to have offspring. The natural selection of the sane was therefore very stringent. For some time, however, lunatics have been treated with great humanity and skill. Beyond all classes of the community they are watched over by the State. Men of sound mind, but suffering from bodily ills, may perish in the slums for lack of proper care and nourishment; but the insane are removed to special sanitaria where, without expense to themselves, they receive food and lodging and are placed under the care of trained nurses and medical specialists, over whom in turn the Commissioners in Lunacy exercise a zealous supervision. As a consequence the lunatic frequently recovers, and is restored to his family with a right to have as many children as he pleases.

This statement about English conditions is just as applicable to those of our own country. In the course of a single year more than 20,000 men and women are discharged from the hospitals for the insane in this country, of whom, self-evidently, a great many subsequently become fathers and mothers. What has been said about the insane applies with even greater force to the feebleminded. Of the actually known feeble-minded in the United States only a small proportion is under temporary or permanent restraint. The rest go on multiplying. Their offspring is peculiarly prone to mental derangements as a consequence of even moderate alcoholic indulgence and later on figure in a greater or less degree in the returns from hospitals as having become insane solely on account of drink.

All that has been said above should not be construed as an effort to minimize the evil effects of intemperance, which are obvious enough. So long, however, as attempt is made to trace all our social ills as a result of the use of intoxicating liquors, it becomes extremely difficult to deal rationally and effectively with social problems like insanity and feeble-mindedness. There can be no greater mistake, for instance, than to attribute a majority of the insane and feeble-minded cases in the country to the liquor habit. People are never cured of a trouble by being treated for one they have not.

There appears to be no escape from the melancholy conclusion that "the rate of increase is greater for the insane in the United States than it is for the general population." (United States Census report on the insane, 1906.) While the hospital returns upon which the official statistics are based do not disclose all the facts,

"they invariably point to an increase in the prevalence of insanity." (Ibid.)

No one has ventured an adequate explanation of this phenomenon, if indeed one can be made. But to accept the view that most insanity is due in some way to intemperance would, in the face of this growth of mental disorders, be equivalent to declaring, that the liquor habit is continually assuming greater proportions; that temperance teaching and preaching has proved futile; that repressive or prohibitive legislation is inoperative; that the per capita production and consumption of intoxicants increases rapidly, etc., etc.

The facts as seen by open-minded students appear to be much more that as a nation we are growing more abstemious, and that the drink habits of the old days are disappearing. Many factors have contributed to this. The temperance advocates have done their share. Industrial and economic conditions have imposed abstinence as a condition of employment. Legislation has brought the liquor traffic under better control; and if it has failed utterly to prohibit, it has at least diminished consumption to some extent, particularly in rural districts. Yet "the rate of increase is greater for the insane in the United States than it is for the general population."

Available statistics of the insane do not permit accurate comparisons between States. The ratio of insane, as disclosed by hospital returns, indicates the extent to which the mentally sick are cared for in institutions rather than their numerical strength in a State. This is made apparent by the most casual study of the figures given in the next table. The most ingenious search would fail to discover any relation between the ratios of insane in the different States and the prevalence of the liquor habit.

Incidentally, however, the fact stands out that insanity has not diminished in States where the liquor habit is supposed to have been driven to the wall. In Maine, for instance, the insane hospital population goes on increasing with the same relative rapidity as elsewhere. In 1903 it had 125.3 insane in hospitals per 100,000 population. This ratio is lower than for many States, but merely shows the extent to which the insane are cared for in special institutions. The Census report says that in 1890 Maine was one of four States in which "the number of insane enumerated outside of hospitals exceeded the number found in these institutions;"

and "in none of these States has the accumulation of insane in hospitals since 1890 been so large that the number still outside of hospitals can be presumed to have been greatly diminished, much less exhausted." In other words, if Maine cared for her insane in hospitals to the same extent as some other States, her ratio of insane would proportionately be the same.

Kansas and North Dakota also yield ratios of insane per 100,000 population which do not reveal the slightest benefit in this respect from the prohibition of liquor. Exhaustive comparisons are superfluous.

In conclusion: The precise extent of the causal relation between insanity and intemperance is still to be discovered. Meanwhile it is as absurd to say that most insanity is due to drink as it would be to say that insanity is never caused by drink.

ADMISSIONS OF INSANE TO PUBLIC AND PRIVATE HOSPITALS DURING 1904 AND NUMBER PER 100,000 OF POPULATION, FOR STATES

MORTALITY AND ALCOHOLISM.

The available statistics of deaths from alcoholism have, on the whole, an uncertain meaning. Says the United States Census Report on Mortality Statistics for 1906, "The death rate from alcoholism in 1906 was 8.6 per 100,000 of population, the same as the rate for the year 1903;" but adds:

"It is not at all likely that there should be very definite returns of death due to this cause, especially those due to the indirect effects of alcohol. Many chronic degenerative diseases, such as cirrhosis of the liver, must be considered in estimating the total effect of alcoholism, and as the certificates of death from secondary effects of alcohol frequently make no reference to alcoholism as a primary cause, it is impossible to make a complete statement in this respect."

The following table exhibits the deaths from alcoholism per 100,000 population for a series of years. The figures are taken from the United States Census report. The "registration area" and "registration cities" referred to comprehend the area and the localities from which official mortality returns are received each year.

NUMBER OF DEATHS FROM ALCOHOLISM PER 100,000 OF POPULATION.

How alcoholism compares with other causes of death may be gleaned from the next table which likewise is taken from the latest census report.

Whether alcoholism is a more fruitful source of mortality than a few years ago cannot be determined from the statistics cited. The variations from year to year are so slight and may be wholly due to more or less perfect methods of reporting causes.

In European countries there is the same uncertainty. Dr. Printzing characterizes the existing statistics as "very inexact”