CAUSES AND PREVENTION OF INSANITY. 107 



fact of tlie number of insane persons under care and treatment." 

 Yet a glance at his tables shows that forty-two per cent of the cases 

 admitted to the New York State hospitals for the year ending Sep- 

 tember 30, 1895, are to be noted as suffering from constitutional de- 

 generacies, and so presumably to be incurable. The more than twenty 

 per cent of cases of insanity reported to have had hereditary antece- 

 dents, although undoubtedly as accurate as possible under the circum- 

 stances, merely chronicle the more obvious matters, and must neces- 

 sarily have left out of account all the less obvious but in many respects 

 even more important ones. And so with all the other series thus far 

 published. They are good as indicating where we are to look for some 

 of the steps toward insanity, but for the most part they are quite in- 

 adequate for a basis of comprehensive discussion or anything like 

 accurate conclusion. 



The pressing need, then, is that there shall be obtained a series 

 of statistics which shall be founded upon the most definite, penetrat- 

 ing, and far-reaching studies of cases that it is possible for the trained 

 scientist, with the help of an intelligent, willing laity, to make. 

 In this respect it may be said that the assistance of the latter is 

 just as essential as the painstaking devotion of the former; for it 

 is upon the facts which an intelligent laity can observe and report 

 that the scientist can bring his training to bear in such a way as to 

 arrive eventually at accurate and therefore most useful generaliza- 

 tions. But such concurrent observation and study will never be 

 untU the public shall have come to look upon insanity as merely an 

 unfortunate disease instead of a stigmatized disgrace, which, with 

 certain exceptions, it should not be considered to be. l^or will this 

 be the case until professional examiners in lunacy shall regularly ask 

 for such family records, and thus create a need for their being made. 

 When both the public as well as the profession lay aside entirely the 

 common notions of a transcendental origin of insanity, and set to 

 work to study the perfectly natural steps through which degenera- 

 tion and breakdown eventually come to be, all will see the desirability 

 of such health records being accurately and fully kept^ not only as 

 a help toward determining the nature and prospects of any given case, 

 but also toward preventing the development of those constitutional 

 tendencies which lead to trouble, as well as in helping on those that 

 provide against it. 



When we come to study the causes of insanity with a view to 

 successfully preventing it, we are led to the supposition that the 

 nearer to very first steps we can push our investigations the greater 

 will be our service. Remembering that the well-born, well-bred 

 personality generally bears almost every sort of stress with compara- 

 tive impunity, it becomes us to ask just how does the opposite — the ill- 



