tuberculosis for instance. But here we observe that we are not dealing with any simple factor to which Mendelian principles can be readily applied, but with an enormously complex affair which still awaits analysis.

The laws of heredity are two, viz:

The law of inheritance and the law of sanguinity. The law of inheritance is that the offspring tends to inherit every attribute of the parents and will do so, unless some counteracting influence appear. Of course, there are cases in which attributes of parents do not appear in the offspring, but these are not exceptions to the law.

The laws of nature knows no exceptions and when apparent exceptions occur, it is either because the laws are acting in ways not understood or through the counteraction of other laws. That the law is true of the gen eral and broad outlines of structure and function as universally accepted is indeed a truism. "Do men gather grapes of thorns or figs of thistles?" "Even so every good tree bringeth forth good fruit." The law is san

The more dis

guinity may be summarized as follows: similar up to a certain point, parents are, the stronger and better the offspring, but individuals whose constitutions and temperaments are alike will either have no children or degenerate children.

The stability or instability of a person's highest ner vous arangements depends primarily and chiefly upon inheritance. Every man is the outcome and the product of his ancestry. Doubtless every individual is to some extent moulded into conformity with circumstances by the influence of environments upon him; but the smal amount of new character that environments can produce in any individual, in comparison with the characters transmitted to him by his ancestry, may be gathered from the length of time that circumstances of environments can act upon him, in comparison with the aggregate length of time during which the long line of his ances try has been subject to modification by environments.

We are all familiar and know of practical examples of an inherited peculiarity in gait, gesture and general bearing. It is true also, that there are family similarities in handwriting as strong and as frequent family similarities of features, and this is important since a peculiarity of handwriting depends upon an arrangement of nerve-tissue that must be extremely delicate, elaborate, subtile, diffuse and yet precise. In comparison with such a quality of nervous arrangement the peculiarity of tissue organization, which underlies insanity, is gross indeed, and if one is true, we may be quite sure of the other.

SOME STATISTICS.

Owing to the meagre and incomplete histories furnished authorities of State Hospitals, it is impossible to justly estimate the percentage of admissions with hereditary taints. The very nature of the inquiry makes it difficult to obtain the desired information. In the first place, the recorder of the histories of patients frequently neglects to extend his inquiry far enough to include all the transmissible psycho-neuroses. Secondly, the relatives of patients are prone to conceal any hereditary taint in the family. For instance, a table prepared by the lunacy commissioners, showing the causes of insanity in 136,478 admissions to the asylums in England and Wales, estimate the hereditary influence at 20.5 per cent. The admissions to the Georgia State Sanitarium for the past year were 972 including the colored race, and according to the histories furnished by the commitment 16.36 per cent. of them gave a history of direct hereditary taint. Now these histories are filled out with only one end in view, and that is to have the patient admitted to the sanitarium. The scientific value of the answers to questions asked on blanks furnished to the Ordinaries of the different counties is never thought of, even when filled out by the family physician, and it is

requested that the family physician fill them out whenever practicable. The answers to some of the questions are sometimes almost ludicrous. Hence the incorrectness of such a low estimate. It is difficult to get any information of value through correspondence, and relatives to some of the patients we never see. Taking the statistics of the New York State Hospitals for the fiscal year from October 1, 1907, to September 30, 1908, it is seen that 76.2 per cent. of all admissions were consid ered to have "normal" mental constitution, of these patients 29.4 per cent. gave a history of insane heredity. The mental constitution of 20 per cent. of the admissions was "inferior" and of this number 37.7 per cent. gave a history of insane heredity. Patients with a "defective" constitution, a class that we wish to emphasize, made up 3.8 per cent. of all admissions and gave a history of insane heredity in 44.8 per cent. These estimates are based on admissions of 5301 patients, of which 2791 were men and 2510 were women.

Those of us that have given this matter any study know that these estimates are too small. J. Ragues DeFursac, a French alienist and author, states that a "congenital predisposition exist in about two-thirds of the insane." For that group of psychosts, known as Dementia Praecox, he estimates that 50 per cent. of them give a history of hereditary taint Kraepelin, that peer of workers of modern psychiatry who has done more than any other man of modern times toward grouping into true clinical entities, from a prognostic view, the different forms of psychoses from the symptom-complexes, is of the opinion that 70 per cent. of these cases have a hereditary taint.

Diefendorf estimates that this form of psychosis comprises from 14 percent. to 30 per cent of all admissions to insane institutions. Take the Manic-Depressive group and it is estimated by good authority that is comprises from 12 per cent. to 20 per cent. of all admissions to Insane Hospitals, and it is computed that 70 per cent.

to 80 per cent. of these give a history of hereditary taint Diefendorf states that defective heredity is the most important etilogical factor in this group. Take the Epileptic group and it is estimated that there is a hereditary taint in 87 per cent. of cases. Of the constitutional psycho-pathic states estimates vary from 70 per cent. to 80 per cent. of hereditary taints.

Mendel says that "among the predisposing factors of insanity, the hereditary basis has by far the greatest significance."

Berkley states that " heredity is by far the most important factor with which to deal in the consideration of the pathology of the main types of insanity. Its influence may be recognized in divergencies from the normal in the structure of the brain convolutions or in the very numerous abnormalities that may be noted in every day findings in the cerebral vessels of those dying insane." He also states that from 60 per cent. to 70 per cent. of all forms of mental disease give a history of hereditary taint. These facts alone are enough to warrant us in believing that heredity is the most important factor in the etiology of insanity.

The population of the Georgia State Sanitarium for the fiscal year 1890 was 1510. There was admitted during that year 403 patients. The population of the Sanitarium for the fiscal year ending December 31, 1908, was 3112, and there were admitted during that year 947 patients. We see from these figures an increase of over 100 per cent. in population and annual admissions. If some prophylactics are not adopted, what will be the figures twenty years hence?

THE REMEDY.

Gentlemen, we as a body of physicians must realize these facts and use our influence for the adoption of remedial measures. When we come to the actual study of the annual increase in the admissions to the different

State Hospitals, we readily realize that its importance is not secondary to the employment of prophylactic measures in the prevention of contagious and infectious diseases. We are duty bound by the very nature of our professions to realize and recognize these facts, and the laity are looking to us for measures of some kind.

The strength of a state or nation is measured by the health, both mental and physical of its inhabitants. If we would pay as much attention to the mating in mar riage of our sons and daughters, that we do to the breed ing of our stock and poultry, I am sure that we would be amply rewarded.

I think we should go down on record as favoring the enactment of a law requiring all applicants for marriage license to present a health certificate from his family physician, or one duly authorized to issue same, certifying that said applicant was not afflicted with any transmissible disease, furthermore, said certificate should be filled in the Ordinary's office for future reference.

There should also be enacted a law to make sterile every defective or degenerate, as we readily realize that this class of cases are hopelesly incurable, and they furnish the largest per cent. of hereditary taints. This sterilization can be accomplished by means of the simple operation of vasectomy in the male and salpingectomy in the female. Some of the states are already moving forward along this line.

Dr. H. C. Sharp, of Indianapolis, in an article entitled, "Vasectomy as a means of preventing procreation in defectives," read in the section of preventive medicine at the last meeting of the American Medical Association, stated that the disposition to permit all classes to procreate without restriction has brought about interesting satistics in Indiana. The cost for maintaining the state institutions including the poor and orphan asylums was $1,201,461.24 for the year 1890. While for the year 1908 it was $2,443,140.55, an increase of over 100 per cent.