,
Celibacy,
Unrequited love,
Seduction,
Domestic afflictions,
    "    trouble,
Family [affairs.]
Bad conduct of children,
111 treatment,
      •'     from husband,
      "       "  parents,
Abuse from husband.
Infidelity of husband,
    "    of wife,
False accusation,
Imprisonment for crime,
Difficulty in neighborhood,
Avarice,
Anticipation of wealth,
Speculation in  Stocks,
      •'       Moras Multicaulis,
      "       Lottery Tickets,
Perplexity in business,
Pecuniary difficulties,
Disappointment in business,
Loss of Money,
   *'   Property,
Reverse of  Fortune,
Fear of Poverty,
Want of Employment,
   "    Occupation,
Destitution,
Mortified pride,
Ungoverned passion,
Violent temper,
Misanthropy,
Jealousy,
Envy.
Duel,
Religious anxiety,
     "    excitement,
Remorse,
Millerism,
Mormonism,
Struggle between  the religious princi-
            ple and power of passion.
Epidemic Influences.*
  * " As there are certain atmospheric conditions, which render epidemic and
contagious diseases more or less frequent,  so there are,  in the spirits, certain
general dispositions, which cause mental aberrations to extend, propagate and
communicate itself to a great many individuals by a sort of moral contagioo."—
Esquirol, Maladies Men tales, i. 63. 
25
   These are not all the diseases, accidents, events, habits
 or circumstances that can disturb the regular actions of
 the brain,  but they probably include all the classes of
 such causes,  and  all the channels through which they
 may reach the mind.
   The question now is whether these disturbing causes
 are increasing, stationary or diminishing.
   An examination shows, that some of them are increasing
 in frequency and in force, some are probably stationary,
 and a few are diminishing with the advancement of civil-
 ization.  Some of them are essentially inherent in man,
 in every condition, the savage and the  refined nearly          \
 alike, and are to be found throughout  the world and in
 all ages.
   Some of the diseases which are supposed to be causes
 of insanity, such as measles, scarlatina, small pox, dysen-
 tary, rheumatism, fevers, exposure to cold and insolation,
 have probably diminished in frequency and power; cer-
 tainly the description which Sydenham gives of the pre-
 valence and fatality of  several of these finds no counter-
 part in the observations of the present day.
   Some other diseases as suppressions of secretions, con-
 vulsions, hydrocephalus, the effects of old age, generally
 the diseases and the disturbances of the  uterine  func-
 tions,  erysipelas, * rheumatism,  haemorrhoids,  have  re-
 mained stationary, and act as disturbing causes with about
 the same force in one age and among one class of people
 as another.  Intemperance and its consequences vary in
 different ages, and in different nations ; but in all there
 are some, and in some there are  many, who are prone to
 this indulgence.  There has been less  of it within the
last thirty years, than in the  century  previous in New-
England,  and probably through the  United States and
Great Britain.   But there is more now than there  was ten
           d 
26
years ago in Massachusetts. There is more in cities than
in the country.  The proportion of cases of lunacy caused
by this habit to all the cases from known causes was in
Great Britain 136 in a 1,000, in the United States 116 in
1,000, and in France 78 in a 1,000.
  Syphilis is said to be compartively a modern disease.
This is probably said, not from want of facts, but  from
want of observers and records.  As  long  as men have
lived on earth there probably have been causes for this
disease; and without doubt, it has in all time been itself
a cause of more or less mental disturbance.
  We have no means  of knowing whether masturbation
increases or diminishes.
  Other diseases as gout, dyspepsia, ill health in general,
consumption, phrenitis, arachnoiditis, nervous  irritation,
neuralgia, cerebral congestion  have  probably increased
and are increasing with the progress of the age.
  Almost the whole class of accidents, injuries and ex-
posures to noxious elements, and to dangers of body and
limb, has increased. With the new improvements in the
mechanic arts, the increase of machinery, the new and
sometimes uncontrolled if not uncontrollable motive pow-
ers, and the new modes of travel, more accidents happen,
and more injuries  are inflicted on men, and in their  way,
they multiply the  causes of cerebral disturbance.
  In course of the same progress of improvement, there
are more chemical agents discovered and applied to use
in the common arts of life.
  Men are therefore more  exposed to minerals,  salts,
acids, gases, paints, dye-stuffs, and combustible and ex-
plosive mixtures, which are sometimes more or  less inju-
rious to health, and the sources of accidents dangerous
to those who are exposed to them.
  These therefore multiply the causes of insanity. 
27
   The moral causes may be subjected to a similar analy-
 sis, as they belong to man in every state, and as they be-
 long to civilization or are increased by its progress.
   They  may be also arranged into classes, as they affect
 the mere mental action.
