Daniel Hack Tuke

“ It is constantly forgotten that while there is nothing better than true civilization, there is something worse than the condition of certain savages, and that almost anything is better than that stratum of civilized society which is squalid, and drunken, and sensual; cursed with whatever of evil the ingenuity of civilized man has invented, but not blessed with the counteracting advantages of civilization. ”

“ Recklessness, drunkenness, poverty, misery, characterize the class; and no wonder that from such a source spring the hopelessly incurable lunatics who crowd our pauper asylums, to the horror of rate-payers, and the surprise of those who cannot understand why the natives of Madagascar, though numbering about 5,000,000, do not require a single lunatic asylum. We may add that they do not destroy the few insane and idiots which they have. ”

“ If the questions which are now asked are not too severe when taken alone, they are regarded by many competent judges as frequently too severe when taken in combination with the other subjects examined upon, and also that they are sometimes calculated to puzzle the student, from the form in which they are worded. Not long ago an examiner at the London University, speaking to another examiner, boasted of the puzzling questions he had been ingenious enough to ask, whereupon the other replied, to my great satisfaction, "You should try and find out how much, not how little, the students know." ”

“ A luxurious, idle life is her curse. That insanity itself, as well as mere hysteria, is developed by such a mode of existence, we fully believe. The mind, although not uneducated, deteriorates for want of either healthy intellectual excitement, the occupation of business, or the necessary duties of a family. Life must have an aim, although to achieve it there ought not to be prolonged worry. ”

“ Had Hunter been trained upon the present system, had he been weighed down by tightly compressed facts when a student, and subsequently, by out-patient-seeing, on the one hand, and pupil cramming on the other, it is scarcely to be supposed that even his mind could have burst the iron fetters, and could have regained its elasticity and love of work, or that even he could have found time for those reflections which gave such impulse to the science and practice of surgery. ”

“ While insanity may not directly result from this stuffing, and very likely will not, exciting causes of mental disorder occurring in later life may upset a brain which, had it been subjected to more moderate pressure, would have escaped unscathed. Training in its highest sense is forgotten in the multiplicity of subjects, originality is stunted and individual thirst for knowledge overlaid by a crowd of novel theories based upon yet unproved statements. ”

“ With Democritus 'we should strive not after fullness of knowledge, but fullness of understanding'; that is, that we should strive for good, clear, solid, intelligent, producible, and available knowledge, of the kind that will be useful in after-life; not so much the refinements of chemistry, anatomy, and physiology, which stupefy and then pass away like chaff before the wind, but the essential fundamental facts and principle, welded together, and so woven into the student's mind that he can hold them firmly and wield them effectually ”

“ So again with regard to intemperance, and all that it involves, in spite of the difficulty of discriminating between the many factors which often go to make up the sum total of causes of an attack, we have no doubt of the large influence for mental evil exerted by drink—always admitting that where the constitution has no latent tendency to insanity, you may do almost what you like with it, in this or any other way, without causing this particular disease. A man will break down at his weak point, be it what it may. ”

“ In a large proportion of other cases we satisfied ourselves that overwork meant not only mental strain, but the anxiety and harass which arose out of the work in which a student or literary man was engaged. The overwork connected with business, also largely associated with anxiety, proved a very tangible factor of insanity. Indeed it is always sure to be a more tangible factor of mental disease than overwork from study, because of the much greater liability to its invasion during the business period of brain-life than the study period. ”

“ In conclusion, I would express the hope that the expression of opinion in the Psychological Section of this Association will strengthen the hands of the Metropolitan branch, which has taken up this question with much earnestness, and, although starting from a different stand-point from my own, has been equally impressed with the evils attending the present system of medical education. I am moved by the conviction that its influence upon the mind is injurious; they by the fear that it fails to produce the best men, and the belief that it is altogether unreasonable.—Journal of Mental Science. ”

“ The number of hours actually spent in school does not (as a general rule) appear to be excessive in our large public schools. There are exceptions, but this evil and the multiplicity of subjects taught apply rather to the private schools. Where the chief danger seems to lie in most schools is in the encroachment made on the play-hours. In some day schools the lessons set to learn at home are absurdly long and tedious. I find that in other schools, public and private, a great deal of work is done during the period nominally allotted to recreation only. ”

