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lighten the people on the subject of insanity, its predisposing causes, its hereditary tendencies, its relations to intemperance, poverty, and crime; and therefore they do not improve the community in this respect, except in removing from its care some of its greatest burdens."

Says another expert, who was long superintendent of one of the largest hospitals in New England, in his report, The more we see of mental disease in its various forms, the more we are convinced that the study of its prevention is infinitely more important than even the study of its cure, and that the dissemination of more correct views of the true way of living and a more rigid observance of the laws of health and nature would greatly diminish its frequency."

What is the testimony of still higher authority on the subject? The Commissioners in Lunacy for Scotland, in a late report, state that, "It is impossible to come to any other opinion than that insanity is, to a large extent, a preventable malady; and it appears to us that it is in the direction of preventing its occurrence, and not through the creation of institutions for its treatment, that any sensible diminution can be effected in its amount. Lunacy is always attended with some bodily defect or disorder, of which it may be regarded as one of the expressions, or symptoms. We must therefore attempt to prevent its occurrence in the same way as we attempt to prevent the occurrence of what are called ordinary bodily diseases; and if it be admitted that to a large extent preventable diseases exist among us in consequence of the ignorance of the people, it is clear that we can only convert the preventable into the prevented by the removal of that ignorance through a sounder education. In short, we can only hope that preventable diseases will be diminished in amount when the education of men is so conducted as to render them both intelligent and dutiful guardians of their own physical, intellectual, and moral health. To this, and not to any machinery, however good it may be for the treatment and cure of insanity, can we reasonably look for a diminution in its amount."

Let us cite another witness on this point, who may be considered as high authority as can be found. Last year a select committee was appointed by Parliament to inquire into the operations of the "Lunacy Law." In the testimony given before this committee by Sir James Coxe, is this statement: "That prevention is better than cure,' is a saying familiar to every one; but it does not seem

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to have been sufficiently considered that it would be possible to take measures to stop the occurrence of insanity. The fact is that we have allowed a terrible evil to grow up among us, and that we have been content to lop the branches, leaving the growth as luxuriant as ever, instead of directing our efforts to destroy it at the roots."

Sir James Coxe, in speaking of the results of hospital treatment in the cure of insanity, says "only about forty per cent of the admissions prove recoveries." "The fact is indisputable, that, as the case actually stands, asylums are places of curative treatment for only ten per cent of their inmates, and mere places of detention or safe custody for the remaining ninety per cent." The statement here made respecting the asylums in Great Britain will apply, we fear, with equal force to the insane in this country. It is a sad thought, that ninety per cent of all the inmates of these institutions are incurable, and hence the rapid increase of chronic insanity. What a powerful argument does this fact present in favor of using all possible means for the prevention of the malady!

Within a few years more careful investigations have been made than ever before, respecting the cure of insanity. As a result of these inquiries, much surprise has been expressed at the large proportion considered incurable. After the disease has continued a year or so without improvement, the case is regarded as chronic, and the chance of recovery as small. Inasmuch as many new cases have no proper treatment, and others receive no permanent benefit from treatment, large numbers are constantly passing into the chronic state. Nearly all the insane now found in private families and almshouses are composed of this class, and who are by far, the largest proportion in the lunatic hospitals. As society grows older, the greater is the proportion of the chronic insane. Thus in New England this class would be larger than in the Western States.

So rapidly and extensively have the insane increased, that their support has become very burdensome. Individuals and families have expended money liberally, year after year, upon some friend, looking in vain for improvement. States, cities, and towns have been called upon to increase from time to time their appropriations for this class. So oppressive has this burden become in some quarters, that the question is now often raised, "What can we do with the chronic insane?" How much wiser and more pertinent the question, "What can be done to prevent insanity?"

Wherever in society any abuses or evils exist, in order to check or eradicate them we must understand distinctly what they are and what are their primary causes; and not the mere results or effects of an evil, but its chief sources, or constituent elements, must be clearly apprehended. Thus, in regard to insanity, its results or fruits, in certain aspects, have been pretty well understood; but much less its causes. What, then, is insanity? and can it, to any extent, be prevented? All admit that it is a disease, and, like all other diseases, a violation of some law, - it may be physical, mental, or moral. Says one of the highest authorities. on the subject, "Insanity is a disease of ignorance, -ignorance of the human organism and the laws which regulate it; and the only way to check its growth is by a general diffusion of a knowledge of these laws, and the use of all those means necessary for the preservation of good health. Insanity originates in some form of disease, in a deterioration of the body rather than in an exclusive affection of the nervous system. The six leading factors are, dissipation in various forms, overwork, meagre fare, lack of ventilation, and neglect of moral culture." In these few words we have much truth expressed.