   As  excess of mental labor in study in general, study
 of special subjects,  phrenology, metaphysics, excessive
 devotion to business.
   As  quickness and violence of mental action, as excite-
 ments of various  kinds  in law-suits,  politics, anti-rent,
 fourierism, &c.
   As  they affect the feelings and emotions, and mostly of
 the depressing kind, as grief for the loss of friends  and
 relations.   As anxiety, grief connected with fear, as in
 case of  sickness of  friends, home-sickness, or grief for
 hopes suddenly blasted,  as  in disappointment  ol love,
 ambition, or other expectations. Sorrow for the miscon-
 duct of others—husbands, wives,  children, &c.   Suffer-
 ing and  sorrow on account of ill-treatment from relatives
 or friends.  Sudden and overpowering apprehension of
 evil, as in fear, fright, &c.
   As they are connected with property involving both the
 excess of mental action and  the disturbance of the moral
 affections.
   As in  avarice,  labor to acquire, and anxious fear of
 loss, dealing in merchandize of uncertain value,  specu-
 lations in stocks, lands, &c.
   Pecuniary difficulties, perplexity in business in which
the mind struggles to accomplish and gain what it cannot,
and at the same time  the feelings are oppressed with
anxieties and fears.   Disappointment in business, losses
of property involve the same troubles of mind and heart. 
28
   Poverty, and the fear of poverty cause much labor of
the mind, unsupported by hope and confidence, but em-
barrassed by doubt and depression.
   As they affect the maddening and evil passions, anger,
violent temper, jealousy, pride, all of which have their
depressing and exhausting influence upon the brain.
   These last causes  are often mingled with the others,
and  co-operate with them, as in family and neighborhood
quarrels, lawsuits, and sometimes in political strifes and
disappointm ents.
   As they affect the  religious element, when there is a
great struggle of the  mind to  comprehend the doctrines
and  the  mysteries, there may be intense  exhilaration
joined with the hopes, and an  agonizing  anxiety joined
with the  fears connected with  the  eternal  interests.—
There is so great a prize to strive for and to  gain, and so
complete a destruction to be avoided, that the mind labors
with all-absorbing energy to secure that which is offered
and to escape that which is threatened, and these con-
nected with such an overpowering anxiety, that the  over-
tasked brain sometimes falters and then acts with uncer-
tainty.
   Some of these causes are the same in all  ages and in
all nations, and in all states of barbarism and civilization.
   Those  especially which belong to  the malignant and
the evil passions, anger, hatred, jealousy, pride and vio-
lent temper, are probably the  same  at  all  times,  and
have an unvarying amount of influence on the  sanity of
the brain.
   Those  causes  connected with the depressing emotions
and  feelings, anxiety on account of the suffering of friends
and  relatives, fear of  their  loss, sorrow  for  their death,
and  probably those causes which are connected  with
family variances, and misconduct, with the ill-treatment 
                         29

of parents and husbands, remain as active now as ever
and no more.
  There are  other causes of grief which  become more
painful with social cultivation, and therefore disturb the
nervous system more.
  In a higher state of refinement, the sensibilities become
more keen, and the tender passions more  powerful and
more relied upon as sources of happiness.  Then the
affections between the sexes are more ardent and abiding,
and have a more controlling influence over them, than in
a ruder state, and a rupture of the proposed union, a dis-
appointment in love, the failure in tenderness, of respect,
or of fidelity in a partner after marriage, would produce
a keener anguish, a more effective shock, and wear upon
the spirits more in a refined, than in a less  cultivated
state  of society, where less was hoped, and less suffer-
ing would follow failure or disappointment.  Therefore,
we may look for more insanity from disappointed love or
domestic troubles now than in former ages.
  But on the other hand, the same cultivation of life and
spirit would  probably engender  more permanence  of
affection in both parties, more respect,  and faithfulness,
and tenderness in the domestic circle,  so as to diminish
the frequency of the causes of their disappointments and
sorrows.
  Some  of the other causes connected with the feelings
and passions, quarrels,  duels, lawsuits, have probably
diminished.
  The causes connected with religion have doubtless di-
minished within the last thirty years.   These have' al-
ways been active as far back as even in the days of the
oldest heathenism of which  we have any  record, there
were those who became so exalted with their feelings pf
inspiration, that  they  imagined themselves  especially 
30
endued with knowledge  and gifts from superior beings.
The Pythoness  " spoke the oracles of the God often with
loud howlings and cries."   There were  the enthusiasts
and the uncontrollable fanatics in all the days of the Ro-
man church.  Since  the Reformation, when sects have
multiplied, the various forms of doctrines meet more va-
rieties of temperament,  and probably more are brought
under their active influence.  With this change  comes
more desire to produce immediate and powerful impres-
sions, and a greater confidence that  this  impression will
establish  one in a more satisfactory religious condition.