“ THE relation between modern civilized life and insanity cannot be regarded as finally determined while a marked difference of opinion exists in regard to it among those who have studied the subject; nor can this difference be wondered at by any one who has examined the data upon which a conclusion must be formed, and has found how difficult it is to decide in which direction some of the evidence points. Statistics alone may prove utterly fallacious. ”

“ It is obvious that such a case as this is the very child of a highly-organized society, that is, of a high state of civilization, and yet that such a young lady is not the victim of high pressure or mental strain in her own person, although it is certainly possible that she may inherit a susceptible brain from an overworked parent. However, the remedy is work, not rest; occupation, not idleness. We certainly do not want to make her more refined or artificial, but more natural, and to occupy herself with some really useful work. ”

“ Fantastic scruples and religious delusions frequently spring up in this soil. Such persons have been saved from the evils of drunkenness and vice; they have also been sheltered from worry and excitement, yet, to the astonishment of many, they become the inmates of a lunatic asylum. They have in truth escaped the Scylla of dissipation or drink, only to be shipwrecked on the Charybdis of a dreary monotony of existence. ”

“ While it must be remembered that, when we speak of boys being engaged in study for ten hours, those who are lazy are not closely and continuously engaged in their work, and that if the master is not strict the strain is not necessarily severe, I can not but think that it would be better for the health of the scholars in this school if the total amount of time engaged in school or study did not exceed eight or at most nine hours. I am quite alive to the danger attending too liberal an amount of time being left at the disposal of schoolboys; they do not find it difficult to get into mischief. ”

“ Huxley said that to expect students to pass an examination in the subjects on which they are now examined, after only four years' study, was little short of "criminal." He characterized the attempt "to cram the student with all these subjects as utterly preposterous. The amount of work expected is simply gigantic." Mr. Hutchinson said: "The best memories stagger under the present load. . . . That after four years' study a student can be expected to bear his subjects in mind is simply an absurdity." ”

“ Educators and examiners must at least have no chance of sinning from ignorance, although, as I have said, some who know most of the laws of physical and mental health are the chief culprits. It must be insisted that they are oftentimes putting too heavy a weight upon the camel's back, and it is for them in the first instance to consider in what way they can best diminish the tension, and, as regards medical education, rearrange the curriculum. ”

“ Unpreventable lunacy will still exist, but a great saving will be effected for British rate-payers when that which is preventable shall have been reduced to a minimum by the widest extension of a thorough but not oppressive and too early commenced education, by the practical application of the ascertained truths of physiological and medical science, and by the influence of a Christianity, deep in proportion to its breadth, which shall really lay hold of life and conduct, and mould them in accordance with itself.—Macmillan's Magazine. ”

“ Again, the lessons are taught of the importance, not of mere education, but a real training of the feelings; the evil of mental stagnation, not simply per se, but from the train of sensual degradation in one direction, and of gloomy fanaticism in the other, engendered, and the danger of dwelling too long and intently on agitating religious questions, especially when presented in narrow and exclusive forms, which drive people either to despair or to a perilous exaltation of the feelings. ”

“ That the increase of known cases of insanity has been very great, no one, therefore, disputes. Further, that the attention paid to the disease; the provision made for the insane; the prolongation of their lives in asylums, and the consequent accumulation of cases, and other circumstances into which our limits forbid us to enter, account for the greater part of this alarming apparent increase, is certain. Whether, however, there is not also an actual increase, unaccounted for by population, or by accumulation, remains an open question, which statistics do not absolutely determine. ”

“ Overwork is often confounded with the opposite condition—want of occupation. Civilization and mental strain are regarded by many as identical, and in consequence much confusion is caused in the discussion of the present question. It is forgotten that an idle life, leading to hysteria and to actual insanity, is much more likely to be the product of civilization than of savagery or barbarism. This is quite consistent with the other truth, that without civilization we do not see evolved a certain high pressure, also injurious to mental health. ”

