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Part IV.
THE AFFLICTED CLASSES.
THE BLIND, DEAF, DUMB, IDIOTIC AND INSANE.

In the family schedules distributed by the census enumerators in the spring of 1875, information was solicited concerning certain afflicted classes in Massachusetts, -- the blind, the deaf, the deaf and dumb, the idiotic and the insane. The facts sought for were to embrace not only the actual number of individuals in each of those classes, but were to include also data of the causes of the disability. These accumulated facts touching the numbers, age, sex and locality of the people in this State affected as above mentioned, and touching also the causes and duration of their infirmity, have been submitted to an analysis of which it is the aim of this paper to give the results.

These afflicted classes are inevitably a burden upon society. In proportion to their disability, the blind, the deaf-mute, the idiotic and the insane are dependent upon their fellow for sustenance. They eat the bread which they do not earn, and consume what they have small part in producing. They are the unfortunate and pitiable objects of human commiseration. Happily, in these latter days, enlightened philanthropy has done unspeakable good in alleviating the condition of these, the unsound in mind and body; and the State does well to honor the memory and the labors of those who, with assiduous devotion, have wrought out the methods which give light to the darkened eye, reason and self-control to the clouded mind, and speech to the mute tongue.

It is one of the functions of the census to determine the statistics of these classes, to ascertain the amount of this burden upon the State, and to find its relative increase or diminution at intervals of ten years. This undertaking is of modern origin; it had no place in the census taken under the Servian constitution of Rome, nor in the enumerations under the Mosaic law. In England, a country to which we are accustomed to look for all that is excellent in these matters, it was not till 1851 that the afflicted classes were numbered; and it was not till 1871 that a complete enumeration, embracing lunatics out of asylums, and idiots and imbeciles, was made. Of 32 governmental census returns made between 1860 and 1870 in Europe and the United States, Dr. Jarvis found only 24 which gave statistics of the blind, 29 of the deaf and dumb, 16 of the insane, and 14 of the idiotic. It is believed that the recent census of Massachusetts attained in these respects a completeness as regards details and fulness of data beyond anything hitherto secured, at least in this country.

The "prior schedule," or "family schedule," used in this census, possessed especial advantages as a means of acquiring the desired facts, in that it permitted deliberation and family consultation preparatory to the filling of the blanks. Even in cases in which the head of the family failed for any reason to fill the schedule, the census enumerator found the information awaiting him and ready for his record with much less delay and inaccuracy, than would have been the case under the older method of house-to-house visitation, with the requirement of unpremeditated answers to personal, and in many respects, disagreeable questions. An inspection of the schedules, as returned to the bureau, shows abundantly that householders and heads of families appreciated the utility of the work to which they were called to contribute; an honest and conscientious purpose to fulfil the request made is apparent in almost every case.

It is to be remarked, however, that a valid claim of absolute accuracy can hardly be made in behalf of all this accumulated information. It is to be understood that these returns afford an approximation only to a correct statistical knowledge of the afflicted classes in Massachusetts; and while we have no hesitation in asserting that the present census has surpassed all previous similar attempts to gather this knowledge, we are yet free to grant the limitations to which all such endeavors are subject. To fulfil the requirements of scientific accuracy in results, would necessitate the application of scientific tests and methods in gathering the data for those results. The statistics here analyzed are supplied by the people themselves concerning their own physical condition, or that of kindred or dependents. In only a portion of the cases do we have the aid of professional medical skill in supplying the original facts. The hospitals and asylums give, indeed, the best information attainable with regard to certain of the classes under consideration; and it may be remarked, too, that in a great many individual instances we have the reflection of skilled medical opinion in the returns, the nature, degree and cause of the infirmity being entered in the schedule in accordance with the previously expressed view of the family physician, or of some specialist from whom relief was sought. But there, is a great mass of the material which is based substantially upon personal, unskilled judgment; sometimes, indeed, the basis has a flavor of the fanciful and the superstitious. (1)

