Prevention of Disease, Insanity, Crime and Pauperism
208 Art. II.? * :Author: NATHAN ALLEN, M.D., Lowell, Massachusetts, Commissioner in Lunacy to the Commonwealth of Massachusetts.
Upon a subject so large and important as the above title indicates, only a few brief suggestions can be made in a short essay. The topics mentioned cover the whole ground of public charity and involve the most essential agencies in its administration. No community or people can be found so advanced in civilisation, or so perfect in morals, as to be free from these terrible evils; and notwithstanding the immense labour bestowed and expense incurred to check or prevent them, still as a whole they seem to increase, certainly in some directions. The agencies employed to check them do not appear very successful, nor do the ends attained correspond to the amount of labour and expense which have been put forth. In all attempts at reform, or for the removal of great evils, it is the dictate of wisdom to select those agencies which are most likely to bring about the greatest results with the least labour or sacrifice of means ; in other words, to nip the evil in the bud, or to dig up and destroy its roots, rather than to lop off only its branches. A great amount of time, labour and cost are consumed in dealing with the affects of evils, without reducing or removing their chief sources or primary causes. Thus in the history of disease and insanity, while there has been an immense expenditure of labour and means to cure these evils, little comparatively has been done to ‘prevent- them; The same holds true in respect to crime and pauperism. No truth in history is more self-evident than that if we would remove evils, whatever may be their nature, their primary causes must first receive attention. And in order to do this successfully, their origin, or roots, must be made our careful study, and be exposed and set before the public in such a variety of ways, that proper means will be employed to eradicate them. The greater the evil and the more de- structive its influence, the more important is its removal. Having had occasion for many years to visit, in an official capacity, almshouses, prisons, and lunatic hospitals, we have * Read at the Conference of Charities connected with the meeting of the American Social Science Association, at Cincinnati, May 22, 1878. been profoundly impressed not only with the magnitude of the evils which they present, but with the conviction that there is great need of reforms, which reforms may be indicated under the following heads :?
1.?PREVENTION OF DISEASE.
Nowhere, perhaps, can we find better illustration of these principles than in the history and treatment of diseases. Once they were thought to be some distinct entities, some evil spirits, or mysterious agencies, affecting the human body, and to expel or subdue them resort must be had to the art of divination, appeals to supernatural or divine power, or the application of some strange artificial means or mysterious medication. As the structure and laws of the human system became better understood, in the sixteenth and seventeenth centuries, these delusions began to disappear, and more correct views of disease to be entertained.
By discoveries in anatomy and physiology ; by the use of the microscope and the application of chemical science; by careful observation and experiment, a flood of light has been shed upon the nature and causes of disease. Amid all these discoveries and improvements the main inquiry has hitherto been how to cure disease. Scarcely anything can be found in medical books and journals till within half a century on the subject of preventing disease. The first two writers (living in advance of their times) who started some important inquiries in this direction were Dr John Forbes, in Great Britain, and Dr Elislia Bartlett, in the United States?men distinguished for their independence and originality of thought.
While attending medical lectures in Philadelphia, in 1840, the writer became particularly interested in hygiene, and from the first day of entering upon the practice of medicine his interest has constantly increased in all matters pertaining to the preservation of health, and especially in the prevention of disease. All writings on the subject, like those of Dr John Forbes, Dr Andrew Combe and others, attracted his attention ; and a personal acquaintance with Dr Elisha Bartlett served to increase this interest.
In the British and Foreign Medical Review, for January 1846, Dr John Forbes, in his celebrated article on “Young Physic,” speaking of the importance and results of certain changes in medical practice, said : ” Redoubled attention should be directed to hygiene public and private, with the view of preventing diseases on a large scale, and individually in our sphere of practice. Here the surest and most glorious triumphs of medicine are to be achieved.”
About the same time, Dr Elisha Bartlett published a work in this country on the ” Philosophy of Medicineand in urging upon the profession a more thorough knowledge of the causes and nature of disease, said : ” The next thing to be done is to find out the best methods of modifying and preventing disease. This is the great mission which now lies immediately before us; this is to constitute the great work of the next and succeeding generations.”
Both of these writers were fully impressed with the truth and importance of the sentiments contained in these para- graphs. They predicted with much positiveness that a great reform was soon to take place in the treatment of diseases, and their predictions have proved true. At no period in the history of medicine have there been such discoveries and improvements as within the last thirty years.
Great advances have been made in ascertaining the primary causes of disease, as originating in filth, bad air, impure water, foul gases, poison from decaying animal and vegetable matter, &c. It has been found, moreover, that the spread and fatality of infectious and contagious diseases can be very much con- trolled by isolation, by disinfectants, and by a resort to sanitary laws. To carry out these measures in a community, or ex- tensively among a people, it becomes necessary to employ some public agency and enlist legislation for enacting laws and establishing boards of health. In this way has arisen what is called “sanitary legislation,” or “State medicine,” the chief object of which is to prevent diseases.
The leading agency in carrying on this work in Great Britain has been the Registrar-General’s department, requiring regular returns of births and deaths from every part of the kingdom, with a bureau of health connected with Government. For thirty years or more, sanitary interests have been frequently discussed in Parliament; stringent laws on health have been enacted; cities and counties have been divided into districts, and an officer of health appointed to each. Instructions and reports on the subject have multiplied, together with discussions in journals and newspapers. The object of all this legislation and labour is to prevent disease?not cure it.
