Two things are obviously needful to a full statistical investigation of the prevalence of insanity at a given date as compared with its prevalence at a later date. The first is a complete register of all cases of the disease at the two dates taken: the second is a similar register of the incidence and disposal of all cases occurring between the two dates,—how many came under observation for the first time, how many recovered, how many died, and how many disappeared from view without either death or permanent recovery. For instance, if the Scotch gentlemen could state exactly the whole number of insane persons anywhere in Scotland in 1874, the corresponding number in 1894, and then all the first admissions, deaths, recoveries, and other disappearances in the whole kingdom between these two dates, it would not be hard to say, knowing the population as a whole in 1874 and 1894, whether insanity in Scotland (new cases) was gaining or losing ground. No such fulness of data being even claimed for Scotland (or as yet for any country or region), the best that can be done is to approximate to this desired but unattainable exactness. This Sir Arthur Mitchell and his colleagues undertake to do; and their several methods are ingenious, sincere, and laborious. But they all start with a belief that they shall not find any increase of new cases, beyond the population-rate, in the twenty years; and, as we generally find what we look for, and only now and then come upon the unexpected, so here they could find no considerable gain in new cases. But let us suppose that they or we or any other inquirers into this important but perplexed question should have taken certain fixed. points from which to reckon, for instance, all the visible population, both sane and insane, at a given date, then consider the actual deaths in this classified population for twenty years, and the visible number living at the end of that time,— and see what conclusion is forced upon us by the computation. It will appear in Scotland, for example, that the sane population in 1855 was about 2,970,000, and the insane 7,400; that in 1894 the sane had increased to 4,111,000, or 39 per cent., while the insane had grown to nearly 14,000, a gain of 85 per cent. Yet in this period of nearly thirty years the insane had been dying at a rate more than twice as large as the sane deaths of the same ages. They had also been recovering at a still higher rate; and yet so many were the new cases, or those for the first time visible, that the insane, who should have decreased, actually gained faster than the sane. Where could this gain have come from for the past dozen years, if not from an increasing number of new cases? In the years immediately following 1874 it might be supposed that a stricter classification of the insane would lead to an apparent increase; but this could not long continue to offset the natural decrease by the double death-rate, which, from figures given by Doctor Sibbald in his paper, was for Scotland at least a treble death-rate, being more than 60 in 1,000 cases of the insane. The average death-rate for the sane of all ages above ten years in Scotland is not before me; but it cannot well have exceeded 20 in 1,000, and was probably less than this. Therefore, if three insane persons died for every sane man and woman in Scotland, it could not be many years, unless new cases of insanity also increased fast, before the accumulation of the chronic insane of that country would cease, and a diminution would begin, since all the while recoveries would be going on, and would still farther reduce the material for chronic insanity. A presumption in favor of the increase in new cases of insanity not necessarily of acute cases—is therefore raised by the mere fact of the accumulation of chronic insanity; and this presumption is strengthened by the fact, which will hardly be questioned, that the insane die much faster than the sane, while yet the accumulation steadily continues, and shows no sign of material diminution. But in certain regions (in Massachusetts, for example), where an actual count of new cases has been made for fifteen years, with some approach to accuracy, it is found that they do increase beyond the gain in population. That is to say, the increase which accumulation and inference make highly probable is found, in fact, to exist, and to continue from year to year. Hence we reason (and there seems to be no flaw in the argument) that, if the same pains were taken as in Massachusetts to compute the exact number of new cases of insanity, it would be found even in Scotland, as it has been found in Ireland, that occurring insanity, not less than chronic insanity, is really gaining ground. It is not necessary to suppose that it gains equally fast everywhere; but, until some reasonably exact registration is made of cases which are actually new,- that is, appear for treatment for the first time, we have no right to say that such new cases are not increasing beyond the natural gain in population. It is difficult to prove a negative, especially when all reasonable inference from observed facts tends to an affirmative. A single word as to the real causes of the increase of insanity, which, in the form of accumulation, everybody admits, and which I have shown also to exist in Ireland and in Massachusetts, in the form of new cases. It is within the observation of most physicians who have the care of the insane that the insanity of physical degeneration, resulting from