248 PSYCHIATRY 



reckoned with by economists; and the side which cannot be repre- 

 sented by figures is still more important, viz., the sorrow and suffer- 

 ing and indirect loss in health and happiness. 



If there were a science of state medicine, the economic study of 

 insanity which brings out some such figures as those I have just 

 presented would be called into demand. 



State medicine in some of its branches is supposed to give us means 

 of relief from social evils due to disease. In the case of insanity it 

 would have to call upon various minor divisions of science for help. 

 The study, for example, of the causes of insanity, teaches us that if 

 we could subtract alcoholism from our social life, and nothing took 

 its place, we should cut out about a tenth of the cases of insanity 

 brought on directly by this poison. We should probably subtract 

 a large number, brought on directly through alcoholic parents. If 

 we could subtract syphilis from our civilization, we could cut out a 

 tenth more of the insane. If we could do away with violent passions, 

 shocks, mental strains of various kinds, we could cut out perhaps 

 25 % more of the insane. 



But after all, supposing even these practically impossible feats 

 could be accomplished, there would still be left a large percentage 

 of the alienated, and this percentage would include persons who 

 developed disordered minds because they were born with a tendency 

 to mental degeneration. 



It follows that the most immeasurably important factor in attempt- 

 ing to limit and prevent insanity is to secure well-born children ; to 

 see that those people who have weakly constitutions, or poisoned 

 constitutions, do not propagate the kind. This is, of course, a thing 

 which can only be accomplished by long years of careful education 

 and training. The science of eugenics is hardly yet existent, and if it 

 were a full-fledged science, the people are not educated to receive its 

 teachings. There are, however, known to be certain fundamental 

 principles of "eugenics" which cannot be too strongly insisted upon. 

 One of these is that persons who have strongly alcoholic tendencies, 

 or who are dipsomaniacs or drug-takers, are almost sure of breeding 

 degenerate children. And the same is true of those who are plainly 

 syphilitic, or who are on both sides tuberculous, or on both sides 

 psychopathic or neuropathic. One further point only I wish to make 

 in connection with this subject, and that is the question of the results 

 of the amalgamation of races in this country. While the ratio of 

 insanity in the United States is fully up to that of other civilized 

 nations, it is not especially in excess, hence it cannot be said that the 

 fusing of different races here has yet caused deterioration. Never- 

 theless, it is a practical and serious question as to what will be the 

 eventual result. We know that when widely different races, like the 

 African and Aryan, mix, they do not breed good men and women. 



