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in the North Canongate School in Edinburgh, found more than half of them had eyes so optically imperfect as to interfere with their daily tasks. Hearing was defective in 40 per cent., and nearly all had diseases of the nose or throat. Dr. David Lennox summarises his anthropometric experiences in regard to children in the town of Dundee, between 12 and 13 years of age. Their average height was 53*14 inches, against 53.72 of the general population at the same age. Many of them were insufficiently fed and clothed, they had bad teeth, and suffered from indigestion and bloodlessness. They had small chests, which indicated obstruction in the respiratory passages, or a want of fresh air and malnutrition. Dr. Lennox further states that the proportion per cent. of Dundee recruits for the regular army rejected for defective developmeut amounted to 114 against 9'06 for the whole country. Dr. Hall, of Headingly, near Leeds, has published most instructive statistics in regard to the comparative physique of Jew and Gentile children from the poorest Board School districts of Leeds. He found the Hebrew children much better developed than the Gentiles born and bred in the same slum district. (By his kindness I am permitted to show comparative pictures of these children and I am pleased to say that he is here himself.) The Jews were superior in height and weight, much less rickety, und had better teeth than the other children living in the same working-class districts. This result is due to the fact that in the case of Jewish parents greater efforts are made to nourish and nurse the children. They are fed more rationally, and watched more carefully and closely than is the case with other poor mothers. It is said by one of the medical officers that in Sheffield only one in eight of the infants is brought up at the breast, the rest are bottle-fed, with consequent ill-health, evidenced by rickets, diarrhoea, snd a high infant mortality. There is further a deplorable spreading of this practice of artificial feeding, which, if not the chief cause of the high infant mortality, leaves the survivors to continue the struggle for existence with constitutions seriously weakened and impaired. Whilst upon this point I might mention the success, not only by direct benefit to the children, but also by the educational value to the mothersof providing clean milk in regular and uniform doses. In one place (Leith) the superintendent of the milk-shop is a qualified nurse, who has strict injunctions to refuse milk for infants who

may still be fed on the breast. The greatest credit is due to Drs. Robertson, McCleary, and Hope, of Leith, Battersea, and Liverpool respectively, as also to the municipalities of these places and of St. Helens and Ashtonunder-Lyne, for directing attention and taking steps to the saving of infant life. Many mothers, even among the poorer classes, seem to have lost the recognition for the dignity and responsibilities of a mother's life. There is an increasing devotion to pleasure among married women of the lower classes, and it is a serious assertion that they look with complacency upon the conjunction of an increased marriage and a diminishing birth-rate. This self-indulgence carries with it a blunting of the sense of pity and a tendency to undiscipline of temper. That this is so is evidenced by a comparison of the birth and marriage rates for England and Wales in the fourth quarter of 1903, just published. The birth-rate was 27.3 annually per 1,000 of the population, as against the mean rate of 28.5 for the corresponding quarters in the previous ten years, showing a diminution of nearly 1 per 1,000. The marriage-rate during the third quarter of 1903-which is the last published one-was equal to an annual rate of 17.1 persons per 1,000 of the estimated population, against an average rate of 16.8 per 1,000 in the third quarters of the ten years, 1893-1902. For London during the same period the marriage-rate was 20:4, considerably higher, showing how lightly people consider and how readily they undertake matrimonial obligations. There is certainly among the poor a vast amount of ignorance in regard to the upbringing of children and the common duties of motherhood. In one district of London, during an average period of ten years there has been an annual infantile mortality during the first year of life amounting to 226 infants per 1,000 births. It is not so high in the six next large English towns as in this district of London. Of the total deaths in the last quarter of. 1903, over 25 per cent. were those of infants under one year. From information I have obtained through the Registrar-General, the rate of infant mortality under one year of age per 1,000 births was higher in 1902 than it was in 1881. This excessive infant mortality has, however, coincided with a lower general death-rate during the last quarter of 1903, than has been the average for ten preceding and corresponding quarters; but although a welcome indication of less illhealth and consequent expense, yet it must