These reflections upon the character of the statistics returned are designed to promote a more intelligent understand of the results reached, without, however, an undue disparagement of their value, -- to point the way to better methods, without decrying the improvements already attained. The kind of knowledge which the census gives is of more moment than its amount or variety. "The tendency toward complexity in the nature of the returns must always be checked," says Dr. Farr, "by the liability of the people at large to make blunders and create confusion where they are required to attest facts not of the most obvious nature, and by the difficulty of getting a sufficient number of subordinate officers to understand and carry out a complex classification." The time will doubtless come when, instead of relying upon the statement of individuals that their children are "dumb" because of the "Massachusetts school system," or "idiotic" because "marked with a snake," or "blind" because "moonstruck" the compiler of statistics of the disabled classes will feel full confidence in his facts, knowing that in the course of their primary enumeration they have been submitted to uniform standard tests, such as are applied for example by the oculist who determines the degree of blindness in his patient by means of the test type, or by the aurist who ascertains deafness and its amount by the distance at which the ticking of a watch is heard. The science of vital statistics is one of slow growth. Experience will continually point out retrospective defects and suggest improved methods. Perfection in the census of a people, as in all other human undertakings, is attainable by slow approaches, if it be attainable at all. The approximations offered in the present instance are the result of a system matured with exceptional care, and are believed to be possessed of exceptional value in point of freedom from the errors both of omission and commission.

The Blind.

The number of persons who reported themselves in this class is 2,512. (2) This number gives a rate of fifteen blind persons in every 10,000 of the population of Massachusetts, or one person blind in every 657. This ratio is greatly in excess of what has been found by the census of this State in previous years, and in excess also of the proportion deter in other countries. In 1865 the ratio was one in 1,663, and in 1855 it was one in 2,404; both of these enumerations probably fell far more short of the truth than the number in 1875 exceeds the truth. In 1871, in England, the ratio was one blind to every 1,052 persons; in Scotland it was one to 1,112, and in Ireland it was one in 852. The magnitude of the aggregate in Massachusetts, as set forth in the census, is to be explained in two ways: partly by the fuller returns made, but mainly by the fact that many have reported themselves as blind who, if special inquiry were made, would be found to be, not totally blind, in the meaning and intent of the prior schedule, but deprived of sight to a very considerable degree; the enumeration has determined a near approximation to the number of persons in Massachusetts who are destitute of vision to a degree which incapacitates them for the usual avocations of mankind.

The subjoined table shows the distribution of these numbers of the blind in the several counties. It will be observed that the proportion of the blind to the population is largest in the rural counties, and least in the counties containing the cities, and large towns.

Persons reported as Blind, their number in each County in 1875, and their proportion to the Population.

The number of those reporting themselves as blind, and their number in proportion to the people, is seen to be in excess, as a rule, away from the centres of population. The cities and manufacturing villages attract the young and the sound from the agricultural sections and from across the ocean. The old, decrepit and infirm are thus left in excess in the country. These, observations are further illustrated by the ratio of blind persons to population in some of the Massa cities. Thus, in Boston (the inmates of the Perkins Institution and of the Massachusetts Charitable Eye and Ear Infirmary being excepted from the account), the proportion was one blind person to every 926 of the people; in Lowell, one in 1,156; in Cambridge, one in 1,167; in Fall River, one in 1,334; in Lawrence, one in 1,126.

Thirty towns in the State appear to be especially favored; their inhabitants report themselves exempt from the infirmity under consideration. But none of these towns have more than 3,000 inhabitants, and their aggregate population is less than two per cent of the population of the State.

