H.—7

3

in Table Xlii the principal cause is stated as assigned on admission. Omitting cases in which no cause was assigned and grouping others, the percentage proportion of the principal causes operating in the admissions of the year under review was as follows : — Male. Female. Total. Heredity .. .. .. .. .. 8-56 8-13 8-38 Congenital mental deficiency .. .. .. 18-29 12-95 16-02 Predisposed by previous attack. . .. .. 6-86 17-1.6 11-14 Critical physiological periods .. .. .. 4-49 J -14 7-1.3 Senility .. .. .. .. .. 13-79 10-24 12-26 Mental stress (prolonged) .. .. .. 10-79 11-74 11-14 Alcohol .. .. .. .. .. 11-03 4-20 8-38 Syphilis .. .. .. .. .. 10-06 0-31 6-00 Epilepsy .. .. .. .. .. 5-21 3-31 4-38 influenza .. .. .. .. .. 2-99 2-70 2-87 Other causes .. .. .. .. .. 7-92 \ 18-04 12-14 When one recognizes that the healthy, stable brain, Uie organ of mind, will withstand the assault of massed stresses, it is obvious that the factor of heredity is understated; and also the fact is not sufficiently brought out that numbers of those contributing to this table, have had their resistance reduced by impaired general health, or bj some stress often not recognized as such, acting from within the organism, or without, over long periods, and itself impairing the mental and emotional faculties, or imperilling them when the system has to submit to some intercurrent toxic or other stress, regarded as the exciting cause of the mental disorder. Other predisposing influences are necessarily more serious where there is a family history of insanity or the higher neuroses, and experience bears out Mercier's dictum that heredity and stress are in inverse ratio. We cannot insure ourselves or carry a charm against the onset of mental disorder, but for those with a bad heredity to sit with folded arms awaiting the stroke of doom argues an extraordinary pusillanimity, or an ignorance—a guilty ignorance—of the value of a proper environment. The lawmakers of Erewhon were not altogether absurd when they classed illness as crime. Perhaps never before was there so general a mental stress, operating insidiously and predisposing to mental, moral, and nervous disorder, as there is at. present; and. as there arc so many persons blind to their own needs, there was never a greater need for directing and safeguarding the health of the community, it would not be out of place to illustrate the nature of the present spirit of restlessness. Any one reading this will have passed through two critical periods at least—puberty and adolescence— associated with the special development and the. maturing for function of organs, from which each impulse of thb process is transmitted to the brain. Every other organ is likewise forwarding messages, but these, having become familiarized by repetition, cease to disturb the consciousness. It is otherwise with new or unaccustomed messages —received as indefinable, obscure, and voluminous sensations—which are profoundly unsettling till in due course they themselves become familiar and provide an. important contribution to an ego now stable and modified by the. experience. The differences in. deportment during the transition are matters of common knowledge, and it needs no high degree of observation and understanding to appreciate the accompanying intellectual, moral, and emotional instability. It is by virtue of this recognition that the torrent with its destructive tendency is directed by the wise, into channels of safety; but, unfortunately, there are many who are not wise or wisely instructed. While this state of mind is expressing itself in vanities, departures in thought, feelings, and conduit from the hitherto normal, the, individual is under a stress, the nature of which he doe;; not realize till the. danger is past and he can regard himself in the retrospect. These is an analogy between such stresses acting from within and. a disturbance of the same faculties by indefinable resentments and discontents acting from without, the individual in this critical period of the world's history. The present cycle of dissatisfaction with what is has been developing, with exacerbations and remissions, through some generations ; and individuals wishing to gain the ultimate at onee —without a thought of the resulting chaos —while restlessly attempting to adapt themselves to varying conditions, have glimpsed the mirage of social Utopias and experienced the inevitable disappointment. Little wonder that some look back regretfully at tin; passing of the simpler life in thought and labour which preceded the eraj of science and the newer purpose. So gradual has been the recurring process that the stages are, hardly recognizable of individual revolts aggregating to a mass consciousness, of that mass gathering momentum to reach the unattainable, staggering back disappointed, and then disintegrating, while across the void echoes the wisdom of the ancients, ■"You will go safest in the middle." The importance of the reference in this connection is that mental and emotional instability undoubtedly accompanies the exacerbations, a fact easily demonstrable where in gathered numbers words and deeds are applauded which each unit in the security of his home would repudiate and abhor. With no prophetic gift, but as an ordinary deduction, I stated that the war would reduce the ratio of insanity; and, now that the effect of this period of high purpose and genuine altruism seems to be exhausting itself, there is a danger of. losing our ethical values ; and tin; ordinary stresses which lead to mental disorder will meet with less resistance, when the. individual, taken at a disadvantage, is attempting to adjust himself to an environment apparently slipping on its foundations. The war, in a measure the consequence of a general half-reasoned sense ot revolt, by the very magnitude of its disastrous upheaval compelled a consideration of the world-sickness, and this has led to a helterskelter rush for remedies. It has disclosed to many for the first time that the pervading unrest, whatever its origin was, is tending to make mankind depart from aspirations for a high and attainable ideal in which the happiness of the individual is merged in the well-being of. the whole, community. Though it may not be, apparent to the individual, the general condition induced is one of mental perplexity, of moral titfulness and emotional hunger, and predisposes to nervous disorder and a perversion of ethical standards. There are abundant signs of a. sense, of chafing under irksome restrictions, without consideration whether their complete removal would, mean interference with the liberty of others; of a call tor self-expression, good, bad, or indifferent; of a, desire lor self-gratification in the enjoyment of the present, and a discarding of precedents—till pointing to an iconoclastic attack on