not be assumed that a low death-rate is an indication of national improvement, for degeneration and longevity may proceed pari passu. Never in the history of the insane have more so-called senile cases of insanitysome of them due to the natural involution of old age-been brought into asylums, where they live on at the public expense, ending their days unnaturally separated from their kith and kin. I do not say they were brought unnecessarily into the asylum, on the contrary it was imperative for their own care and the safety of others. This breakdown was doubtless partially caused by the hurry, the rush and pressure of the age, the intolerance of affliction, and the growing egotism of men and women, who will not suffer their pleasures to be curtailed. This unnatural activity of the age is responsible for much overstrain, and high arterial tension, which is one of the most fertile causes of premature senility. There are forms of heart disease now which were unknown in the early years of the last century. Cardiac and brain sedatives are much more common, and nerve tonics in the shape of phosphorus, arsenic, and strychnia are more frequent prescriptions. So common is headache now that the cheap daily Press advocate headache powders in every issue, and almost every little village shop stocks them. I can point to not one but to many cases of men and women who are total wrecks and completely

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played out" at 55! and yet it seems to be a matter of surprise that more old people are decadent and require asylum care, whilst the cry goes out that our asylums, or our Poor-law, or our medical clinics want reforming. believe in money wisely spent upon scientific investigation, but I believe more in the prevention of insanity than in its cure. For the whole of the County of London during the ten years 1893-1902, there were 4,478 persons (2,476 males and 2,002 females) over 65 years of age brought into asylums, being a proportion for London of 16.2 per cent. males and 11.3 per cent. females of the total admissions of all ages, a higher proportion than that throughout England and Wales, viz., 10°47 (males 10:03, females 1079), which includes urban and rural districts. The Lunacy Commissioners, in their last report, call attention to the increase of senile cases in asylums, and state that whereas, in the quinquennium 1897-1901, the proportion per 10,000 of the population was 15.6 for males and 140 for females; ten years ago the proportion for the quinquennium 1888-1892 was 116 for males and 10.2 for females.

The revolt against domestic service among the lower classes is a serious reflection. It reflects in part upon our system of education, as it also does upon the love of pleasure which dominates every class. I have repeatedly seen young women who seek situations as nurses in the asylum, and are looked upon as the triumphs of our educational system, but who have not the faintest knowledge of domestic duties, and although professing it, not much more of piano playing. I have also under treatment as patients many from the class of factory girls who teem in East London; all of these are practically ignorant in regard to household economy. Some of this class could not lay a fire and could not do their own washing, others, it is no exaggeration to say, hardly knew one end of the needle from the other. Although they marry hurriedly-and nature, as Mr. H. G. Wells says, is a remorseless coupler, and she remorselessly destroysthey are absolutely incapable of bringing up children, or clothing them, or of cooking simple food for home consumption, preferring to fall back on the tinned enormities of local provision stores, the contents of which are, in many cases, either sophisticated with harmful preservatives such as formal, boric, or salicylic acid-the latter closely allied chemically to carbolic acid, which is a poison unless much diluted-or they are prepared under insanitary condi. tions, the proteid or albuminous food undergoing chemical decomposition, and forming ptomaines which resemble the poisonous vegetable alkaloids, thus becoming unfit for human consumption. The offspring of such mothers I have myself seen. They are attenuated, neurotic, and sickly, and they contribute to the ranks of the maimed, the deformed, and the degenerate. I venture to assert that the cause of the children is a national asset which we can ill afford to neglect, for the success of a nation depends upon the physical and mental health and strength of its citizens into whom the children grow. Dr. Farquharson has painted sad pictures of them sitting-under the direction of the Educational Department-crowded on forms for weary hours, ill-clad and ill-fed. Surely a child is born to the State as well as to the home, and every child has a natural right to be fed. Children cannot themselves call attention to their sufferings. The responsi、 bility of their care rests, in the first instance, with the parent or natural guardian, and it is the duty of the State to see that this obligation is discharged or enforced when the natural

parent has failed, or neglected his duties in this respect. This doctrine has received the sanction of long usage, and forms the basis of our existing Poor-law system.