Of the total number of the blind, 1,407 are males and 1,105 are females. In proportion to the population, the former are as one to 564 of the whole number of males, and the latter are as one to 775 of the whole number of females; in other words, there are 18 males blind in every 10,000 of the male population and 13 females blind in every 10,000 of the female population. This excess of blindness among the males is undoubtedly due to the greater outdoor exposure of men, and to their greater liability to accidental injury. The following table exhibits the age distribution of those in Massachusetts who report themselves deprived of sight: --

It will be observed, that in childhood the proportion of blind persons to the general population is at the minimum. After the age of 40 years, the increase is progressive until, in advanced life, it is found that one person in every 31 is deprived of sight in greater or less measure. In childhood, both sexes share alike the infirmity of blindness; after the age of 20 and until the age of 70, blind men are in excess of blind women; after the age of 70, females are more numerous than males in this class, the excess corresponding nearly with the excess of females in the general population above the age mentioned.

Of the total number of persons reporting themselves blind, 201, or one in 12 of the whole class, are described as "blind from birth." According to the latest English census, the proportion of the born blind to the total of blind persons was one in 11 in England and Wales.

Among the matters included in a study of blindness in any community, the cause or causes of the infirmity are of obvious interest and importance. Information upon this point, so far as Massachusetts is concerned, is afforded as one of the fruits of the late census. Of course, for very clear reasons, there can not be the same exactness in this part of the schedule as in the matters relating to sex, age and occupation, but of the answers returned a very large proportion show intrinsic evidence of genuineness. This being the first attempt to define the causes of the blindness among the people of the State with some detail, we can not make a comparison to show whether through improved skill in ophthalmic surgery, or from other causes, certain kinds of blindness are diminishing. The following table gives a numerical exhibit of the causes as they were returned in 1,618 cases, and includes those cases only which show tolerably well marks of accuracy. The sources of the information upon which this table is founded are to be remembered, and the conclusions to be drawn are subject to modification ac In many cases, the causes assigned are undoubtedly derived from medical consultation; in many more instances, probably in the majority, the decision is that of the sufferer himself, who is not expert in discovering an obscure real cause for his infirmity in the place of an apparent but erroneous one. Such names as amaurosis, cataract, Bright's disease, and glaucoma, indicate the intervention of professional skill in the case, while other assigned causes show quite plainly, that a coincidence has been made to stand as a substitute for the real agency in producing the effect.

Gunpowder has had a considerable part in the production of blindness in Massachusetts, the premature explosion of blasts being the chief cause of the injury. Frequently sight is totally lost by this accident, and in many more cases where one eye is destroyed the other follows its fellow by sympathetic inflammation. Accident by firearms, including the mischief done by percussion caps, is in the same class.

The cases of lost sight attributed to age would probably be redistributed after a careful investigation. The degeneration of the crystalline lens, known as cataract, would include most of these instances.

Belladonna is given as the cause of blindness in two instances. Whether the drug was given in the form of atropia by a physician for its specific effect to dilate the pupil of the eye, or was taken for other purposes, or was used without medical advice, we are not informed.

Cataract is given as the cause of blindness in 238 instances. The constant progress making in ophthalmic science and art suggests the hope that this cause of lost sight pay appear in lessening numbers in the future. Indeed, it was not a rare note to find in a schedule as returned: "formerly blind from cataract, but sight is now partially restored by means of surgical operation."

Diphtheritic inflammation is charged with having caused two cases of blindness. Probably many more are included in the general class of unspecified inflammations.

Diseases of the brain and nervous system include a variety of causes, such, for example, as paralysis, fits, meningitis, hydrocephalus, disease of spine, headache.

Diseases of a constitutional and specific nature comprise cancer, scrofula, humors and syphilis.

Exposure expresses a variety of assigned causes, some of them of singular character. A considerable number of per living near the sea attribute their loss of sight to the brightness of the sunlight upon the water. The exposures of army life are blamed by many blind men as the cause of their infirmity.

The mischief done by scarlet fever is partially represented in the 55 cases which place it at the head of the list of fevers in producing blindness.