The inquiry naturally arises, What is the result or fruit of these sanitary operations ? It is not time yet to obtain the full benefits of such means; for while the advantages of observing some sanitary laws may be seen very soon, it will take many years to reap the complete benefits of others. In certain localities in Great Britain, where these laws have been only partially applied for a few years, there has been witnessed a marked decrease in the amount of sickness and rate of mortality, From careful investigations it is estimated that this diminution will already range from one-fourth to one-third; but it is the opinion of the best judges on the subject that, when sanitary science is faithfully applied, there will be a decrease of more than one-third of the sickness and mortality which formerly occurred. The immense advantage, or value, which will be gained by this prevention of disease, in the saving of time and expense, in the prevention of pain and distress, in the general improvement of health and prolongation of life, cannot be estimated in figures or described in language. The more extensively and thoroughly these principles are applied, the greater good will they accomplish, and the more perfectly we shall find the laws of the external world adapted to the human system, showing that man has a far greater control of those laws than has generally been supposed.
Another important consideration is, that the more thoroughly sanitary agencies are applied on a large scale, they not only serve directly to prevent disease but furnish essential aids in curing it. Thus the more you improve ventilation and the quality of water, drainage and sewerage, and have regard to dietary habits and physical exercise, &c., the more successful will be the operation of all therapeutical agencies. Again, the general application of sanitary science must tend to diffuse among all classes a more thorough knowledge of the principles of physiology, so that they will possess better and more correct views of the laws of health and life. Thus every individual will be able to take far better care of himself, to understand his own peculiar weaknesses and predispositions to disease, so that in process of time, by care and watchfulness, the constitution itself will become very much strengthened. Let this course be continued through two or three generations, and one of the most fruitful sources of disease, by means of heredity, will be diminished. Heredity is a powerful agency in the pro- duction of disease, which has been too much overlooked, and should receive greater attention than it has hitherto. In the inheritance of morbid tendencies we have one of the most fruitful sources of disease. This will become more patent in proportion as the principles of physiology shall become better understood in their connection with hereditary influences. Without attempting to describe the various ways in which the seeds of disease are transmitted from parent to child, we may say they are manifold, in organisation and function, in defective and abnormal structure, in the weak or excessive development of this or that organ, in the general want of balance in the organs, and of harmony of function; in tlie quality of the blood and the marked predisposition to certain diseases, like scrofula and consumption.
If it be said that sanitary agencies do not reach directly this class of diseases, yet their influence will gradually help to prevent them by improving the general health and constitution of people. Besides, they will direct attention to certain sources of disease in heredity, and show that these should be avoided in forming matrimonial alliances. If legislation cannot be brought to bear directly upon this point, self-interest and public opinion can. The time will come when good health and a sound con- stitution will be better appreciated, when the duties and responsibilities of matrimony will be regarded in altogether a different light from what they have been. This change may be slow in progress, but when it comes a great amount of disease from hereditary sources will be prevented.
This sanitary movement has certain advantages over all other reforms. Its success does not depend upon the medical profession alone, nor upon Government support, nor upon any one body of men, but upon all classes, both men and women. In carrying on this reform, the parties become at once par- takers in its rewards?in improved health and strength; and its benefits become everywhere so manifest that the work must go on with accumulated power. What is the testimony of one of the best judges in the country on this subject? Says Dr. H. I. Bowditch, in his work just published upon ” Public Hygiene in America”: ” We stand now at the very dawn of the grandest epoch yet seen in the progress of medicine. While philosophically, accurately, and with the most minute skill studying, by means of physiology, pathological anatomy, chemistry, the microscope, and, above all, by careful clinical observation, the natural history of disease and the effects of remedies, our art at the present day looks still higher, viz.: to the prevention of as well as to the cure of disease. And this is to be done by sanitary organisation throughout each State?the nation, the laity and the profession heartily joining hands in this most noble cause.”
If by such means one-third or more of the sickness and the suffering consequent thereto can be averted, if the rate of mortality can be very sensibly diminished, public health everywhere greatly improved and human life prolonged, ” the glorious triumphs ” predicted by Dr John Forbes, it may truly be said, ” are being achieved.”
2.?PREVENTION OF INSANITY.
The idea that insanity can be prevented may surprise some persons. The impression entertained among people generally has been, that it arises from causes obscure and mysterious, or is the visitation of evil and supernatural spirits, so that it cannot be fully comprehended or easily cured. It is certain that no intelligent and systematic attempts have ever been made for its general prevention. But, on the other hand, there has been an immense expenditure of time, labour, and means to cure the insane.
What are the facts in the case? In all civilised and Christian countries this unfortunate class in large numbers have been gathered into asylums with two objects in view, vi^. safety and cure. Once, it was thought, if the treatment of insanity was commenced in its first stages from 80 to 90 per cent, of all such cases could be cured ; but now the cures are less than half that per cent. If the great majority of the insane?say 9 out of 10?were cured, their number would surely be diminished. But if only from 30 to 40 out of every hundred new cases are cured, and 8 to 10 annually die, we have certainly one-half of all the persons becoming insane to add every year to the chronic insane.