In regard to our system of education, one is inclined to question at times whether it has come up to our expectations, and fulfilled its functions. Although we have a body of teachers with enlightened views of their profession who are fully alive to the responsibilities of their great calling and to whom all of us are greatly indebted, yet I fear the answer is not as satisfactory as might be wished. Children are treated too much together-too mnch en bloc, and the weakest must suffer. The old idea of education was putting something into the child. Matthew Arnold said that "education should teach people to do the right thing in the right way and at the right time." We have now learnt that education should be so directed as to develop the full man, and that it should draw something out of the natural capacity of the child, so as to improve his condition in life, subordinating his life to the intellectual and moral well being of the many, and we have further learnt that education is of small service unless it is directed with this end in view to a healthy race. The new Education Bill correctly aims that each local authority should determine what should be taught in each district, and that children should be fitted to come to a commonsense conclusion upon a practical question. It has been stated that people do not now think for themselves and that men have not sufficient capacity to be able to concentrate their thoughts upon any difficult mental task for any considerable time, and that work never took it out of people as it does to-day. The Poet Laureate the other day stated his conviction that we were less intellectual and less spiritual than our ancestors, that material prosperity was the cosmopolitan creed and religion of the time, and that wealth was the very divinity of the age. Ours is certainly less a thinking than a reading age, and boys are often taught to read only to use their acquisition to get the sporting tips. Fifty years ago there was much less reading than to-day, but but no one can say there was less intelligence. Our ancestors certainly read less than we do, but their reading was of a more solid and enduring character than is ours. The scarcity of books and the comparative rarity of journals induced readers to master what they read, with the result that they absorbed nourishing intellectual food. A superficial attention

to an ill-digested course of reading, dulls and benumbs the intellect. Some of the journals of to-day have to be helped off by prizes, lotteries, treasure hunting, and all manner of tricks and dodges which appeal only to the weak and the degenerate. I have had not one, but several youths, whose insanity was distinctly traceable to the injurious tone of the literature they indulged in. It is also stated by those qualified to give an opinion, that the steeping of our youth in the prurient, exciting, and unreal literature of to-day has been the principal cause of neglected household duties, unhappy homes, and a large percentage of crime, as is often testified in the summing up of our various stipendiaries. I am of opinion that instruction in cooking, domestic economy, and household duties, should be the primary consideration of the educational authorities as regards girls, and that some standard of efficiency should be required in the place of the shop window elegancies," as I have elsewhere ventured to call them, of piano playing and drawing. The ornamental attainments should come after, and not precede the essentials. The description of the domestic economy department of the Battersea Polytechnic, opened on February 24th, by the Prince and Princess of Wales, in which is provided a laundry demonstration room, housewifery, kitchen, scullery, larder, and bedroom, needlework and dressmaking rooms, shows how this question has now come to command attention.

I consider domestic service to be the only real training which can enable girls to become good wives and mothers, and its unpopularity is indirectly responsible for the high infant mortality already referred to, as also for the impairment of physique and the perversion of natural development which I have portrayed, and which is, without doubt, affecting a stratum of the present generation by the improper rearing of children. This scepticism as to education is not limited to that received by the lower classes, it has invaded that given in our public schools as well as our Universities, "the home of lost causes and impossible beliefs." This doubt of the efficiency of our system proceeds from two opposite standpoints, the one from the mental, in regard to the over-pressure of a weakened physique, the other from the engrossing devotion to sport without serious attention to intellectual pursuits, and it is in the main, in my opinion, a sign of life and of reawakened interest in the two necessary

aspects of mind and matter, a relationship which is insisted upon as the basis of this paper.