Injury of the head, blows, falls and the like, caused loss of sight in 15 instances.

Rheumatism produces its harmful effects on vision by attacking the sensitive muscle of the iris, and causing a serious and often irreparable inflammation.

In these days, small-pox does less harm to the eyesight than falls to the blame of either scarlet fever or measles.

Sunstroke is charged with 16 cases of blindness.

At the Perkins Institution and Massachusetts Asylum for the Blind, the principal charity in the State for the reception and instruction of the blind, the number of occupants in May, 1875, was 118; the original causes of the loss of sight in these cases were given in 55 instances, as follows: --

The Deaf. The number of those who reported themselves as deaf (deaf-mutes excluded) is 7,241, -- forty-four in every 10,000 of the entire population, or one person deaf in every 228. Obviously this proportion does not express the exact amount of this disability in Massachusetts; on the one hand, it gives a ratio too large for the number of the totally deaf, while, on the other, it does not represent the whole number of those whose function of hearing is partially lost or indeed seriously impaired. This result arises from the difficulty which belongs to any attempt to discriminate degrees of disability by any standard short of an exact scientific measure.

The following table, giving the distribution of the numbers of the deaf in the several counties, shows that the people of Barnstable County are especially afflicted with this defect, while the inhabitants of Suffolk County are the least subject to it.

Persons reported as Deaf, their number in each County in 1875, and their proportion to the General Population.

Many of the contrasts apparent in the above table would disappear if the same census enumerator gathered the facts for the entire State, or if all persons, census enumerators included, were endowed with identical faculties of observation, and shaped their judgments by the same measure. It has been the experience of most governments that data of a specific nature, like those of the afflicted classes under consideration were much more fully returned from rural than from urban populations. This experience is exemplified in the next table, which gives an analysis of the numbers of the deaf reported in each city and in the State at large. By this it appears that only one of the cities, Salem, gives a proportion of deaf persons to population less than that of the State. If we seek an explanation of these contrasts outside of errors and omissions in the enumeration, the chief determining element of the disparity may be found in the greater proportion of young and healthy persons in the cities, or conversely, in the greater relative number of elderly persons in the country, persons more subject to the infirmities of advancing age.

With regard to the sex distribution, the number of males reported deaf is 3,733, or one in 213 of the male population; the number of females is 3,508, or one in 244. Here, again, as in the case of the blind, the greater exposure of men impresses itself.

The age distribution of the deaf is exhibited in the follow table: --

The progressive increase in the proportion of deaf persons in each vicennial period of life, is suggestive of the decay of power and impairment of function which come with advancing years.

The observation illustrated in the last table, that age is an important factor in the matter of deafness in any community, finds further exemplification in an analysis of the assigned causes of the defect. Of the 7,241 persons avowing them deprived of hearing, 4,815 give their opinion of the circumstances in which their deprivation occurred. Nearly a fourth of this number (1,067) assign advanced age as the cause of their deafness. Scarlatina is next to old age in the list, 951 cases being charged to the account of this scourge of childhood. Inflammatory action, variously described as otitis, sores in the head, ulcers in the head, abscesses in the ear, catarrh, was the cause of deafness in 878 persons. Fevers of various kinds, typhoid being the chief, are charged with 280 cases. Congenital cases numbered 280, and hereditary cases, 211. Measles are the assigned cause of 216 instances. Among the 283 cases of deafness caused by accidental injury, are 44 which are ascribed to the "discharge of cannon," or to "cannonading"; a number add the clause, "in the army." The "noises of trip-hammers" and, other "factory noises," chiefly in boiler-works, founderies and cotton mills, are blamed by 50 persons. Others among the assigned causes are as follows: scrofula (144); neuralgia (48); disease of throat (32); cerebro-spinal meningitis (36); exposure (57); cold bathing and diving (40); erysipelas (30); diphtheria (31); sunstroke (17); whooping-cough (19); small-pox (15); thunder storms (11); cancer (5). Among the improbable and fanciful causes are: mumps (16); vaccination (4); asthma (2); hay fever (1); cholera (1); chicken-pox (1); fright (1); abuse (1).