The question whether insanity is increasing faster than population is one upon which there is difference of opinion ; but the evidences, we believe, lean strongest in favour of the relative increase. For a long time it has been apparent that the number of the insane was everywhere rapidly increasing, that lunatic hospitals were crowded, and large, new establish- ments were frequently being erected. It has come to this, that the support of this class, and the management of such institu- tions, are becoming very burdensome, and to all appearance are likely to be still more so. The impression is becoming general, that the multiplication of lunatic hospitals is doing but little to check insanity, and that if this evil is ever to be checked, some different means must be provided. The fact that these hospitals do not cure more of the insane, nor serve to check insanity, suggests the question whether the fault is in the nature and treatment of the disease, or in the management of these institutions. The explanation generally given is, that proper treatment was not received in its first stages. What is the testimony of experts upon the subject? Says the Super- intendent of the McLean Asylum?the oldest institution in New England, and admitted to be one of the best-managed in the United States?in a late report: “For the treatment of insane persons, we could wish some practice more encouraging in its remedial effects might be devised. As now administered, asylums for such unfortunates afford little more than a place where they may be isolated from society, kindly treated, and a watchful oversight maintained to prevent them from committing injury upon themselves or their attendants.”
Says another expert, who was superintendent for many years over the next oldest hospital in Massachusetts: ” Lunatic liDspitals do not prevent insanity, because they do not, by the intercourse of their officers with society at large, published reports, and by their general relations to the public, seek to enlighten the people on the subject of insanity?its predisposing causes, its hereditary tendencies, its relations to intemperance, poverty and crime ; and therefore they do not improve the community in this respect, except in removing from its care some of its great burdens.”
Says another expert, who was long superintendent of one of the largest hospitals in New England, in his report: ” The more we see of mental disease in its various forms, the more we are convinced that the study of its ‘prevention is infinitely more important than even the study of its cure, and that the dissemi- nation of more correct views of the true way of living and a more rigid observance of the laws of health and nature would greatly diminish its frequency.”
What is the testimony of still higher authority on the subject? The Commissioners in Lunacy for Scotland, in a late report, state that?” It is impossible to come to any other opinion than that insanity is, to a large extent, a preventible malady, and it appears to us that it is in the direction of preventing its occurrence, and not through the creation of institutions for its treatment, that any sensible diminution can be effected in its amount. Lunacy is always attended with some bodily defect, or disorder, of which it may be regarded as one of the expressions or symptoms. We must therefore attempt to prevent its occurrence in the same way as we attempt to prevent the occurrence of what are called ordinary bodily diseases; and if it be admitted that to a large extent preventible diseases exist among us in consequence of the ignorance of the people, it is clear that we can only convert the preventible into the prevented by the removal of that ignorance through a sounder education. In short, we can only hope that preventible diseases will be diminished in amount, when the education of men is so conducted as to render them both intelligent and dutiful guardians of their own physical, intellectual and moral health. To this, and not to any machinery, however good it may be, for the treatment and cure of insanity, can we reasonably look for a diminution in its amount.”
Let us cite another witness on this point, who may he considered as high authority as can be found. Last year a select committee was appointed by Parliament to inquire into the operations ot the ” Lunacy Law.” In the testimony given before this committee by Sir James Coxe, is this statement: ” That ‘ prevention is better than cure’ is a saying familiar to every one; but it does not seem to have been sufficiently considered that it would be possible to take measures to stop the occurrence of insanity. The fact is that we have allowed a terrible evil to grow up among us, and that we have been content to lop the branches, leaving the growth as luxuriant as ever, instead of directing our efforts to destroy it at the roots.” Sir James Coxe, in speaking of the results of hospital treatment in the cure of insanity, says only ” about 40 per cent, of the admissions prove recoveries.” ” The fact is indisputable that, as the case actually stands, asylums are places of curative treatment for only 10 per cent, of their inmates, and mere places of detention or safe custody for the remaining 90 per cent.” The statement here made respecting the asylums in Great Britain will apply, we fear, with equal force to the insane in this country. It is a sad thought that 90 per cent, of all the inmates of these institutions are incurable, and hence the rapid increase of chronic insanity. What a powerful argument does this fact present in favour of using all possible means for the prevention of the malady !
