SEX IN RELATION TO INSANITY.

The relative frequency of insanity in the sexes varies somewhat in different countries and under the differing conditions of civilization. There can be no doubt that under circumstances and surroundings adapted equally to the maintenance of the health of both sexes, there would be as little disease of brain in the one as in the other. The conditions of life, however, nowhere exist bearing alike on both. While there are certain hardships, exposures, and dangers to be endured by the male to which the female is little liable, on the other hand there are many unfavoring experiences growing out of the nature of her labor and duties as arranged in modern civilization, as well as from the constitution of her system, from which the male sex is exempt. While the male is more often exposed to the inclemency of weather, the cold of winter and the heat of summer; while he must endure the hardships of war by sea and land, and the larger expenditure of physical force in the performance of his labor; while he is much more liable to injury of the nervous system from accidents arising in connection with his exposures in the larger sphere of locomotion; on the other hand the female is much less favorably situated in relation to the beneficial effects arising from living much in the open air. The sphere of her activities is much more circumscribed, and the larger portion of her time is passed in-doors, and often in an atmosphere less favorable as to its hygienic conditions.

There are, however, certain physical conditions of the female sex which are intimately connected with the sexual system, and which have been supposed, by both lay and professional persons, to be closely allied, as causes, to mental derangements, to which I desire to call attention for the present. These will relate more especially to the unmarried.

In a general way the sexual system in the female exerts a much larger influence on the whole physical and mental economy, than in the male. A very intimate sympathy exists between it and both the stomach and the brain. This becomes especially manifest at the period of puberty, and continues until after the cessation of menstruation. The whole moral nature appears to become changed, or rather it appears to come into existence and activity when the child becomes a woman, and thereafter, for thirty or thirty-five years, the whole person is largely affected one fourth of the time by the functional activity of the pelvic organ.

The amount and quality of the blood, and its physiological effect upon the vessels and cells of the brain, must largely depend upon the regularity and perfect discharge of this function; and in the case of married women the whole economy is subject to the large changes which come from conception, pregnancy, child-birth, and lactation.

The cessation of menstruation must also, in most cases, be attended by such changes as are of grave import: the calling into a larger activity other organs of the body, especially the liver and the skin for the purpose of eliminating those products of secondary metamorphosis which before had passed from the system by the uterus; the consequent disturbance of the circulation while this adjustment of functions is being made; the increased amount of carbon left in the blood, and its effects upon the brain;—every general practitioner of medicine has abundant occasion to witness how great effects all these experiences produce upon the nervous system; how excited or depressed, how irritable and nervous and changeful the brain becomes from their influence upon it.

But in addition to these generally obvious effects, the gynÆcologist has occasion to observe other, and which he may regard as no less potent, results of reflex influence on the brain from uterine disturbance of other kinds, which more especially affect the unmarried class, which every year becomes larger among all the older civilizations.

The condition of marriage is doubtless the normal one for both sexes, and, as a rule, a larger degree of physical health is enjoyed by persons who live in this relation. In no other is the discharge of the natural functions of the sexual organs possible. As society is at present constituted, however, more especially in the older civilizations, marriage and its consequent responsibilities become more and more difficult, and the female is the larger sufferer by a failure to consummate this relation. All those instinctive yearnings for objects of affection and love in the way of husband and children; all the outgoing of longing for all that is implied in home, the care of it, and all connected with it; with no one to cling to and depend upon in hours of sickness and trial; the turning back, keeping down, and putting forever away into darkness all those natural desires and passions which arise and tend to press forward for recognition from time to time;—in short, the failure to develop and bring into its mutual relation to other portions of the system this, which is arranged and designed by nature to play so significant a part in the female economy of life, can but tend in no small degree to cause a somewhat abnormal condition and activity of the general nervous system.

Persons become nervous, capricious, irritable, and hysterical. A feeling of lassitude and weariness results from any considerable physical effort, and they are unable to endure the friction and annoyances of ordinary daily life without much complaint. They feel badly without knowing why, and are unable to long apply the mind to any particular task, or persistently to carry forward any kind of employment. An experience of a year or two, more or less, of this kind of nervous debility and suffering generally lands many of these persons in the hands of the physician, and no small number in those of the gynÆcologist.