  The desire to be so impressed, and the impression  it-
self, after it is received,  create in some a state of doubt
between  hope and fear, an anxiety and a mental struggle
to attain to the position of security and happiness.
  There  is probably less of insanity from  this cause in
New-England now, than there was in the last and the pre-
ceding generation, yet all ages are subject to it.
  The causes connected with mental labor, in its mani-
fold applications have increased and are increasing con-
tinually.   In the progress of the age, education has made
rapid advances, both in reaching a wider circle of per-
sons and  in multiplying the subjects of study.
  The improvements in the  education of children and
youth have increased their mental labors,  and imposed
more burdens upon their brains, in the present than in the
preceding ages.  The proportion of children  who are
taught in schools increases every  year in the  United
States, and in most civilized nations.  There are more
and more of those whose love of knowledge, whose sense
of duty, whose  desire of gratifying  friends, and whose
ambition, impel them to  make their  utmost exertions, to
become good scholars.   Thus  they  task their minds un-
duly, and sometimes exhaust their cerebral energies and 
31
leave their brains a prey to other causes which may de-
range them afterwards.
  The new sciences which have been lately discovered,
or the old sciences that were  formerly confined to the
learned, but  are  now simplified and popularized, and
offered to the young as a part of their education, multiply
the subjects of study and increase the mental labor of
almost all in schools.
  Men  and classes  of men, such as in the last century
would have thought of nothing but how they should obtain
their bread, are now induced to study subjects and pur-
sue  sciences, and burden their brains with  great and
sometimes excessive labor.   New fields of investigation
have been laid open within the last hundred, and espe-
cially within the last fifty years.  New inducements are
offered, so that a greater variety of tastes is invited to
their peculiar feasts of knowledge.   Many persons now
study phrenology, metaphysics, mathematics, physiology,
chemistry, botany, and other branches of natural history,
to say nothing of mesmerism, biology, &c, and thus they
compel their brains  to labor with more energy and ex-
hausting zeal than those of any former generation.  In
this  multiplication of students,  there are some who at-
tempt to grapple with subjects, that they cannot master,
and  sink under the burden of perplexity which they can-
not unravel.
  In this general  increase of mental activity, some men
become interested and give their minds intensely to the
study of public topics, politics, State or National affairs,
and  the subjects of legislation, the banking system, tariff,
anti-rent, anti-masonry,  the license question,  &c, or to
public moral questions, anti-slavery, temperance, and
general or special reforms,  any or all of which impose
upon them great anxiety and mental labor. 
                          32

   In this country, where no son is necessarily confined to
 the work or employment of his father, but all the fields
 of labor, of profit, or of honor, are open to whomsoever
 will put on the harness and enter therein, and all are in-
 vited to join the strife for that which may  be gained in
 each, many are in a transition state, from the lower and
 less desirable to the higher and  more desirable condi-
 tions.  They are struggling for that which  costs them
 mental labor, anxiety, and  pain.  The mistake,  or the
ambition, of some, leads them to aim at that which they
 cannot reach,—to strive for more than they can grasp,—
 and  their mental powers are strained to their utmost ten-
 sion ; they labor in agitation, and they end in  frequent
disappointment.  Their minds stagger under the dispro-
portionate burden; they are perplexed with the variety
of insurmountable obstacles, and they are exhausted with
 the ineffectual labor.
   There are many whose education  is partially wrong,
and some whose education is decidedly bad.  These per-
 sons have wrong notions of life. They are neither taught
to understand the responsibilities  that they must meet,
nor are they prepared to sustain them.   They are filled
with false hopes. They are flattered in childhood and
youth,  but they are not accustomed to mental labor, nor
disciplined and strengthened to bear burdens. They are
lead to expect circumstances that will not belong to them.
They look for success,  honor, or advantages, which their
talents,  or  education, or habits of business, or station in
the world, will  not obtain for them.  Consequently, when
they enter responsible life, they are laying  plans which
cannot be fulfilled, they are looking for events which will
not happen. They are struggling perpetually and unsuc-
cessfully against the  tide of fortune.  They are always
hoping, but they are frequently disappointed.   Their in- 
33
 effectual labor exhausts them, and their disappointments
 distress and disturb them.  They are thus apt to become
 nervous, querulous and despondent, and,  sometimes, in-
 sane.
