In England and Wales, according to the Commissioners on Lunacy, intemperance is found, taking a yearly average for the past five years, to be responsible for 22.1 per cent. of the admissions to insane hospitals. Dr. Clouston, of the Edinburgh Royal Asylum, arrives at 25.7 per cent. as the proportion of cases who are admitted in part or wholly because of intemperance.

What makes statistics of drink as a cause of insanity of so uncertain a value is the impossibility in many cases of distinguishing between that intemperance which is merely the obvious sign, and the only one, of incipient mental disorder and that intemperance which is a direct cause. It is perfectly easy and natural in the case of a deranged individual known to be markedly intemperate to assume intemperance as the probable cause, especially as in very numerous instances the authorities cannot obtain a clear and detailed history of the individual and of his family. Until recently too little attention has been given to the fact that insane inebriates have become such, not primarily as the result of drink, but from congenital defects. The most instructive observations on this point have been made by Dr. Branthwaite, the Inspector of Inebriates' Homes in England. He has shown, as intimated elsewhere, that about 62 per cent. of the cases committed to reformatories for inebriates are mentally defective. He has found, furthermore, that a large proportion of those who are simply committed as inebriates were really suffering from various forms of insanity. This led him to the conclusion that "the large majority of inmates of this description were either actually insane during their court history or in a state bordering on insanity, and that mental disease was the condition for which they were habitually imprisoned; mental disease masked by alcoholic indulgence. Sentenced to reformatories as habitual drunkards, they were found to be, when admitted, actual lunatics or bordering on insanity." The exact relationship between drunkenness and insanity in such cases is, of course, exceedingly difficult to determine. It is precisely the same difficulty of diagnosis that the majority of our asylums for insane have had to contend with, especially as in this country there are practically no institutions, outside hospitals for the insane, to which alcoholic persons showing mental disorder can be sent.

Dr. Branthwaite alludes to the fact that mental disease in some cases may be due to tissue degeneration produced by persistent alcoholism, to repeated alcoholic epileptiform convulsions

and recurrent attacks of delirium tremens, or to a shock to the nervous system from the sudden discontinuance of alcohol. Yet he continues, "notwithstanding this, I am satisfied that the majority of our insane inebriates have become alcoholics because of congenital defect or tendency to insanity, not insane as a result of alcoholism, and that the drunkenness which preceded 'alcoholic insanity' was merely the herald-the one obvious sign-of incipient mental disorder. In relation to the final insanity, drunkenness in such cases is the intensifier, perhaps, and not the cause of the disease.”

To state the case briefly, current statistics purporting to show the causal relation between intemperance and insanity are of uncertain value because drunkenness is very frequently a symptom, not a cause of weakness or disorder of the mind. This fact is seldom given due weight. At this point some will reason back and say that where mental weakness exists it was in all probability the result of parental drunkenness, and that there is no reason for minimizing the liquor habit as a contributory cause of insanity.

Unfortunately for this argument, there is no reliable information showing that the children of drunkards are prone to become mentally defective. An inherited characteristic must be the same in kind as that from which it springs. Mr. Burbank gets interesting varieties from his experiment with sweet peas, but never got a poppy from a pea. In a recent paper on the problem of the feebleminded read before the Manchester Statistical Society, Miss Mary Dendy states, "As a matter of fact the children of drunkards are not more prone to become mentally weak than the children of sane people." In one hundred cases she finds that 56 of the parents of feeble-minded children were definitely sober; in 13 they were, definitely, one or both, drunkards; in 29 there was no definite. history either way, but it is probable that of these 29 some were drunkards. Thus a majority of the parents were sober."

It is much more in line with reason and observation to believe that the many mentally weak who turn up in our asylums as insane drunkards spring from stock long tainted with insanity, and that their mental disorder was intensified by drink rather than caused by it. It is almost obvious that it should be so. As Archdall Reid, the English expert, says: "Until very recently in the vast majority of cases the unfortunate lunatic was placed under conditions that insured death or permanent insanity. From the very moment that his mental unsoundness declared himself, he ceased

to have offspring. The natural selection of the sane was therefore very stringent. For some time, however, lunatics have been treated with great humanity and skill. Beyond all classes of the community they are watched over by the State. Men of sound mind, but suffering from bodily ills, may perish in the slums for lack of proper care and nourishment; but the insane are removed to special sanitaria where, without expense to themselves, they receive food and lodging and are placed under the care of trained nurses and medical specialists, over whom in turn the Commissioners in Lunacy exercise a zealous supervision. As a consequence the lunatic frequently recovers, and is restored to his family with a right to have as many children as he pleases.