For the prevention of insanity, then, the same course must be pursued as with reference to other diseases. Ascertain its causes, diffuse information on the subject. This may be accomplished in a variety of ways, - by enlisting the press, through journals and books, by family and educational training, by legislation and associated action. For illustration: if intemperance is one of the leading causes of insanity, it is high time the fact should be generally known, and the warning brought home to all. If ill health is adjudged a more fruitful source of the malady, let us understand that. If hereditary influences, in all their diversified forms, constitute another fruitful source, let us understand better the laws that regulate these influences; or, if fast living or high pressure in our educational systems are steadily swelling the ranks of the insane, the sooner these truths are brought home to the public mind, the better.

Some may say that the causes of insanity are involved in so much obscurity and mystery that they cannot be found out. Fifty years ago this remark might have been made respecting a great many diseases which are now correctly understood. Let the same means be as carefully and thoroughly employed here as upon other diseases, and the causes and treatment of insanity will be far better known.

It has been remarked that within a few years there have been great advances made in a better understanding of the laws of life and health; special pains have been taken to diffuse in the community a knowledge of physiology as connected with sanitary and hygienic agencies. To such an extent has this knowledge been diffused, that the inquiry is beginning to be raised on all sides, not merely how to cure, but how to prevent, disease. In many States boards of health have been formed, and legislation has commenced in earnest in devising plans and providing on a large scale the means for the prevention of disease.

But how is it with insanity? What progress has there been made towards its prevention? How much do people at large understand about its causes? How can the increase of this disease be stayed, unless proper means are employed to make people acquainted with its causes? The medical profession itself should give this subject far more consideration, and be better prepared, not only to treat the disease, but to counsel the public wisely in respect to it.

There has been a large accumulation of facts expressed in tables and figures, in hospital reports and books, which, if brought together and analyzed, would throw much light on the subject. But there has been no demand on the part of the public for such services, and no inducements offered by legislatures or trustees of institutions. Any amount of money can be expended in building and managing lunatic hospitals, but nothing comparatively to prevent insanity. If one-tenth of the means now so lavishly bestowed upon this unfortunate class in large institutions were expended in different ways, to prevent insanity, -in cutting off the supplies, what a vast difference it would make, in diminishing the number of the insane and reducing the amount of suffering! How long will it take the public, and legislative bodies particularly, to learn the truth of the proverb, "An ounce of prevention is worth a pound of cure"? If, by a general diffusion of a knowledge of hygiene and the application of sanitary laws, one-third or more of the sickness and premature mortality can be prevented, certainly one-third of the existing insanity should be prevented by similar means, especially as preventing diseases and improving the general health will aid essentially in checking the first approaches of insanity.

It should be the settled policy of all legislative bodies and the executive officers of every State, to carry on some systematic

measures for the prevention of insanity; and unless such provision is made by legislative action, the work, we fear, will never be done. The number of the insane and of lunatic hospitals, together with the burdens of their expense, will increase more and more. Let prevention receive some attention, as well as cure. The claims of humanity and public economy demand it. So does a higher state of civilization. It is not wise to build great institutions, and make large appropriations for carrying them on, without doing something to remove the causes which necessitate such measures.

The Conference then proceeded, without debate, to Dr. Luther's Report, which was read by Mr. Milligan of Pennsylvania. At its close the whole subject was debated at some length. Dr. Luther's report is as follows;

THE EXTENT TO WHICH THE STATE SHOULD ASSUME THE CARE OF THE INDIGENT INSANE.

BY DILLER LUTHER, M.D., READING, PENN.

That the State bounty should be granted for the benefit of the insane poor, is universally admitted. Destitute and friendless, irresponsible, and incapable of self-care, the safety of society and the claims of humanity alike demand that they should be made the wards of the State, and as such should receive from it care and guardianship. This proposition, like all others of a general character, has been accepted from the beginning; and, without being questioned, has been acted on with little or no inquiry into the question whether the State benevolence should be applied to the whole unfortunate class, or be confined within certain carefully defined limits.

The subject claims attention, and opens a door for important inquiry. For, whilst the Christian philanthropist will be satisfied with nothing short of the amplest provision for every want and necessity, overburdened tax-payers, on the other hand, though not unwilling to see State aid appropriated in sufficient extent to prevent actual suffering, earnestly desire to know whether some limit, as to cost and the number to be provided for, may not be justifiable. A solution to this problem is anxiously looked for, and must be made, to satisfy the spirit of inquiry which has been awakened. This necessarily leads to a consideration of several important questions, about which differences of opinion exist, and which I propose briefly to present to the Conference.