Within a few years more careful investigations have been made than ever before respecting the cure of insanity. As a result of these inquiries, much surprise has been expressed at the large proportion considered incurable. After the disease has continued a year or so without improvement the case is regarded as chronic, and the chance of recovery is small. Inasmuch as many new cases have no proper treatment, and others receive no permanent benefit from treatment, large numbers are constantly passing into the chronic state. Nearly all the insane now found in private families and almshouses are composed of this class, and who are by far the largest proportion in the lunatic hospitals. As society grows older, the greater is the proportion of the chronic insane. Thus in New England this class would be larger than in the Western States. So rapidly and extensively have the insane increased that their support has become very burdensome. Individuals and families have expended money liberally, year after year, upon some friend, looking in vain for improvement. States, cities and towns have been called upon to increase from time to time their appropriations for this class. So oppressive has this burden become in some quarters, that the question is now often raised, ” What can we do with the chronic insane ? ” How much wiser and more pertinent the question, ” What can be done to prevent insanity ? “
Wherever in society any abuses or evils exist, in order to check or eradicate them we must understand distinctly what they are and what are their primary causes : and not the mere results or effects of an evil, but its chief sources, or constituent elements, must be clearly apprehended. Thus, in regard to insanity, its results or fruits in certain aspects have been pretty well understood, but much less its causes. What, then, is insanity ? And can it, to any extent, be prevented ? All admit that it is a disease, and like all other diseases a violation of some law?it may be a physical, mental, or moral. Says one of the highest authorities on the subject: ” Insanity is a disease of ignorance?ignorance of the human organism and the laws which regulate it; and the only way to check its growth is by a general diffusion of a knowledge of these laws, and the use of all those means necessary for the preservation of good health. Insanity originates in some form of disease?in a deterioration of the body rather than in an exclusive affection of the nervous system. The six leading factors are : dissipation in various forms, overwork, meagre fare, lack of ventilation, and neglect of moral culture.” In these few words we have much truth expressed. For the prevention of insanity, then, the same course must be pursued as with reference to other diseases. Ascertain its causes?diffuse information on the subject. This may be accomplished in a variety of ways: by enlisting the press, through journals and books ; by family and educational training, by legislation and associated action. For illustration: if intemperance is one of the leading causes of insanity, it is high time the fact should be generally known and the warning brought home to all. If ill-health is adjudged a more fruitful source of the malady, let us understand that. If hereditary influences, in all their diversified forms, constitute another fruitful source, let us understand better the laws that regulate these influences; or, if fast living or high-pressure in our educational systems are steadily swelling the ranks of the insane, the sooner these truths are brought home to the public mind the better.
Some may say that the causes of insanity are involved in so much obscurity and mystery that they cannot be found out. Fifty years ago this remark might have been made respecting a great many diseases which are now correctly understood. Let the same means be as carefully and thoroughly employed here as upon other diseases and the causes and treatment of insanity will be far better known.
It has been remarked that within a few years there have been great advances made in a better understanding of the laws of life and health; special pains have been taken to diffuse in the community a knowledge of physiology as connected with sanitary and hygienic agencies. To such an extent has this knowledge been diffused that the inquiry is beginning to be raised on all sides, not merely how to cure, but how to prevent disease. In many States boards of health have been formed, and legislation has commenced in earnest in devising plans and providing on a large scale the means for the prevention of disease.
But how is it with insanity ? What progress has there been made towards its prevention ? How much do people at large understand about its causes? How can the increase of this disease be stayed unless proper means are employed to make people acquainted with its causes ? The medical profession itself should give this subject far more consideration and be better prepared, not only to treat the disease, but to counsel the public wisely in respect to it.
There has been a large accumulation of facts expressed in tables and figures, in hospital reports and books, which, if brought together and analysed, would throw much light on the subject. But there has been no demand on the part of the public for such services, and no inducements offered by legis- latures or trustees of institutions. Any amount of money can be expended in building and managing lunatic hospitals, but nothing comparatively to prevent insanity. If one-tenth of the means now so lavishly bestowed upon this unfortunate class in large institutions was expended in different ways, to prevent insanity? in cutting off the supplies?what a vast difference it would make in diminishing the number of the insane and reducing the amount of suffering ! How long will it take the public, and legislative bodies particularly, to learn the truth of the proverb?” An ounce of prevention is worth a pound of cure ” ? If, by a general diffusion of a knowledge of hygiene and the application of sanitary laws, one-third or more of the sickness and premature mortality can be prevented, certainly one-third of the existing insanity should be prevented by similar means, especially as preventing disease and improving the general health will aid essentially in checking the first approaches of insanity.
It should be the settled policy of all legislative bodies and the executive officers of every State to carry on some systematic measures for the prevention of insanity; and unless such pro- vision is made by legislative action, the work, we fear, will never be done. The number of the insane and of lunatic hos- pitals, together with the burdens of their expense, will increase more and more. Let prevention receive some attention as well as cure. The claims of humanity and public economy demand it. So does a higher state of civilisation. It is not wise to build great institutions and make large appropriations for carrying them on without doing something to remove the causes which necessitate such measures.
3.?PREVENTION OF CRIME.
A little more than one hundred years ago John Howard published his celebrated work on the Prisons of England and Wales. From that period a new element entered into the treatment of prisoners. They began to be treated more like human beings, with the possibility of reforma- tion. The principles of humanity and philanthropy prior to that time had scarcely been recognised in dealing with this class of persons. But during the first half century?from 1778 to 1830?the reform made very slow progress. About this latter period commenced two great experiments in prison discipline, denominated the ” congregated system ” and that of ” solitary confinement.” These experiments created much dis- cussion, which gave a new impulse to the reform. Daring the last half century, and especially within twenty- five years, many changes have been made. New questions in prison discipline have continually arisen and experiments of various kinds have been tried. While some nations have shown more interest and made, perhaps, farther advances in reform than others, each has had its own system of discipline with its peculiar merits. In our own country important improvements have been made, but still many defects exist; we fail to reap the results which ought to be obtained, especially in the reformation of prisoners and the prevention of crime. The leading objects of prison discipline may be expressed under these three heads : ‘punishment, safety, and reform. As to the importance of securing these three objects all, we believe, are agreed, however they may differ in the modes of doing it, or on minor points. These objects are here placed in the order in which each has come up in history and in accordance with the prominence which many persons seem to attach to the whole subject; but really reformation should be the main object of confinement and punishment, for it is more important than both of the others.