This statement about English conditions is just as applicable to those of our own country. In the course of a single year more than 20,000 men and women are discharged from the hospitals for the insane in this country, of whom, self-evidently, a great many subsequently become fathers and mothers. What has been said about the insane applies with even greater force to the feebleminded. Of the actually known feeble-minded in the United States only a small proportion is under temporary or permanent restraint. The rest go on multiplying. Their offspring is peculiarly prone to mental derangements as a consequence of even moderate alcoholic indulgence and later on figure in a greater or less degree in the returns from hospitals as having become insane solely on account of drink.

All that has been said above should not be construed as an effort to minimize the evil effects of intemperance, which are obvious enough. So long, however, as attempt is made to trace all our social ills as a result of the use of intoxicating liquors, it becomes extremely difficult to deal rationally and effectively with social problems like insanity and feeble-mindedness. There can be no greater mistake, for instance, than to attribute a majority of the insane and feeble-minded cases in the country to the liquor habit. People are never cured of a trouble by being treated for one they have not.

There appears to be no escape from the melancholy conclusion that "the rate of increase is greater for the insane in the United States than it is for the general population." (United States Census report on the insane, 1906.) While the hospital returns upon which the official statistics are based do not disclose all the facts,

"they invariably point to an increase in the prevalence of insanity." (Ibid.)

No one has ventured an adequate explanation of this phenomenon, if indeed one can be made. But to accept the view that most insanity is due in some way to intemperance would, in the face of this growth of mental disorders, be equivalent to declaring, that the liquor habit is continually assuming greater proportions; that temperance teaching and preaching has proved futile; that repressive or prohibitive legislation is inoperative; that the per capita production and consumption of intoxicants increases rapidly, etc., etc.

The facts as seen by open-minded students appear to be much more that as a nation we are growing more abstemious, and that the drink habits of the old days are disappearing. Many factors have contributed to this. The temperance advocates have done their share. Industrial and economic conditions have imposed abstinence as a condition of employment. Legislation has brought the liquor traffic under better control; and if it has failed utterly to prohibit, it has at least diminished consumption to some extent, particularly in rural districts. Yet "the rate of increase is greater for the insane in the United States than it is for the general population."

Available statistics of the insane do not permit accurate comparisons between States. The ratio of insane, as disclosed by hospital returns, indicates the extent to which the mentally sick are cared for in institutions rather than their numerical strength in a State. This is made apparent by the most casual study of the figures given in the next table. The most ingenious search would fail to discover any relation between the ratios of insane in the different States and the prevalence of the liquor habit.

Incidentally, however, the fact stands out that insanity has not diminished in States where the liquor habit is supposed to have been driven to the wall. In Maine, for instance, the insane hospital population goes on increasing with the same relative rapidity as elsewhere. In 1903 it had 125.3 insane in hospitals per 100,000 population. This ratio is lower than for many States, but merely shows the extent to which the insane are cared for in special institutions. The Census report says that in 1890 Maine was one of four States in which "the number of insane enumerated outside of hospitals exceeded the number found in these institutions;"

and "in none of these States has the accumulation of insane in hospitals since 1890 been so large that the number still outside of hospitals can be presumed to have been greatly diminished, much less exhausted." In other words, if Maine cared for her insane in hospitals to the same extent as some other States, her ratio of insane would proportionately be the same.

Kansas and North Dakota also yield ratios of insane per 100,000 population which do not reveal the slightest benefit in this respect from the prohibition of liquor. Exhaustive comparisons are superfluous.

In conclusion: The precise extent of the causal relation between insanity and intemperance is still to be discovered. Meanwhile it is as absurd to say that most insanity is due to drink as it would be to say that insanity is never caused by drink.