Geographical Distribution of Insanity 365 



the semi-tropical regions, which are 

 relatively free from the sudden changes 

 of weather so common in the northeast- 

 ern and northern central regions, is com- 

 paratively low. If we turn to the 

 seasonal influences the same criticism 

 applies, though the changes take a some- 

 what longer time. As regards climate 

 and seasons, Berkley,* an eminent 

 American authority, says : ' ' These are 

 factors of very minor importance in the 

 evolution of insanity. The harmful 

 effects of heat in the south are more 

 than counterbalanced by the more prev- 

 alent abuse of alcohol in colder regions. 

 In a general insane asylum, where the 

 middle and lower classes of the popula- 

 tion are received, a study of the records 

 will show that a larger number of admis- 

 sions in one year may occur during the 

 winter, whereas in other years the same 

 holds good for the spring, summer, or 

 autumn. Hence one is obliged to con- 

 clude that the seasons have little to do 

 with the evolution of insanity." 



In the last analysis, however, the 

 effects of all these agents which col- 

 lectively I have spoken of as consti- 

 tuting man's physical environment 

 upon his mind must be only secondary, 

 mediate and not immediate. If we 

 will study the effects of any one of 

 them — for example, temperature, hu- 

 midity, altitude — we will find them ex- 

 pressed in terms of respiration, pulse 

 rate, evaporation from the cutaneous 

 surface, blood pressure, &c. — effects 

 which I grant you are potent, but 

 which, nevertheless, are not primarily 

 mental. 



This whole matter reminds me very 

 forcibly of the learned judge who could 

 not understand why the expert called 

 upon to testify as to the mental condi- 

 tion of the defendant should have meas- 

 ured his feet. The medical profession 

 have been largely responsible for this 



* Henry J. Berkley. Insanity: General Eti- 

 ology. Reference Handbook of the Medical 

 Sciences, Vol. V. 



conception, especially our misguided 

 friend, the gynecologist. This gentle- 

 man has insisted that all forms what- 

 soever of mental disease affecting the 

 female were traceable to an affection 

 of the uterus or its appendages, and has 

 devised all manner of operations to re- 

 lieve such conditions. True, the insane 

 female who may have a local pelvic con- 

 dition which is amenable to surgical in- 

 terference is just as much entitled to 

 the relief that can be obtained from that 

 source as her more fortunate sister, and 

 it is quite conceivable that the relief 

 of a local condition which was painful 

 or debilitating by reason of frequent 

 hemorrhages, or other cause, would 

 place the organism in a better condition 

 to rally from any abnormal state. But 

 the sort of stuff that mind is made of is 

 not to be found in the abdominal cavity. 



This brings us again to the basis of 

 our argument. If we are to seek for 

 an adequate cause to explain the con- 

 ditions to which I have directed your 

 attention, we must seek for a mental 

 cause, not a physical one. 



If we look back over organic nature 

 we shall see that in the progress of evo- 

 lution the nervous system has come to 

 play a progressively more and more im- 

 portant part until we get to the higher 

 animals — the vertebrates — in which the 

 brain comes to be of paramount im- 

 portance. 



Still, in the lower races of men, al- 

 though the brain is of such great im- 

 portance in the struggle for existence, 

 that struggle is, after all, in the main 

 and relatively a physical struggle ; it 

 consists largel}' of collecting food which 

 is often ready at hand in the tropics, of 

 pursuing and killing game, and often 

 of personal encounters with his fellow- 

 man, as a result of which the conquered 

 is killed or reduced to slavery. When 

 we get to civilized man, however, the 

 picture is different. Here the struggle 

 for existence has become an essentially 

 mental struggle, and success is a func- 