The true test of such discipline is in the proportion of prisoners discharged, improved or reformed on the one hand, aod, on the other hand, of those released unimproved and per- haps made worse. If the former object was generally secured there would be few re-committals and far less increase of criminals. But unfortunately statistics show that crime is constantly increasing, that prisons of all kinds are everywhere crowded, and that nearly one-fourth of their inmates are re-committals. It is very evident that there is something’ wrong in the present methods of dealing with criminals?that the ends attained do not correspond to the means employed that reformation in the prisoner is not generally effected. Without attempting anything like a full discussion of the sub- ject, we propose to notice it briefly from a single point of view, viz. the prevention of crime.
There are two standpoints from whence facts and arguments may be brought to show how crime can be prevented : First, we may check crime in criminals, and secondly, keep persons from becoming criminals.
While, in the present state of society, it may be impossible for human means to prevent some persons from entering upon a criminal career, much may be done to break up such habits when once formed, and to produce a radical change for life. It is an encouraging fact that wherever the proper means have been brought to bear, the character of prisoners has been improved and the number of criminals reduced. Unfortu- nately this part of prison discipline has been altogether under- rated or neglected, while confinement and punishment have received relatively too much attention. Keform in habits and character has been considered of minor consequence. In fact, such has been, not unfrequently, the treatment of criminals both in spirit and manner, as to produce anything but a refor- matory influence upon them. There are laws of mind as well as of body which, if violated, serve to make the individual more of a criminal. Let the animal and selfish nature in the prisoner be mainly exercised, without developing his moral and intel- lectual powers, and no reformation in his habits or character takes place or can be expected. As this treatment of prisoners involves laws which lie at the foundation of all reform and, of course, of correcting criminal habits, it should receive the most scrupulous attention. The criminal is a human being and governed by law. Crime is a violation of law?not merely civil, but moral?a law of nature. The criminal has all the faculties of other persons, but not well balanced or properly enlightened and trained. While the safety of the community and the principles of justice require that the criminal should be confined and punished, it should be done in harmony with laws which develope his higher and better nature. No criminal was ever reformed by being treated in a brutish manner, nor by appeals only to his animal and selfish nature. The conscience must be enlightened and the intellect instructed. Hence educational, moral and religious influences ought to be brought into requisition far more than they are. No prisoner should ever be discharged without being improved if possible in his habits and character. This reform must be an individual work ?the treatment varied or adapted to every case. Eeform seldom if ever occurs in classes or large numbers at once. Such a work requires time, labour, and means, but its results will abundantly pay.
It is in this respect that prison discipline fails?its subject is not reformed, neither is crime checked. It is in this direc- tion that improvements should be made, which woidd have a powerful influence in the prevention of crime.
The most important reform in prison discipline that has anywhere occurred is in Ireland. This is based upon a system of improved classification of rewards and promotions, as well as of encouragement and assistance to prisoners after being re- leased. This reform commenced some thirty-five years ago, and has resulted in a great decrease of crime as well as of the number of convicts. Improvements of a similar character have been introduced into the English prisons, and have been attended with decidedly beneficial results.
We regret that we cannot report favourably in this respect of prison discipline in our own country. Since the Civil War, crime has everywhere rapidly increased, and in some States it is estimated that it has doubled. No thorough and systematic measures are taken to reform prisoners; the old ranks are kept good, and new recruits are constantly being added. Great pains are taken to provide prisoners with labour, to make contracts and obtain as much money as possible out of their work. If we had the same amount of effort expended in reforming their habits and character, crime and criminals would decrease. There is great need of legislation on this particular point, and that the managers of prisons have the power and be specially instructed to adopt efficient measures for the reform of prisoners. The second means of preventing crime, viz. keeping per- sons from becoming criminals, opens up a very important field of inquiry. It may be convenient to discuss both those agencies that shape and mould human life after birth, and those that beget and fashion the constituent elements of the body prior to birth.
All history proves that the criminal class as a body originate from a peculiar stratum or type in society?sometimes from the middle or common walks of life, but more generally from the lowest orders, especially from the ignorant, the shiftless, the indolent and dissipated. Occasionally we find some from high life, from those in good circumstances, from well-trained farni- lies, from good homes. But these are altogether the excep- tions. In such cases, any new or additional means to reform them would be comparatively useless. If our object, then, is to prevent crime on a large scale, we must direct attention to its main sources?to the materials that make criminals ; the springs must be dried up, the supplies must be cut off. This fruitful source or fountain head of crime is found among children of poor or miserable parentage, surrounded by bad influences and exposed to all manner of temptation, with no one disposed or qualified to train and educate them. Such are the liot-beds of vice and crime. On account of indolent, shiftless, and dissi- pated habits, such people continue poor and dependent, the children stray away from their homes, large numbers also become orphans and fall upon the public for support, or become pests to society. All such children should be picked up and gathered into reformatories, or find homes in good private families, which are the best reformatory institutions in the world.
