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and £25 in England, making up a total of two millions sterling, to which
if we add the cost of those maintained by their friends, we arrive at
a grand total of three millions per annum, with the inevitabie pro-
spect that it will reach six millions by the close of the nineteenth
century, unless we adopt the precautions within our power.
are the more interested in the matter, as the United Kingdom has a
higher rate of insanity than other countries, the latest returns show-
ing as follows:

No. of Per Million Ratio of Annual

Ipsane. Inhabitants. Recoveries. Death-rate.
England .

81,570 3,190 39 p. cent. 10 p. cent.
Scotland.
11,575 3,215

42

8
Ireland
19,445 3,676

48
France

82,873
2,203

15
Germany
85,140 2,302 31

8
Italy

44,102 1,629
Spain.

10,200

603
Belgium & Holland 10,376 1,364

32

14
Scandinavia. 18,100

2,920
United States (1871) 61,181 1,590

47

9
Canada

7,300

1,840
Australia
4,900 1,830

45

7
As a rule, the New World and the British Colonies are less afflicted
than Europe, this being no less true in the proportions of deaf, dumb,
blind, &c. The only item in the above table which is not reliable, is
that of Spain, where the real number is probably double.

The Commissioners of Lunacy have invented numerous theories
to account for the rapid rise of pauper lunatics in Great Britain, but,
after all due allowance for the reasons alleged, it is painfully mani-
fest that this disease is increasing among the working-classes, the
ratio of pauper lunatics per million inhabitants, showing as follows:

England.

Scotland.
1861-65

2,080

2,050
1871-75

2,581

2,290
1880. .

2,792

2,580
If we compare the number of pauper and private insane with
their respective strata* in society, we shall find how much greater
is the proportion among the lower than the middle or upper orders,
just as the death rate of St. Giles's exceeds that of Belgravia :-
No. of Insane.

Population. Ratio per Million.
Working-class. 83,757

24,150,000

3,490
Middle and Upper. 28,833

10,790,000

2,670
United Kingdom 112,590

34,940,000

3,217
The excessive ratio among the working-class shows that we do

.

* Working-class 69 per cent., middle and upper 31 per cent., as shown by Probate
returns in CONTEMPORARY REVIEW for February, 1882, p. 326.

not take sufficient measures to promote their health, and that Nemesis of insanity scourges us for our short-comings. Our neglect in this particular is also productive of moral deterioration, for Dr. Guy finds that the majority of criminals have a very low range of intellect, and that 12 per cent. of the prison population of Scotland are only a few degrees above idiotcy, and about 4 per cent. in England.

It is commonly supposed that women are more liable to insanity than men, simply because there are 15 per cent. more female than male lunatics, but this arises from two causes ; lst, That in most countries the number of persons over twenty years of age shows an excess of at least 10 per cent. for females : 2ndly, That insane women live much longer than men of the same class. If we compare the numbers admitted of each sex, we shall find that in Great Britain the males are 14 per cent. more; and the preponderance in other countries varies from 12 to 28 per cent. for males, although the number of female inmates be greater.

The average of ten years' statistics for England reveals the interesting fact that not only are women less prone to insanity than men, but the disease assumes with them a less malignant form, viz

Male.

Female, Gen. Average.
Ratio of Recoveries 35 p. cent. 43 p. cent. 39
Annual Death-rate 124

9

103 It is difficult to imagine why some parts of England or Scotland should have three times as much insanity as others, but such is proved by the following ratios per million inhabitants :England.

Scotland.
Durham.
1,290
Shetland .

960
Cornwall . 1,580

Orkney.

1,070 Lancashire

Lanark

1,280
Middlesex
3,040
Argyll

2,590
Oxford
3,120
Kinross

2,990 What may be the local causes, or how far remediable, would be a subject worthy of Parliamentary inquiry, for it seems strange that Nottingham should have double as many insane as Leeds or Sheffield, and that Birmingham should be enormously in excess of Liverpool. *

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2,030

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II.-CAUSES AND PREVENTIVES OF INSANITY, It was not until sanitary improvements were introduced into our cities that men became aware of the prodigious waste of human life that had gone on so long through municipal neglect. Nor will it be readily believed how large a waste of human intellect is due to the vis inertie that obstructs so many valuable efforts to improve the condition of the masses.

* The ratios per 10,000 inhabitants in the principal towns are : Leeds 16, Sheffield 18, Liverpool 22, Manchester 27, Birminghamn 30, Nottingham 31, London 36. ,

.

If we take the medium average of ascertained causes of insanity in England, France, and United States, we shall find as follows :Hereditary or congenital

24 per cent. Habits of drunkenness

14 Business and anxiety

12 Loss of friends .

11 Disease and want

10 Accidents

6 Various causes.

23

.

100

Hereditary insanity is by no means uniform, being 19 per cent. of all cases in England, 24 in France, 25 in Germany, 27 in United States, and 49 per cent. in Scotland. The taint occurs equally in both sexes, but is oftener transmitted from the mother. It is frequently, as among Quakers, the result of intermarriage, to which cause Dr. Mitchell ascribes 14 per cent. of the idiotcy of the United Kingdom. We know that 2 per cent. of all marriages in England are between cousins, whereas in Spain and Italy, where such marriages are only permitted in extreme cases (by special leave from the Vatican), insanity is rare. Dr. Boyd mentions, among congenital causes in Scotland, a habit of Highland women doing field-labour in pregnancy, and shows that the Highland counties have 3,160 insane per million inhabitants, the Lowlands only 2,010, although the latter include the crowded cities, where drunkenness and death-rate are always very high.