On examination there is frequently found to exist uterine derangement of one kind or another: it may be congestion or a sub-acute inflammatory condition of the neck of the uterus; in some cases there is endo-metritis, or peri-metritis, abrasive ulceration attended with discharge, or there may be displacement in the way of any of the flexions. Or again, there may be defective, or irregular menstrual discharge, dysmenorrhoea, or amenorrhoea. My impression is that some one of these various lesions of the uterus will be found to exist in a large number of females who have exhibited, for some time, such physical and mental conditions and symptoms as have been detailed above.Now, one of the inferences of the gynÆcologist is likely to be, that the uterine lesion, of whatever nature it may chance to be, is the cause of the failure in mental and general health; that it is the “fons et origo” whence has arisen the long train of nervous symptoms, and, doubtless, in some cases this may be a correct inference; but in a vast majority of cases my impression is that both the existing debility of the nervous system and the uterine lesion are to be regarded as consequences, and that neither is a cause of the other, but rather that they both result mainly from a failure in the discharge of those functions which more especially pertain to the sexual system, and a disregard of the laws of health as to physical exercise.

But what I desire to specially note in this connection is, that these symptoms or manifestations of nervous derangement are not those of insanity, that they rarely pass over or develop into those of insanity. There is prevalent, both among lay and professional persons, an idea that a large number of females become insane, from the existence of some such uterine conditions, or that these have a large influence in producing insanity. My experience, however, points to an opposite conclusion. It is rare to find any of the uterine lesions referred to existing among insane women; and this is doubtless explicable for physiological reasons.In almost all cases of acute insanity there exists a much larger amount of mental activity than when the brain is in a normal condition. The processes of thought go on during a larger number of hours every day, and the period of sleep, in which there is a demand for a more limited supply of blood in the brain, is correspondingly diminished. Then, again, the character of mental operations is generally of much greater intensity; impressions are more numerous, sensations are more vivid, and thoughts press their way onward through the channels of nerve-cells and fibres of the brain with greater rapidity and constancy.

Almost the whole force and energy of the nervous system appear to be centred in the brain, and to supply the wear arising from such increased activity of the brain, the system calls for a larger supply of blood in this organ. It is therefore diverted from other portions, and there results a diminished sensibility and activity especially of the sexual system. In a large majority of these cases also, the monthly discharge ceases to appear, and the sexual functions are in partial abeyance.

Now, in consequence of those changes which tend to occur in the vessels and cells of the brain when a person becomes insane, if there were existing any such functional uterine lesions as I have referred to, there would at once arise a tendency to recovery from them; the monthly congestions generally disappear, and such passive congestions as may have long existed would also tend to pass away. An inflamed, or irritable, or ulcerated neck would, in the absence of the usual physiological activities of the organ, have a tendency toward recovery, except in some few rare cases; and by the removal of congestions there would exist little if any cause for displacements.

This may be said to be mere theory, but it happens to be certainly in accordance with the experience of those psychologists who have studied the tendencies and conditions of the uterus during periods of insanity. In an experience extending over many years and embracing many cases, the number of the above-named uterine diseases found by me could almost, if not quite, be counted on my fingers.

While, therefore, such diseases of different kinds and degrees may, and generally do, co-exist with general debility of the nervous system, they are rarely found to be, and probably seldom are sufficient in themselves, as causes of insanity, though they may sometimes be allied with other and more potent influences in its production.

I may add that similar conditions of the female nervous system not unfrequently arise among the married, when persons long live in the relations of marriage, and yet without its natural results in the way of a number of children, especially if, as is almost always the case, improper measures are used to prevent the increase of the family.

I might in this place refer to another of those conditions of life inherent in our civilization, which is unfavorable to the mental health of the female sex, viz., the limited sphere of physical and mental occupation, as compared with that of the male sex. So much, however, has been written on this subject in its relations to and effects upon the general welfare of women, and there appears to be so large a tendency on the part of society, at least in this country, to admit her to any and almost all such occupations as she may qualify herself to follow, that I shall not refer to it further than to remark that, in so far as there may exist a disposition on the part of women to avoid the care and responsibility incident to home life and family, and, instead, to indulge in physical inactivity; in so far as they avoid physical exercise in the open air, and spend their hours of leisure in reading exciting novels, or love-stories, whose heroes and heroines are generally of almost any other kind of character than real, living, healthy, ones; in so far as they avoid the conscientious discharge of those duties which devolve upon them by virtue of their high mission as wives and mothers, and seek, instead, to follow occupations or professions for which they cannot be best qualified by reason of the nature, physiological activities, and duties of their sex; in so far as they divert that nervous energy and physical strength which is designed by nature to enable them to discharge the sacred function of motherhood into other channels of activity, however high and ennobling they may be,—in just so far are they deviating from that great highway which leads to mental health and the highest interests of humanity.

No aspirations of woman can ever reach so high and grand a sphere in the activities of the world as that enshrined in the name of mother; and since Nature has crowned her with this supremest function, all effort to forget or change it, to belittle or push it aside for other more transitory pleasures or missions, can only lead, in the end, to unhappiness and too often to disease.

POVERTY.