syphilis, paralysis, intemperance, under-feeding, epilepsy, etc., is growing more and more common. These are the least hopeful forms of insanity; and it is their prevalence which seems to have caused a diminution in the rate of recoveries, almost everywhere noticed within the last twenty years. Cases really acute, and not complicated with these forms of disease and degeneracy, recover as easily and as fast as ever; and there is even a tendency to virtual recoveries of the chronic insane, which was not so much noted until recent years. But the crowding of population into cities in all civilized countries, and the growth of vice and disease consequent upon this rapid growth of city populations, have increased those degenerative tendencies noticed by Nordau and other writers, and have thus made certain forms of insanity not only more frequent, but less curable. There is a natural limit to this melancholy state of things, and there are limitations and palliatives which science can apply; but it does not seem that we have yet reached that limit or that those remedial agencies have yet been effectively applied. Till that is done, insanity must continue both to accumulate and to increase actively. IX. Child-saving Work. TRADE SCHOOLS: THEIR PLACE IN INDUSTRY, EDUCATION, AND PHILANTHROPY. BY PROFESSOR CHARLES R. RICHARDS, PRATT INSTITUTE, That there is no longer an opportunity for a boy to secure an adequate training in the mechanical trades through the old apprenticeship system is now almost universally recognized. Articles are constantly appearing in the various trade papers with statements of the complete decay into which the system has fallen, and deploring the severe lack of properly trained craftsmen. The legally bound apprentice, living for a term of years in the household of his master, has undoubtedly passed away for all time. In the report of the Commissioner of Labor for the State of New York, for 1886, it is stated that no case of a legally indentured apprentice was found during that year in the entire State. Not only is the principle of the system under which the old apprentice served his time out of harmony with the spirit of to-day, but the industrial conditions that made the system practicable have entirely changed. The causes for this disappearance of the apprentice are to be found in the great industrial and social changes that have occurred during the last century. Previous to that time a term of apprenticeship was the universally recognized method of entering upon a trade. trade. Under this system a youth entering upon a trade was bound to a master workman for a term of years by a legal instrument called an indenture. By the terms of this instrument the master became the legal guardian of the apprentice. He agreed to receive him into his household and watch over his moral welfare, as well as to instruct him in all the details of his craft. This system of apprenticeship formed a universally accepted feature of the social system throughout Europe, from the Middle Ages down almost to our own day, and was closely related throughout its early history to the acquirement of political rights and privileges on the part of the apprentice. The length of the apprenticeship was generally fixed by law, and varied in the different countries. In England it was seven years, in France three or four years, and in Germany two to four years. As long as industrial operations were confined to hand work, this system fulfilled its purpose naturally and effectively. Throughout this period the unit of industrial production was the master workman and his corps of journeymen, and the working-place was the household shop. The master workman in those days was not only the employer, he was first of all the master craftsman, and himself worked in the shop among his men. The number of journeymen under any one master was comparatively small, and the master's relations with his men were direct and intimate. The thorough instruction of apprentices under these conditions was not only natural and convenient, but was strongly for the master's interest, in order that their services might return him as great a profit as possible. But the steam-engine and the introduction of machinery changed all this. The economic advantage of quantity production appeared, the household shop changed gradually into the factory, and the master workman into the manufacturer and contractor. With these changes the old relations between the master and the apprentice, between the teacher and the learner, have ceased. The employer and director no longer works in the shop among his men, but controls the movements of an industrial establishment from his office. In such an establishment each member has his specific duties. Every division of work and responsibility is provided for with the greatest nicety, but nowhere is there provision for the apprentice. He has been left out in the new adjustment of things. No one has taken the place of the master as his instructor, and he has become an anomaly and an outcast. As a consequence of this changed state of things, the few boys who now gain the opportunity of learning a trade are generally set to petty drudgery about the shops or put to such small tasks as can be most readily mastered, and kept upon these for long periods, to the neglect of comprehensive training. As a matter of fact, the apprentice is left to pick up the practice of his trade by observation, and such opportunities as chance and the good nature of his fellow-workmen afford. Under such conditions 1 |