With regard to drink, it was asserted by Lord Shaftesbury that 60 per cent of the insanity of the United Kingdom arose from it, and all the advocates of temperance have ridden this horse to death. Nevertheless, good wine is at times most useful to check insanity, as when the wretched victims of Pellagra are sent to hospital, exhausted from poorness of diet. Indeed, wherever wine is cheap and abundant, we see little of lunacy or idiotcy. No one ever yet went mad from wine, any more than from eating cabbage, although the ancients had that impression. * It is when nations discard the use of wine for stronger stimulants that insanity spreads devastation among the

Of this we have a sad proof in the case of France, where wine was the sole drink of the people for centuries without any bad results, until the introduction of absinthe in recent years, with the following lamentable consequences Gallons spirits

Insane

Ratio of insane per 100 inhab.

per million.

cases from drink. 1841-50 .

33
925

7.83
1851-60

46
1,950

9.55
1861-70

52
2,405

14.78 * Galen tells his pupils to beware of cabbage and the flesh of hares, as incentives to

ess, and Cælius says: “Insania sæpe ex vinolentia.”

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These figures are from official sources, quoted by Dr. Lunier, who adds: “ This alarming increase of insanity arises from the abuse of alcohol and from general paralysis, which I am tempted to call the disease of this century, especially in towns." He further shows that absinthe produces insanity, but that in those departments where nothing but wine is drunk, the cases are few. Parchappe confirms the above, and says, “Insanity is more prevalent in town than country, because of drink.” On the whole we find the amount of madness caused by intemperate habits varies little in countries, being 10 per cent. in Denmark, 12 in the United States, 14 in Great Britain, and 15 per cent. in France, without including the idiotcy arising from drunken parents. The latter has been ascertained by Dr. Howe to average in England 48 per cent. of the total number of idiots (who are at present over 49,000 in the United Kingdom). If we sum up the effects of " drink” in this country, as regards insanity, the account will stand thus : Ratio from drink.

Number.

Annual cost. Female Lunatics 7 p.c.

2,240

£56,000 Male do. 21

6,310

158,000
Idiots.
48
23,800

590,000

.

...

.

.

...

Insane from drink.

32,350

£804,000 It may therefore be said that nearly one-third of the insanity in the kingdom is the result of intemperance.

Business affairs, coupled with mental anxiety, are supposed to be an increasing source of brain disturbance; for it is said that telegrams have enormously enhanced the speed and friction of the wheel of life, although the city people in London appear to work by no means so hard as their countrymen in the Colonies. And if business and telegrams are so hurtful, how is it that the increase of insanity is greatest among the working-classes ? how is it that Lancashire has less madness than the ratio in Ireland ?

Loss of frierids is twice as injurious to women as men, the ratios being respectively 10 and 4 per cent. Accidents, on the other hand, claim 8 per cent. of male and only 2 per cent. of female; but the burthen of life's ills is balanced by the number of women who lose their reason from causes connected with child-bearing.

Over-study is said by Dr. Jarvis to produce 11 per cent. of the insanity in the United States; and some of the best known" alienist” writers in England and Germany find much fault with the present system of cramming. In one year we have seen nine students of a university in England commit suicide; and the Lancet observes that 40 per cent. of medical students are plucked" in standing for a degree. Even in ordinary boarding schools the number of boys that now wear glasses tells of extra brain pressure, and leads us to anticipate that the next generation of Englishmen will pay the penalty of

this " forcing" system, so contrary to the old precept of Sana mens in corpore sano.

Municipal neglect is also very much to blame, for we know that good air and water are two of the primary requirements of life, and these are denied to large numbers of our people. Of the water supplied last year to London, it was found that 68 million gallons daily were polluted with sewage, 58 millions were sometimes pure, and only 8 millions unexceptionally pure. And yet we wonder that the working-classes will not drink more water, and less beer! Moreover, the crowded dwellings of our work-people are so squalid as to cause a craving for stimulants, which ends in madness, for, as Duncan says, “ civilized poverty is the hotbed of insanity.” Even the Lunacy Commissioners have discovered that " insanity often arises from a depraved bodily condition caused by insufficient food and crowded dwellings.” The value of fresh air is shown by the case of a village in Switzerland, mentioned by Mr. Brudenell Carter, where the municipality removed a high wall, and the ratio of idiot births declined one-half.

The remedial or preventive measures may be summed up very briefly. 1st, To abolish the duty on coffee, which is the greatest foe to intemperance. 2nd, To open museums and galleries on Sunday afternoons. 3rd, To forbid marriages between cousins, under penalty of paying double the ordinary poor-rates. 4th, To imitate Mr. Peabody as far as possible in erecting suitable workmen's tenements. 5th, To recommend less "high-pressure” in our schools. If we do not adopt some such measures we shall have every year an increasing expenditure for lunatics, and a steady rise in the ratio of suicides to population.

III.- INCREASE OF SUICIDE.

Whether we regard suicide as a crime or a disease, the progress it has made in the last twenty-five years is sufficiently disturbing, although in a manner explained by the simultaneous rise of insanity all over Europe. Taking the seven principal countries in the aggregate we find that population has increased 19, suicide 63 per cent., the returns on the latter head being as follows:Yearly Average Number.

Ratio to Million Inhab. 1851-60. 1871-77.

1851-60. 1871-77. England

1,167
1,614

65

67 France.

3,821
5,440

105

156 Germany

3,819
6,478

159 Austria

1,305
3,292

96 Wealy

728
995

31

37 lgium

189
388

46
eden and Norway 381

485

76

.

129

45

71 81

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