Again, in such low communities, abounding with children, and where the children are not separated from their parents, compulsory education should be enforced ; the State or munici- pality should see to it that every child is brought into the public school and educated. Efforts in various other ways should be used to bring moral and religious influences to bear upon such families and neighbourhoods. Children become vicious and criminal frequently on account of their surroundings and immediate exposures. The sooner children can be removed from such localities and circumstances the better. The public are not sufficiently awake to these upas-trees of poison, these pests and hot-houses of vice. All legal and moral means should be employed to reform such classes. Every State and city should adopt systematic measures for this purpose. The saving in taxation alone will pay for it. In no other way can crime be so effectually prevented.
More prolific than any other in the production of crime is the vice of intemperance. This operates in so many ways that it is impossible to trace out all its pernicious effects. It im- poverishes people and brings them into circumstances of tempta- tion ; it corrupts the morals and poisons the blood ; it excites the evil propensities and developes the animal nature; it stupefies conscience and destroys the moral sentiments; it im- pairs in man the powers of free-agency and converts him into a brute. “Whatever produces such effects upon the human system must have a powerful influence in the production of crime. The evidences come from all quarters (and without contradiction from any) that intemperance is the cause or occa- sion of three-fourths of all the crime committed?some estimat- ing it even higher. The habit commences early and more readily with individuals and families who are predisposed to idleness and to a low, animal life. The natural instincts of such persons flow in one direction, and drinking becomes a master-passion. If intoxicating drinks can be withheld from this class of persons, their habits and character become gradually improved. Total abstinence would do much to save them from a life of vice and crime. By this means more than half of the crime committed would be prevented.
But the primal and principal cause of crime exists in a state of things prior to birth. That the ” child resembles the parent,” and ” like begets like,” are acknowledged truisms. It is also true that this resemblance or likeness extends to all parts of the brain, and, of course, to every faculty of the mind. If the lower and posterior part of the brain is predominant and continuously active, the animal propensities and selfish faculties will take the lead in character. If the parents are addicted to habits of dissipation and sensuality, the children will be predis- posed to the same. If these habits are inveterate, the propen- sities are transmitted in an intensified form.
These transmitted qualities are more marked and have a much wider range than is generally considered. The blood itself may be tainted and affect the structure and function of every organ in the body. Such may be the physical develop - ment as to incline one to lead an idle, low, and dissolute life, without ambition or self-respect. A living or means of support must be obtained without work or rendering an equivalent. There may be a strong will and an overmastering passion of selfishness, so that the individual is not inclined to be governed by the principles of justice or to regard the rights of others. Such persons become an easy prey to temptation.
The now celebrated ” Margaret, mother of criminals,” re- ported in New York two years since, furnishes a striking illus- tration of hereditary crime. An investigation was made through the New York Prison Association in the gaols and prisons of the State, extending back six generations, which resulted in tracing out nearly 300 criminals descended from one wicked woman! If a thorough inquiry were made on this subject, doubtless other similar illustrations would be found. If the truth could be known, we believe a large amount of crime would be traced back to hereditary influences.
How much crime might be prevented if certain classes of vicious persons could be hindered from propagation! What right have such individuals to bring upon the public so much misery, shame and cost ? Within a few years laws have been passed for the forcible removal of nuisances and other evils, either injurious to health and life or detrimental to the welfare of the community. With the rapid progress of sanitary science and the great advances in legislation, some means, we believe, will yet be devised for preventing, at least to some extent, the evils growing out of criminal heredity. Let the public mind be enlightened on this subject, let parental responsibility be placed on high ground, and the evils of improper marriages be pointed out, and within two or three generations a great amount of crime would be in this way prevented.
PREVENTION OF PAUPERISM.
The term pauperism applies to that class in the community which is more or less dependent upon the public for support. It includes large numbers of the diseased, the insane, and the criminal, and therefore all efforts made to prevent their increase will go far to prevent pauperism. If these widespread and terrible evils?disease, insanity and crime?can be greatly checked by human agencies, so can those of pauperism. But to do this successfully, its primary causes or sources must be first understood. As the expense of pauperism constitutes at the present day the heaviest single burden which the public has to bear, the subject has been very fully discussed in a variety of ways and by a great many writers. The manner and extent of supporting paupers have received far more attention than the precise means of reducing their numbers. Pauperism will never be diminished by small or large alms- houses, by loose or general statements, nor by dealing with it in the mass. The history and characters of paupers as in- dividuals must be carefully studied ; the precise causes and influences that made them such must be ascertained, and then we must inquire what can be done to remove these causes or modify their influences. Who are paupers? What is their history and character ? What caused or made paupers ? Care- Tul observations show that large numbers have certain charac- teristics in common, making what may be called a pauper class, and continue as such for generations. In every large alms- house are found, to some extent, a permanent set of inmates who have connections in the same or in other almshouses, and whose parents or ancestors have been frequent inmates in such establishments. There is such a thing as families breeding pauperism and perpetuating it for generations. It is found that they have peculiarities in organisation and character, which can be traced back to the same or similar causes. Another striking fact is developed by extended inquiry in almshouses, viz. that the number of really ivorthy poor, who started well in life, with good habits and characters, is quite small in these establishments. It is only now and then that one of this class by a series of misfortunes becomes a pauper. An impression prevails in some communities that there are large numbers of this class in almshouses; but it is not so. Careful inquiries prove that such an impression is erroneous. This fact, as will be seen, is very important, when we come to look at the primary causes of pauperism?its starting-points and leading agencies.