As further evidence of degeneration may be considered the great and serious question of insanity. In the whole range of medical science there is no more painfully interesting subject.

It is the debatable land of the imagination which presents many subordidate varieties of its wanderings-the dream of the poet, the fable of the mythologist, and the fiction of the romancer being woven with its threads.

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Insanity, in the excursions of mania, with its fancied consciousness of unlimited power, its self-satisfaction - that abundant source of mental delight-bestows upon its victim feelings of bliss much more exalted than fall to the lot of sober reason; but insanity in the self-condemnation and the misery of melancholia inflicts far severer pangs than can be produced by the most extraordinary anxiety and the most acute bodily pain. What is it that constitutes insanity? is not the presence alone of delusions or hallucinations. There are many persons in daily life who fulfil all their duties and obligations to society and themselves, and who yet suffer from hallucinations. Although a perversion of the mental functions, insanity is not exclusively an intellectual disorder, for persons gifted with high intelligence may fail to respond to ordinary motives and become so defective in their habits as to be socially unfit to mix in the world. Again, the distribution of the mental faculties may be so uneven, and mental endowment may be so unbalanced, that their possessors are unfit to be at large. There are many persons incarcerated in asylums in whom there are merely exaggerations of normal tendencies, fluctuations of the mental faculties which may be described as excessive, or just beyond the normal limits, and which render these persons unstable, untrustworthy, and even dangerous, yet there is hardly, if any, loss of mind. It is only too well known that there are imperceptible gradations, as well as abrupt transitions between health-which is the easy, harmonious and unconscious performance of the organic functions-and disease, and there is no definite line of demarcation between sanity and insanity.

So far as any trustworthy information is to be had, it appears that insanity increases as man departs from the savage and semicivilised state and approaches the highest

civilisation. In primitive states of society and among uncivilised races insanity is rare, the chief form being associated with the taking of drugs, corresponding to the insanities of civilisation, such as those resulting from alcohol, ether, cocaine, and morphia, which in the main are temporarily curable, provided the cause is removed. Among primitive people insanity which ends in dementia is rare, and dementia itself is uncommon, in fact, it is only when we come to the higher civilisation that the more serious and higher forms of insanity are met with. As to the causation of insanity it is certain that alcohol is one of the most potent causes. Taken to lull and to veil the little worries, the small pains, and the general mental disturbance of whole classes, it is given in the last annual report of the Lunacy Commissioners to the Lord Chancellor as the suggested cause of a fifth of all insanity occurring in men, and more than half this proportion in women. If taken as a contributory cause or in combination with others, the percentage would undoubtedly be much higher, and such a cause calls loudly for definite action. I believe that at the present time no less than 11,000 males and 6,000 females are mentally decrepit through the effects of alcohol.*

During the time that the London County Council asylum at Claybury has been opened, 1893 to 1904, a period of which I have direct experience as medical officer, 9,544 patients (4,251 males and 5,293 females) have been admitted, of whom 965 males and 699 females -a proportion of 22.7 per cent. of the males, and 13.1 per cent. of the females-were definitely ascertained to owe their insanity to drink. This means compulsory detention and support through their own acts at the ratepayers' expense. Through a loss of inhibition, alcohol contributes indirectly to other sensuous excesses, all deleterious to nerve centres; one in particular, viz., the contagion which is the cause of general paralysis of the insane, a disease which is incurable and yet preventible —a form of insanity to which, above all others, our service men, soldiers and sailors, are most prone. Many of the patients admitted through drink were married, and had families dependent upon them, and the misery and cruelty of neglect-apart from any ante-natal causes (such as the transmitted reduction of vitality

During the last ten years 1893-1902, inclusive, 35.916 persons (16,350 males and 19,56› females) have been admitted into all the London County asylums. In the cases of 5,727 of these persons (3,497 males and 2,230 females) insanity was assigned to drink as a cause; a proportion of 21 per cent. among the men and 11 per cent. among the women.