The Dumb.

Of this class, comprising presumably those persons who can not talk, but who can hear, and who are otherwise in the possession of unimpaired faculties, 129 were returned, -- 81 males and 48 females. It is highly probable that a careful inquiry into these 129 cases would result in a very material change in these numbers. Dumbness without deafness is very rare, and when not due to malformation is almost invariably a sign of idiocy; with the exception of a few instances of loss of speech due to anatomical defect, these 129 cases of so-called dumbness may fairly be assigned to idiocy or to deaf-mutism. Some support to our inference, that these statistics of the so-called dumb should be redistributed upon a new classification, is given by the fact that 81 of these cases, nearly two-thirds of the whole number, are under twenty years of age, and 43, or more than one-third the entire number, are under the age of ten years. There is no apparent reason why dumbness should be found in the young so exclusively, and the presumption is that careful investigation would correct such an observation. Seventy-five of the cases are reported as congenital. Very little information is afforded upon the schedules to guide judgment as to the causes of the loss of speech as alleged; one individual is recorded as "born without a tongue"; another was made dumb by shock; another, a Chelsea lad, was rendered permanently speechless by "fits caused by fear of the Pomeroy boy "; and, finally, another attributed his loss of speech to an "overdose of medicine."

The Deaf and Dumb.

According to the returns, the number of deaf-mutes in Massachusetts, in May, 1875, was 654. The census of 1865 ascertained 561 of this class of unfortunates. The enumeration of the deaf and dumb has always been found to be a task of considerable difficulty, but it is noteworthy that the several enumerations in this State have not been greatly at variance, one with another, when the proportion of deaf mutes to population is regarded. This proportion in 1875 was one to 2,536; in 1865, it was one in 2,258. There are many good reasons for believing that the census of 1875 is not less accurate than that of ten years ago; if this be granted, we find that the proportion of the deaf and dumb is diminishing. We are certainly more highly favored in this regard than are most of the countries of Europe. The following table, copied from the report on the Irish census of 1861, gives some suggestive statistics upon this point: --

It will be seen that only one of the above-named countries, Holland, shows itself more exempt from the disability of deaf-mutism than Massachusetts. It is possible that more recent enumerations may have changed the above exhibit in some of the countries, but it is scarcely probable that our condition in this State would be found by the latest statistics to be comparatively deplorable. Judging by past experience, we may confidently anticipate progressive improvement in respect to the number of the deaf and dumb. Increasing skill in treating the diseases which cause deaf-dumbness and in preventing them from spreading, and improved methods in teaching the pitiable subjects of the defect, will lessen this unhappy disability. (3)

The following table shows the distribution of the deaf and dumb in the several counties: --

Persons reported as Deaf and Dumb, their number in each County in 1875, and their proportion to the General Population.

A noteworthy feature of the foregoing table is the comparative excess of the deaf and dumb in the counties of Barnstable, Dukes and Plymouth. The very high ratio in Dukes is especially remarkable; it is accounted for by the fact that by intermarriage a single family appears to have propagated this condition to an extraordinary extent, twenty of the twenty-two deaf-mutes in Martha's Vineyard bearing the same surname. A similar state of things was ascertained by the enumeration of 1865, when the proportion was one deaf-mute to every 175 of the population.

