life alcohol and worry be added. Judging by the results only we may classify the broken-down as feeble-minded, insane, or epileptic. We are far from understanding the problems

FIG. 28. EXAMPLES OF THE INHERITANCE OF INSANITY DRAWN FROM HOSPITAL EXPERIENCE.

involved. In the charts in Figure 27 such families are illustrated and it will be seen that though the parents appear normal in the first family, some of the children are affected. Of insanity, Myerson, out of a wealth of personal contact, has recently written:

It seems probable that in all the periods of life there occur three main types of mental disease. The one is paranoiac type, a disease with hostility, suspicion, a deluded interpretation of the life around it and a gross, egoistic, over-valuation of the self. The second is a dementing disease, whose prototype is dementia præcox, but which occurs in modified forms in the involution and senile periods. The third is a disease marked mainly by a depressed mood, with lowered energy, absent interest and delusions of a depressive, apprehensive nature, occasionally with excitement and apprehension. The main disease of this type is manic depressive insanity but the involution and senile melancholia are related diseases, perhaps the same disease colored by the emotional and mental reactions of these periods of life.20

In his hospital experience Myerson has found many instances in which for successive generations members of given families have appeared in the institutions, as the charts in Figure 28 show.

Myerson has noted that "the psychoses of brothers and sisters tend on the whole to be alike, at least in their main characters." The types of mental diseases are more similar than are parents and descendants and yet he is unwilling to commit himself definitely as to the rôle of heredity. “We have no conclusive evidence at all that mental diseases are true hereditary characters in the strictest sense but that makes them of no less importance." 21

Guyer seems a bit more inclined to stress heredity. He cites the case illustrated in Figure 29.

Where more than one case of insanity occurs in a given family or stock it is presumptive evidence that a hereditary defect is at the bottom of it. As Dr. Wilmarth says, "mental accident may occur in any family, but it is rarely a second case occurs unless there is a tendency to nerve degeneracy." For example, of 818 insane in the Wisconsin State Hospital for the Insane during the biennium 1909-1910, 187 or practically onefourth, were positively known to have insane relatives. Of these 24 had insane fathers, 31 insane mothers, 30 insane brothers, 23 insane sisters, 25 insane uncles, 21 insane aunts, and 21 insane cousins. Where definite information could be secured it was found that of the 5,700 admissions of insane patients to the New York State Hospitals during the year ending September 30, 1911, 27.7 per cent of the cases showed a history of insanity in the family and an additional 22.9 per cent showed a history of alcoholism, nervous diseases, and the like.22

The Michigan Commission reported that 65.4 per cent of 4,917 insane in the state showed tainted ancestry.

FIG. 29. GUYER'S CASE OF THE INHERITANCE OF INSANITY 23

The total number of the insane in the country is probably somewhat less than that of the feeble-minded but the percentage in institutions is considerably larger, in part because most of the insane are adults. The number in the United States in institutions was about 287,500 in 1923 with 23,000 outside but under parole. The number outside not under supervision is a matter of guess. Tredgold says that there are about 36 insane in each one thousand of the population in England.

For many years there has been an apparent increase of the insane and this was true even of the Negroes after the Civil War. Just how this should be explained is much debated. Guyer says:

The rate per 100,000 of population of patients with mental disease under institutional treatment increased from 118.2 in 1890 to 220.1 in 1920. In New York State in 1925 the rate of admissions per 100,000 of population was 416.7 Such figures of course do not indicate a correspondingly rapid increase in insanity but rather the greater accuracy of recent enumerations, the growing practice of sending the insane to hospitals, and to some extent, reduction in their death-rate. Whether or not mental disorders are increasing in greater proportion than general population we have little reliable data from which to form an opinion. Regarding insanities we are almost wholly in the dark; many alienists believe that there has been an actual relative increase in recent years.24

Epilepsy

Epilepsy is a condition more baffling, if possible, than either of the two just discussed. In fact, we know nothing as to its cause. It seems to have a very real relation both to feeble-mindedness and insanity. Tredgold states that epilepsy appears in about 56 per cent of the simple idiots. He says that the "advent of puberty often ushers in a marked alteration of character and behaviour." 25 They become unreliable and destructive. Comparatively few epileptics ever recover. At the Craig Colony from 1896 to 1918 only 62 out of 4,077 patients were discharged as cured. In 1923 there were some 23,760 inmates in our institutions but there must be between 200,000 and 300,000 in the country.

Heredity seems to play a part in epilepsy and the English authorities appear to believe that about 35 per cent of the severe cases are inherited.

...

is

In a paper by Weeks (The Inheritance of Epilepsy) recorded among others a study of 27 fraternities in which both parents were either epileptic or feeble-minded. Of the 28 progeny, 18 lived long enough to reveal their mental state. Of these 3 were feeble-minded, epileptic and 8, from parents who developed epilepsy late in life, were what Dr. Weeks terms "tainted." In 15 fraternities in which one parent was epileptic and the other feeble-minded he found there had been 81 conceptions. Of these 7 were too young to classify and 19 had died before fourteen years of age. Of the remaining 55, 28 were epileptic, 26 feeble-minded, and I insane. Again, in 9 families in which the parents were both feeble-minded, of the 38 surviving offspring who were old enough to classify, 7 were epileptic, 29 feeble-minded and 2 drunkards. In 5 families where one parent was insane and the other epileptic or feeble-minded, 5 children died before the age of fourteen, the condition of 2 was unknown, 2 were epileptic, 4 feeble-minded, I insane, 8 tainted, and 7 seemingly normal. Regarding the latter Dr. Weeks says they came from two families where in the one case the father's insanity seemed to be traumatic and in the other alcoholic.

In a study of 609 case histories of epilepsy by Olive Cushing Smith 336 showed a neuropathic family history, the family histories of 225 were negative (including organic nervous conditions), while those of 18 were unknown. In epilepsy the factor that is most universally present is an inheritable constitutional "peculiarity" of some kind. Such factors as diet, alcohol, injuries or focal infections are probably causative only in a secondary sense in that they operate on a nervous mechanism that is already inherently unstable.26

The discussion of the care and treatment of persons belonging in these three great groups has no place here. In many ways the most difficult social problem lies in the revelation that there are many thousands of potential parents of such defectives who themselves are normal in so far as we can see. Fortunately, good qualities are as heritable as bad, so let us turn to them.

INHERITANCE OF MENTAL SUPERIORITY

Intelligence tests have become very common in recent years. Nevertheless it should not be forgotten that they are far from perfect and the one defect common to all is that in part they are information tests. Yet they have proved valuable and we may expect improvement as time passes. When such tests are carefully applied to a large and unselected group of children, or adults for that matter, we find that the children separate into smaller groups following the "normal curve" of distribution. The following figure 27 shows the results of