   But in an uneducated community, or where the people
 are overborne by despotic government or inflexible cus-
 toms, where men are  born in castes, and die without
 over-stepping their native condition,  where the child  is
 content  with the  pursuit  and the  fortune of his father,
 and has no hope or expectation of any other, there  these
 undue mental excitements and struggles  do not happen,
 and men's brains  are not confused  with new plans, nor
 exhausted with the struggles for a higher life, nor  over-
 borne with the disappointment in failure.   Of course, in
 such a state of society, these causes of insanity cannot
 operate.  But in  proportion as education prevails, and
 emancipates the new generations from the trammels and
 condition of the old, and  the manifold ways of life are
 open to all, the danger of misapplication of the cerebral
 forces and the mental powers increases, and men may
 think and act indiscreetly, and become insane.
   The same  is distinctly manifested in the pursuit of
 business. There are many new trades and new employ-
 ments ; there are new schemes of increasing wealth, new
 articles of merchandise, and speculations in many things
 of new and multiplying kinds.  All these increase the
 activity of the commercial world.  The energy of men
 of new enterprises gives  a hope of actual value, and a
 momentary market value to some new kinds of property.
  The consequent inflation or expansion of prices,  to  a
greater or less degree, makes many kinds of business
more uncertain, and many men's fortunes more precarious.
This increases the doubts and perplexities of business,
           e 
34
        the necessity of more  labor  and watchfulness, greater
*        fear and anxiety, and the end is more frequently in loss,
        and failure of plans,  and mental disturbance.
          Besides (hese uncertainties which may happen to any,
        there are  more that  enter the free and open avenues to
        occupations which  hold out high and flattering promises,
        and for which they are unprepared, in  which they must
        struggle with greater labor  and anxiety than others, and
        in which they must be more frequently  disappointed.
          Besides these causes of mental disturbance in the new
        and untried fields of study,  business,  and commerce,
        there are other causes in the social position which is sub-
        ject to like changes.  Many are passing, or have passed,
        from a comparatively retired,  simple and  unpretending,
        to the showy,  the fashionable or the cultivated, style of
        life.  In this transition state there must be more mental la-
        bor for those who are passing from one  condition  to the
        other;  there must  be much thought and toil, much hope
        and fear,  and much anxiety and vexation, to effect the
        passage, and to sustain one's  self in the new position.
           With the  increase of wealth and fashion there  come
        also, more artificial life, more neglect of the natural laws
        of self-government, more unseasonable hours for food and
        for sleep, more dissipation of the open, allowable and
        genteel kind, and  also more  of the baser, disreputable
        and concealed sorts.
           Consequent upon the new labor and new positions and
        new styles of life, there comes more low health, from ex-
        hausting and perplexing cares  and toils  of business, of
        social life and fashion, and from frequent irregular habits
        of diet and regimen.  The secondary consequences of im-
        paired health, of diminished vital forces, dyspepsia, debi-
        lity, consumption, gout or other disease, are manifested in 
I
                         35

the brain ;  and then nervousness, frequently, and insan-
ity, sometimes, follows.
  Thus we see, that with advancing civilization, and es-
pecially in the present age and in our own country, there
is a great development of activity of mind, and this is
manifested in most of the employments, in the conduct of
the mechanic arts,  agriculture, trade and commerce, in
the attention  to the professions, and to other subjects of
study, and to politics.  This increase of mental activity,
and of cerebral action comes without a corresponding in-
crease of discretion to guide it, and of prudence to re-
strain it.
  And this proneness to  mental action must prevail until
the world learn the nature and the limit of their mental
faculties, the connection of these  with the brain ; and
the connection  of the brain with all the other physical
organs, and govern themselves accordingly.
  In review  of this history of the causes of insanity, we
find that very few of them diminish with the progress of
the world.    Some are  stationary,  remaining  about  the
same in the savage, the barbarous and the civilized state
while many of them increase, and create more and more
mental disorder.
  Insanity is then a part of the price which we pay for
civilization.  The causes of the one increase with  the
developments and results of  the other.   This is not ne-
cessarily the case, but it is so now.  The increase  of
knowledge, the improvements in the arts, the multiplica-
tion of comforts, the amelioration of manners, the growth
of refinement, and the elevation of morals, do not of them-
selves disturb men's  cerebral organs and create mental
disorder.   But with them come more opportunities and
rewards for grept and excessive mental action, more un- 
36
certain and hazardous  employments,  and consequently
more disappointments,  more means and provocations for
sensual indulgence, more dangers of accidents and inju-
ries, more groundless hopes, and more painful struggle to
obtain that which is beyond reach, or to effect that which
is impossible.
  The  deductions, then, drawn from the prevalence and
effects  of causes, corroborate the opinion of nearly all
writers, whether founded on positive and  known facts,
on analogy, on computation or on conjecture, that insanity
is an increasing disease.  In this opinion all agree.
WM. SAUNDERSON, PRINTER.