The sexes share the infirmity of deaf-mutism unequally in Massachusetts, the ratio among the males being one deaf-mute to every 2,219, and that of the females one to every 2,897. The numbers were 358 males and 296 females. It is of interest and importance to learn the ages of the deaf-mutes in the State, so that we may know how many in the population are likely to become the proper subjects for an institution for the education of this class. The following is an exhibition of the ages of the deaf and dumb as reported: --

Without doubt the number of the deaf and dumb at ages tinder five years is understated; a defect, we may remark in passing, that is common to every census enumeration, in Europe or America. The deafness of a child is hardly suspected for several months at least after birth; and parents are usually unwilling to be convinced that their child is actually destined to be a deaf-mute, the hope being entertained that at the worst the ability to talk is delayed only. So, too, if a child, after learning to talk, becomes deaf and then dumb by reason of disease, the parents naturally postpone their conviction that full power of speech is irrevocable. Hence, many children are returned as deaf who are really deaf-mutes, and the small number of the deaf and dumb reported as under five years old indicates that this disability was unrecognized or concealed on the part of the friends of many children whose exact condition would be determined and find a place on census schedules at a later period of life.

The excessive proportion of the deaf and dumb at ages between 60 and 80 is extraordinary and difficult of explanation.

Of the total number of deaf-mutes, 350 (194 males and 156 females) are returned as having been affected from birth. The acquired defect is therefore less than the congenital, of the former being to those of the latter as 100 to 110.

Among the principal causes assigned for the cases of the acquired deafness upon which the loss of speech so largely depends, the following may be mentioned: --

Scarlet fever is charged with 112 cases. Is not this a suggestive fact to be considered in connection with efforts for the prevention and limitation of this infectious disease? Of the cases of deaf-dumbness not congenital, scarlet fever is blamed, and probably upon good grounds, for nearly one-third.

Various forms of fever, other than scarlet fever, caused 29 cases.

Falls and other accidents caused injury in 28 cases which resulted in deaf-mutism.

Eighteen cases are ascribed to measles.

Cerebro-spinal meningitis is the alleged cause of 15 cases.

Inflammatory affections of the ear, of a nature not specified, caused loss of speech and hearing in fourteen instances.

Of diseases of the nervous system, we have paralysis (4), hydrocephalus (5), disease of the spine (6); in all, 15 cases.

The less direct and definite causes assigned were scrofula, whooping-cough, convulsions, cholera infantum, and croup.

Small-pox and diphtheria were credited with one case each.

The Idiotic.

The total number of persons described as idiotic or imbecile in the population of Massachusetts is 1,340. Compared with the entire population, this number gives a ratio of one idiot in every 1,232 persons. This ratio is considerably less than that found in England and Wales in 1871 (one in 771), but it exceeds that found according to the census of Massachusetts in 1865 (one in 1,468). The most careful and alto trustworthy enumeration of the lunatic and idiotic classes in Massachusetts with which we are familiar is that undertaken in 1854 by a commission on lunacy appointed under a legislative resolution. According to the report of this commission, (4) Dr. Jarvis found as the result of correspondence with the physicians in all parts of the State, and by means of careful research, that the idiotic class was then in the proportion of one in 1,034 of the entire population. This ratio is based upon a much more careful canvass than is likely to occur where the ordinary agencies of the census are employed, and is probably as nearly accurate as is practicable. Persons are naturally sensitive about giving information con the mental deficiencies of their kindred, idiocy being generally regarded as a humiliating infirmity, to be concealed rather than described in detail to official canvassers. Especially would this condition of feeling be found in cities where cases of idiocy are less a matter of common cognizance than in rural communities in which family affairs arc kept private with comparative difficulty. But the medical profession, the family physicians of the State, while they appreciate the technical distinction between mental defect or idiocy and mental disease or insanity, are able also to give exact numerical data of the cases which at one time and another come under their charge.

The number of idiots ascertained by the census, approach as it does the proportion found by Dr. Jarvis twenty years ago, is undoubtedly a close approximation to the exact statistics of idiocy in Massachusetts at the present time. The diminution in the ratio may be explained partially by the increased number of immigrants within our territory, who, in forsaking their homes for a new world, have left behind them as far as might be those of their kindred who would encumber them in the efforts to get a living. Idiocy is distributed among the counties of Massachusetts as follows: --

The Idiotic in Massachusetts, their number in each County in 1875, and their proportion to the General Population.