In our attempts to prevent pauperism, it becomes us to inquire where, how, and by what means it can be best done. Like some other evils, it is very difficult to eradicate or check when once started. When an individual once becomes a pauper, he loses that pride and self-respect which have kept him a long time from a position of want and dependence. Then such are the associations and influences that surround this class of persons, that when they once become paupers, it is for life. Only occasionally, by the help of some friend or fortunate circumstance, the inmate of an almshouse gets away from the establishment and finds a support elsewhere, and never returns. Again, sometimes by improvement in health, or the assistance of friends, paupers leave an almshouse for a season, but when their means fail they return to their old quarters. There is still another class of paupers who for various reasons get out of an almshouse, thinking they can and shall in some way take care of themselves, but who, by their indolent and dissipated habits, soon come to want and are returned to the almshouse. So powerful are the influences forcing the pauper downward that he seldom becomes self-supporting.
Thus, in the prevention of pauperism, very little can be done in reclaiming those once paupers and making them permanently self-supporting.
Ignorance has always been considered a leading cause of pauperism. In a careful examination lately of some ten thousand paupers, over 16 years of age, in the city and country almshouses of the State of New York, it was found that 32 per cent, could neither read nor write; 14^ per cent, could read only, and 24 per cent, read and write, while 29^ per cent, had received a fair common-school education. The last class? comprising less than one-third of the ten thousand?is the only portion whose education could be considered of much service in enabling them to take care of themselves.
Intemperance is a fruitful source of pauperism. In the ten thousand paupers examined in the almshouses of the State of New York, almost four thousand males and a little over two thousand females were found of intemperate habits, making 62 1-2 per cent, of the whole. The same line of inquiry was extended to the parents of the twelve thousand paupers in these almshouses; and though nothing definite could be ascertained in respect to large numbers, yet more than four thousand of the fathers and mothers were found to have been intemperate. This fact shows that the law of inheritance may have a powerful agency in the production of pauperism.
It is presumed the same proportion of ignorance and in- temperance found in New York will apply to the paupers in other States. In Massachusetts, attempts have been made by its boards of health and State charities to ascertain, through overseers of the poor, just how far intemperance was the cause of pauperism. The results of these inquiries cannot be given in figures, but in the opinion or testimony of the best judges on the subject. The report from Boston says about 80 per cent.; from the other cities in the State, from 50 to 70 per cent.; and in country towns, from 30 to 60 per cent. In the larger institutions?the State prison, almshouse and workhouse ?the estimate is 75 per cent., and in the lunatic hospitals, confining the estimate to the class who become paupers, the percentage must range from 20 to 30 and perhaps higher. The average estimate for the whole State must be about 67 per cent. Thus intemperance is the cause of two-thirds of the pauperism in Massachusetts.
In making this statement there should be some qualification, by saying that intemperance may not be the sole or exclusive cause. It is sometimes very difficult to separate cause and effect. We may have idleness, poverty, and dissipation, each aggravating the other; but after all, the latter is by far the most active and powerful. Intemperance is therefore called the cause, the chief cause, the occasion of pauperism, as the other agents alone would never bring about such a result. But ignorance and intemperance are not the only causes of pauperism. Indolence, improvidence, and licentiousness con- tribute also their share. These vices very generally go together and enter early into the habits and character of children. Such influences beget paupers ; they are the materials that make them. Wherever individuals, families, and neighbourhoods are slaves of these vices, pauperism has its strongest foothold and will rapidly increase.
Now, such a state of things can be accounted for only in two ways : First, The environments or surroundings ; and second, the conditions of birth. These two agencies constitute the primary causes or sources of much pauperism. Here the anti- dote of prevention should come in, to change these surroundings. Education, temperance, and other good habits cannot be forced upon, or easily grafted upon such individuals and communities. Children so situated should be removed, if possible, from such surroundings and placed in good families or industrial schools. Families living in this way should be separated and scattered ; such neighbourhoods should be reformed or broken up. By such changes a vast amount of pauperism would be prevented. Let public opinion be enlightened upon this point and legisla- tion take hold of it; let proper systematic measures be employed for this purpose, and the reform will come.
One of the most encouraging agencies for preventing pau- perism is a wise provision for poor children. The gathering up of homeless and orphan children, and removing all found in almshouses?placing them in schools and finding homes for them in private families?is doing much to prevent pauperism. Within a few years Massachusetts and New York, by legislation and other means, have nobly taken hold of this work, and immense good is being accomplished. Let this reformatory movement be vigorously carried on for a series of years and it cannot fail to prevent a large amount of pauperism.
The second primary source of pauperism, viz. conditions of birth (including the laws of inheritance), is in some respects more important than all the rest. This is the beginning?the fountain-head?where the streams start. If the seed were good, the stock sound, it would not bear so much poor fruit. It is rare that a person born into the world under favourable condi- tions, from sound, healthy stock, and early trained in a well- ordered family, ever becomes a pauper. Such is the design of Providence, such is the law of nature. So far as pauperism arises from violation of natural law, its origin should be better understood. The most thorough and extended investigation ever made in this country as to the primary causes of pauperism was the one already referred to, in New York. Near the close of that report is found this statement:
” The examination has made it clear that by far the greater number of paupers have reached that condition by idleness, improvidence, drunkenness, or some form of vicious indulgence. It is equally clear that these vices and weaknesses are very frequently, if not universally, the result of tendencies which are to a greater or less degree hereditary. The element of heredity enters so largely into the problem of pauperism that it should receive special attention. Few persons who have not given detailed attention to the subject realise how much of vice and pauperism, idiocy, and insanity is hereditary. It is a subject to which little attention has hitherto been given, at least outside of treatises on physiology; but the time is rapidly approaching when its importance will compel the attention of the moralist as well as the law-maker.”