due to alcohol) in the parents induces a feebleness in the offspring, which it is impossible correctly to estimate. Carefully compiled statistics give 56 per cent. of the children of drunken mothers as dying before the age of two years, against 26 per cent. (a very high mortality) among the general population. Drink involves an enormous loss to the community, through destroying the productiveness of the skilled craftsman. Many of the men brought into the asylum are of this class, and are at their best age, viz., thirty-five to forty, and, curious to relate, during 1903 no less than 30 per cent. of the men, and 56 per cent. of the women (where this could be ascertained) were country born, showing that their town environment to say the least-was not favourable to their self-restraint, and that it is not alone the degenerate who falls a victim to drink. Although alcohol itself is a certain cause of deterioration. I admit that there are many factors, such as competition, insecurity of trade, insanitary surroundings, poverty, and, in some cases, want and starvation, which may have induced alcoholism. Of this, in my mind, there is no possible doubt. Cases of alcoholic insanity are also more liable to phthisis than other varieties, possibly owing to their susceptibility to the inimical effects of cold and exposure. The statistics of life insurance offices are an interesting study, and serve to point a strong moral in regard to degeneration from this cause.

It is not too much to say that there are other forms of injurious beverages besides alcohol. The evidence of Miss Ellis with regard to tea - drinking among Welsh quarrymen, published in a report of the Departmental Committee (1895) upon Merionethshire State Mines, is supported by the medical men practising in the district. Both tea and coffee drinking can be carried to excess, and instruction as to healthy living should be imparted to all children. In the first place, however, the teachers themselves should be acquainted with elementary hygiene. In the wake of drink comes tobacco-smoking, upon which medical opinion is unanimous that, for the young and those of unformed physique, it is inadmissible and pernicious. Personally, I have known it stated by the relatives and friends of some of the inmates in the asylum, to have been the exciting cause of the patient's mental breakdown, but I am unable to state that any definite form of insanity is directly caused by it in this country. I am certain, however,

from experience, that the inhalation of cigarette smoke directly induces functional palpitation, dyspepsia, and an inaptitude for physical and mental energy. It probably creates thirst and may thus favour drinking habits. It is interesting to note that 44 of the 53 United States of America have penalised juvenile tobacco smoking, prohibiting its use under ages varying from 14 to 21 years, or an average age of 17 years, which is higher than that suggested (viz., 16 years of age) by some of the so-called anti-tobacco societies in our own country. ·

In every case of insanity there has been a breaking-point at which stress of some kind has acted as a proximate and enciting cause upon an organism predisposed to break down. This great predisposition is determined in the main by a faulty heredity and an unsuitable environment. In the present day, more than in any previous period, does an inherited instability of organisation make itself evident by a breakdown at one of the physiological crises of life, and a hereditary tendency to insanity is ascertained to occur in more than one-third of all cases brought into asylums. These figures are derived from the collective investigations of medical officers in all the public and private asylums of this country. In regard to the relative influence of heredity and environment, Karl Pearson states from careful and elaborate researches that physical and psychical character are equally inherited, both in the same manner and with the same intensity. He asserts that children inherit in this way their parents' consciousness, shyness, and ability, even as they inherit their stature, form, and span. Those who have had large experience with the insane, and who are in the habit of seeing their relatives, know how true this is, and not only do animals but plants also tend to resemble their progenitors, for when the protoplasm grows under similar conditions, the tendency is to a symmetrical repetition of equivalent parts, and the more similar the conditions the more does the resemblance tend to become complete. There is overwhelming evidence that the environment modifies growth, as we know to be the case in the production of variations, which shows that there must be some latent power in the cell itself, and, in my opinion, this modified growth may be transmitted. There is no proof that each cell in the germplasm is predestined unalterably for a particular rôle on a predetermined plan. The accumulated evidence of clinical experience is against this, and I believe

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