It will be observed that considerable diversity is shown with regard to idiocy in the several counties; the proportion varies from one in 510 in Barnstable to one in 1,779 in Suffolk. If we omit from the account of Suffolk the 94 inmates of the Massachusetts School for Idiotic and Feeble-Minded Youth (the only public institution of the kind in the State) , the ratio for that county would be considerably lessened, -- one in 3, 287 . The excess of idiocy in the country as compared with the city finds most ready explanation in the facts already suggested concerning the migration of people to the centres of population these centres attracting not only the younger and stronger elements from foreign lands, but the productive and self-sustaining portion of the native stock from our own rural sections.

Idiocy has a very unequal distribution between the two sexes, the male idiots being greatly in excess. In 1875, there were in Massachusetts 835 males and 505 females in this class of unfortunates, -- 165 of the former to every 100 of the latter. The ratio to population is, among males, one in 951; among females, one in 1,698. This preponderance of idiocy among males has been observed to exist in other countries.

The ages of the idiotic class in Massachusetts are distributed as follows: --

Two inferences at once suggest themselves upon a review of the foregoing analysis: the comparatively small proportion of idiots at ages under ten years indicates that a considerable number of idiotic children are overlooked in the enumeration, the parents of such children very naturally concealing the mental defects of their offspring through inability or unwill to recognize such an unhappy condition in those near to them, until the advancing age of the subject of the infirmity renders such concealment difficult; and, secondly, the excess of the proportion at ages over seventy suggests that the mental weakness and imbecility of the decline of life have been erroneously described as idiocy, -- the truth being, that idiocy, in the great majority of cases a congenital defect, should diminish in proportion to the population from youth onward. We may fairly conclude, however, that the former of these errors is cancelled by the latter, and that our aggregate number may still be accepted as a true approximation to exactness.

The causes of idiocy have always been an interesting study. Dr. Howe, whose authority in such matters will not be questioned, says with great emphasis: "We regard idiocy as a diseased excrescence of society, as an outward sign of an inward malady. It appears to us certain that the existence of so many idiots in every generation must be the consequence of some violation of natural laws." (5) Among the indirect or more immediate causes of mental defect, Dr. Howe mentions the intemperance of parents, self-abuse, intermarriage of relatives, and attempts to produce abortion resulting in permanent injury to the foetus in utero.

In the report upon the census of England and Wales for 1871, the following occurs: "Residence in deep valleys, damp and unwholesome climate, crowded dwellings or other unhealthy conditions, intermarriages among a limited number of families, and more especially where weakness of brain already exists, -- these are allowed to be predisposing causes, and as they are obviously within human control, the hope may be entertained that the extent oi this affliction may be limited in the future."

The data supplied by the recent census in Massachusetts are too meagre and indefinite to form a basis for satisfactory conclusions with regard to the causes of idiocy in this State; they serve merely as an expression of the popular notion of the matter, and as such alone they are here presented. Of course it is manifest that many of the causes assigned, being post-natal, are erroneous, and that exact investigation would find nearly all cases to be dependent on ante-natal conditions necessarily obscure to ordinary intelligence. Epilepsy is set down as the cause of 159 cases of idiocy. Fevers of various kinds are charged with 49 cases. In 18 cases, fright of the mother during her pregnancy is the alleged cause. Blows on the head, falls and injury at the time of birth, are assigned as having caused idiocy in 34 cases. Intemperance of the father is given in 11 instances. In 10 cases the parents were cousins. This matter of the close relationship of the parents, as contributing to idiocy as well as to other abnormal peculiarities, mental and physical, is well worthy of careful investigation. Among the less fertile and more remote causes assigned are the following: hydro (6), rickets (10), harsh treatment in childhood (3), sunstroke (3), measles (3), fright (4), masturbation (2), overdosing (2).