The time has already come, we believe, when this subject should receive special attention, and in no other way can the same amount of pauperism be prevented than by a better observance of these laws. Let us examine a little into the nature and operation of hereditary agencies in their relations to pauperism; the better these are understood the more import- ance will be attached to them.
If idleness, improvidence, intemperance, and licentiousness are prime factors in the production of pauperism, these have their germs or springs in physical organisation. The desire, the craving, the predisposition for such vices were transmitted from parent to child. A poor physical development throughout or a predominance of the animal nature, characterised un- doubtedly the ancestry for two or three generations. A feeble, sickly body may have been inherited, impregnated with disease, it may be scrofula or some other poison. The diseases thus generated are of the worst type, the most difficult to cure, and the most destructive to industry and self-support. Disease, in all its diversified forms and attendant conse- quences, is productive of more pauperism probably than any other one cause. It is not the disease so much found in hospitals and public institutions as that everywhere scattered in the common walks of life, and especially in the lower orders of society. Sanitary measures and boards of health will, in the course of time, do a noble work in the prevention of pauperism ; but if, then, the hereditary diseases which are generally more prevalent in that class of the community most likely to become paupers, could be prevented or abridged, it would save an untold amount of pauperism, especially in the course of two or three generations.
If this prevention of disease, or improvement in hereditary agencies, could be extended to the defective classes?to the idiotic and feeble-minded, to the deaf and dumb, to the blind, and the insane?it would make a notable difference in the amount of pauperism. The cause of our finding so large a number of paupers in these defective classes, is violated physical laws, either on the part of the individuals themselves or their ancestors. While we cannot determine just what proportion of these evils are of hereditary origin, nor point out exactly the line of causation in their production, there is no question but that a great deal can be done, by proper means, towards prevent- ing them.
In the condition of these several classes there is one feature bearing on pauperism which should be alluded to. Whenever they once become paupers, it is generally for life. The expense of supporting such paupers is very large and becomes every year more and more burdensome. Private means gradually become exhausted, and the public is constantly being burdened with a larger and larger proportion of these dependents. Striking illustrations of this might be cited in the case of chronic insanity. And we can see no reasons why pauperism from these sources should not continue to increase, unless some systematic measures are adopted to prevent the filling up of the ranks of these defective classes.
Within a few years great advances have been made in the knowledge of the laws of inheritance; and there are reasons to believe that we have only entered upon the threshold of researches in this direction. When more extended observations are brought to bear upon this point, and when the quality of the blood and pathological anatomy, in their relations to heredity, shall become more thoroughly inspected by the microscope, these laws of hereditary descent will be far better understood. Besides, it will be found that these laws all have their origin in a general law of propagation, which is based upon a normal standard of physiology, perfect in structure and healthy in function; and that marked deviations from this standard predispose the subject, it maybe, to disease, or insanity, or crime, or pauperism. When these deviations or violations of law are continued through two or three generations, their effects become more marked or intensified. As all these changes are brought about by human agency, the cure or remedy is lodged in the same hands. When these hereditary laws shall become correctly and generally understood, it will be seen that the public at large has the power to modify or avert evils which are terribly oppressive and burdensome. Prevention in this way is infinitely better than cure.
In closing this paper, it is unnecessary to enlarge upon the magnitude of the evils here mentioned. Our aim has been to adhere strictly to a line of thought, fact and argument, which is practical and commends itself to the common sense, as well as intelligence, of the community. The indications are marked that, in the treatment of disease, certain agencies have been set in motion which must result in great reform. If the next twenty years shall witness as much improvement as the past, there will be found at the close of this century a marked dimi- nution of disease, as well as improved rate of mortality and prolongation of human life. The principles of physiology and hygiene in their hearings on health will become far better understood, enabling individuals to take better care of themselves and to ward off tlie first approaches of disease. As about one- third of all insanity can be traced to hereditary sources, the general improvement of the constitution and health of a people will go far to prevent insanity; and in case persons become insane, this same knowledge will afford essential help in its treatment.
It may be said, that while this improvement in physical organisation and extension of knowledge may serve to prevent disease and insanity, its effects in diminishing crime and pauperism cannot be very marked. But in time (it may take two or three generations) such a reform must reach the criminal and the pauper. Improve physical organisation and diffuse practical knowledge concerning it?and the number of criminals and paupers must be diminished. It cannot be otherwise. Improvements, based upon the principles of science and involving the highest welfare of man, never go backward nor remain stationary. Such reforms, once started, must go forward. A distinguished statesman, in the immediate prospect of death, once expressed the desire that, if it were possible, he might live fifty years more to see certain reforms in government. So the philanthropist, in forecasting the future, may well express the wish to live another half-century, to witness the great improvements in society arising from the unfolding of physical laws and the applications of science.
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