“ Having referred to the bearing of the habits of one large portion of the population upon the manufacture of insanity, we pass on to the consideration of the relation between higher grades of modern society and mental disorder. It has been observed in institutions into which private and pauper patients are admitted, that the moral or psychical causes of lunacy are more frequently the occasion of the attack with the former than the latter class. This is not always accounted for—as might have been expected—by there having been less drink-produced insanity among the well-to-do patients ”

“ To true religious reformers, the physician best acquainted with the causation of mental disease will award his heartiest approval. Only as the high claims of duty, demanded from man by considerations of the dependence of his work in the world upon mental health, of what he owes to his fellow-men, and of what he owes to God, are fulfilled as well as acknowledged, will civilized man benefit by his civilization, as regards the prevention of insanity. ”

“ The teacher in a high-school says that the host of subjects on which parents insist upon instruction being given to their children is simply preposterous, and disastrous alike to health and to real steady progress in necessary branches of knowledge. ”

“ I may here record the hours of a school for girls, which appear to me to exceed what is wholesome, and to be well calculated to lessen their mental elasticity and interfere with their healthy development. ”

“ If a Wiltshire laborer is more liable to insanity than other people, it may be not merely because his mind is in an uncultivated condition, but rather because his habits, [2] indirectly favored by his ignorance, and the brain he inherited from parents indulging in like habits, tend to cause mental derangement. It is conceivable that he might have had no more mental cultivation, and yet have been so circumstanced that there would have been very little liability to the disease. ”

“ There is a long period of strain, the climax of which is reached when the period of examination arrives, during which the student's mind has to hold in solution the details of knowledge on many subjects. ”

“ One remarkable feature of modern life—spiritualism—has been said to produce an alarming amount of insanity, especially in America. It has been recently stated by an English writer that nearly 10,000 persons have gone insane on the subject, and are confined in asylums in the United States; but careful inquiry, made in consequence, has happily disproved the statement, and we learn that the amount of insanity produced from this cause is almost insignificant—much less than that caused by religious excitement. ”

“ No time is specified for learning the lines, but they have always to be done between evening school one day and morning school the next, unless the master chooses to set the lesson before." Here we see how important it is, if we wish to estimate the real amount of brain activity in the twenty-four hours, to inquire into the out-of-school tasks, for while, when looking only at the time-table, we may picture to ourselves a boy comfortably asleep in his bed, he may in reality be engaged in hammering his Greek lines into his brain. ”

“ An agricultural county may be found here and there with less lunacy than a manufacturing county, but if a group of counties be taken in which the manufacturing element is greatly beyond the average, and another group in which the agricultural element greatly preponderates, we find one lunatic to 463 of the county population in the former, and one to 388 in the latter, showing an accumulation of more insane paupers in the agricultural districts. ”

“ HAVING met from time to time with cases of brain-fag, and also actual insanity, arising from excessive mental work, I wish to direct attention to-day to this cause of disordered mind, not because it is so widespread a cause as many others, but because for this very reason it is in danger of being treated with indifference, whereas at the present moment I regard it as a serious evil, although comparatively restricted in its operation in consequence of the great mass of the people falling under opposite influences ”

“ He deplored the fashion of the day; the number of subjects crammed within a few years of growing life; the character of the questions which were frequently asked; and the requiring a student to master, at the peril of being rejected, scientific theories, and crude speculations, which they would have to unlearn in a year or two. He sincerely pitied the unfortunate students. During the last year or two the public have been startled by the suicides which have occurred on the part of young men preparing for examination at the University of London ”

“ At a high-school in a large town, I know that some of the pupils have suffered from overwork; two in one family have recently died from "brain-fever," due, it is considered by a medical man, to this cause. Dr. Fayette Taylor, of New York, has drawn a graphic picture of what the Americans are suffering from intemperance in study, and we should do well to take warning from it. "Girls arrive at twelve or fourteen, and, at the threshold of the most important period of existence, utterly unfitted for passing through it. ”

“ It may be stated that the relation between crime and insanity, especially weak-mindedness, is one of the most intimate character, both in regard to the people who commit criminal acts and their descendants. Our examination of the mental condition of convicts, and of their physiognomy and cerebral development, has long convinced us that a large number of this class are mentally deficient: sometimes from birth; at other times their mental development being arrested by their wretched bringing up. ”