The Insane.

A correct enumeration of the lunatic class in any community is as desirable as it is difficult. It is important to ascertain the exact measure of this special burden upon the State and to determine its relation to pauperism. It is of great consequence, also, to learn whether the burden is in; whether the restless activity of our modern modes of life is impressing itself upon the public health in increasing degrees and necessitating the enlargement of the facilities for treating mental disease. But for the reasons mentioned previously, the sensitiveness of people with regard to the mental maladies of their kindred and the unwillingness to report such cases, many instances of insanity of mild or inter type inevitably escape mention upon the census schedules. This error of omission applies of course to those cases of lunacy remaining at home, not being violent enough to require treatment in hospital and not yet cast off by their kindred to become a public dependence as pauper lunatics; so that the deficiency, being limited to a special and numerically minor class of these unfortunates, while it should be; regarded in any analysis of the statistics of lunacy as affect the aggregate in some degree, is not of very great magnitude.

As a result of the enumeration in May, 1875, we have a total of 3,637 insane persons in Massachusetts at that time. This is in the proportion of one lunatic in every 454 of the entire population, or 22 to every 10,000. This ratio is in marked excess of that found by census enumeration in some foreign countries. In England and Wales, by the census of 1871, the proportion was one in 574; in Ireland, by the census of 1861, it was one in 821; in France, in 1856, it was one in 1,028; in Sweden, in 1855, it was one in 938. These comparative statistics, while they show that the burden of lunacy is relatively excessive in Massachusetts, serve also to confirm our view that the number of insane reported is a very close approximation to exactness.

The data which we have aft hand, and the means for verifying them, are unsatisfactory for the determination of the inter question whether lunacy is increasing in this State . Every enumeration is admitted to be defective in greater or less measure, but it is difficult, if not impossible, to ascertain the degree of deficiency. The following is a statement of the relation of lunacy to population according to the latest Statistics based upon enumeration: --

There is good reason for believing that of the above, the first and the last are the most reliable, and furnish the closest approaches to correctness. If this be granted, it is evident that while the actual number of the insane is increasing, the relative number, when population is regarded, is not becoming alarmingly greater, as some would have it appear.

Of the 3,637 lunatics in Massachusetts in 1875, 2,272, very nearly two-thirds of the whole number, were inmates of public or private institutions for the insane, distributed as follows: --

The remaining 1,365 persons insane were either cared for at home by their friends, or, as paupers, were dependent on public support in town almshouses and private families.

These 1,365 lunatics, not in hospitals, were distributed in the various counties as is shown in the subjoined table: --

Here, again, as in other classes of the infirm in the general population, we see the influence of migration in increasing the relative amount of lunacy in the country sections.

In the matter of sex distribution, we find an excess of female lunatics; there were 1,704 males and 1,933 females, or 89 of the former to every 100 of the latter. The proportion in each case to population is: for males, one lunatic in every 466; for females, one in every 443.

The ages of the insane, so far as they are reported, are distributed as shown in the next table: --

It is a well recognized fact among those skilled in the treatment of mental disease, that the curability of a case depends to a considerable degree upon its recentness, the chronic insane being especially intractable. Among the mat concerning which data were gathered in the census was the duration of the disease in cases of lunacy. As the result of the inquiry, we have information upon this point concern 3,128 of the 3,637 cases. In these 3,128 instances, the duration of the disease is returned in 144 cases as less than one year; these most recent cases are only 4.6 per cent of the whole number described. Of cases under five years' duration, there were 1,184, -- 37.8 per cent. The remaining 1,944 -- 62 2 per cent of the whole -- are returned as of more than five years' duration.

The supposed causes of the mental alienation are described in a minority -- 37 per cent -- of the cases. The subjoined table presents these causes in their numerical summary, as they were returned from five large hospitals and from the friends of those who were not under hospital treatment: (6) --