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He was a geologist by instinct from boyhood, a natural collector of stones and shells, an observer from whom nothing escaped. He was passionately fond of his Lecco. Even after extensive travels, he always returned to it with renewed admiration. On the lake, up the narrowing valleys, on the mountain tops, he was ever the ardent naturalist; and with that, too, the poet and patriot. He early arrived at scientific conclusions, the importance of which he did not suspect until a savant was sent down from Vienna to prepare a treatise on the geology of Lombardy, and found that Stoppani had already done the work in the rough. Stoppani's researches were published soon after, under the title of “Studii geologici e paleontologici sulla Lombardia.” With this he at once stepped into the front rank of the world's naturalists.
Not until he had carefully studied his native district, idealized it and philosophized about it, did he turn further afield, over the beautiful peninsula of his greater country, Italy itself. In 1875 appeared his “Il Bel Paese,' the most popular of his books,- a work which revealed to many Italians the many-sided beauties of their own soil, — from the ice, snow, and waterfalls of the Alps to the ineffable blue of the Italian sky and sea. As an example of a monograph on a scientific subject, treated in a popular style, Stoppani's “What is a Volcano ?” deserves to be taken as model. In fact, it was as teacher, as educator in various schools and universities, and as public lecturer that Stoppani left his mark upon the new Italy.
In Pavia, in Florence, as head of the great Ambrosian Library in Milan, he helped to make the Italians conscious of their own possibilities: to live less in the present, to treasure the past, and to prepare for the future. It is one thing to give Italy the appearance of a political unit. It is quite another matter to make it truly united. Stoppani realized this, as did Rosmini and Manzoni. He would have preferred a confederation first, to lead up to a centralized State by degrees. But the fact being accomplished, the next best thing was to raise the morale of the whole people by every possible means.
Toward the end of his life the good old naturalist took to religion more than ever. As an ardent Catholic, he wrote much in the desire to reconcile faith and science. His enthusiasm for Rosmini and everything Rosminian subjected him to constant persecution at the hands of the Jesuits. He was obliged to bring suit for
defamation against one of their organs, the Osservatore Cattolico of Milan; and he won his case, too. Finally, he and his friends actually founded a paper, n Rosmini, expressly for the purpose of defending the name of the dead Rosmini. This sheet, too, was placed under the ban of Rome.
Stoppani spent his last years in raising funds for monuments to Manzoni and Rosmini. That to Manzoni, in Lecco, was unveiled six months after his death. It is now the turn of young Italy to honor itself with a monument to the great patriot-naturalist; and then these three men, who from the southern foot of the Alps sent their influence over the whole peninsula, whose ideals, whether or no we entirely agree with them, are still a large element of the future,- a strong educational force,- will have been suitably remembered.
In the hope of securing the paper read by Dr. Stephen Smith at the opening session of the Health Department, the editor delayed publication for some time. But at the last moment Dr. Smith found that his manuscript had been lost, and under the pressure of exacting duties he was unable to dictate even the substance of it. As the title of his contribution gives the key-note to the essays which follow, essays that work out the leading thought in detail, the title is reproduced in this place. It is “The Importance of a High Grade of Physical Health in the following Classes of Inmates of Public Institutions, with a View to their Cure, Development, or Reformation, and the Best Method of secur. ing such Health.”
I. PHYSICAL HEALTH OF THE INSANE.
BY P. M. WISE, M.D., PRESIDENT OF THE NEW YORK LUNACY
[Read Wednesday morning.)
Insanity is a symptom of physical disease: hence insanity and sound physical health are antonymous. This applies without exception to those mental conditions in which a departure from the individual standard is recent, acute, or active. It must be admitted that, when the pathological activity ceases, when the violence of the mental and physical storm abates, when the destructive forces are subdued and the neuron cicatrices are perfected, there can be a restoration of bodily function, which is sound as far as it goes, lacking the brain function that corresponds with cell destruction. The individual may remain "insane,” but the insanity is a subtraction of functional tissue rather than a pathological process. Like an amputated limb which leaves its subject unable to walk, the chronic maniac is unable to reason, by virtue of destroyed brain-cells and their association processes; yet in each case there may be physical health in the ordinary acceptation of the term.
In a fair proportion of acute cases, where there has been no destructive tissue change, with the return of bodily health there
is also a return to normal mental activity. Health is a relative term. Its standard depends upon environment and development. I assume that, for the purposes of the present discussion, physical health should be considered that functioning which maintains a proper nutrition and excretion without degradation of bodily tissue in the matured, and maintains the usual tissue progression to adolescence in the undeveloped. It assumes also a freedom from extrinsic toxines.
Perhaps an illustration suggested by Dr. Van Gieson will serve our present purpose better, in which health is considered as an equation of the resisting body elements against its enemies. Thus we now know that one of the functions of the blood serum is to neutralize or destroy the toxic influences which are constantly attacking it, and that, when it loses this power, it is overcome and disease exists. In the same way the cellular elements of the body exert an aggressive action against deleterious toxic or bacterial poisons; and, as long as they hold the balance of power, they triumphantly express their function in a normal manner. If this resistance is weakened, either through inherited or acquired causes, they succumb; and we then have a pathological condition.
We can apply this illustration to the mass of persons who become insane, but there remains a small proportion of cases in which the expression of disordered mind seems to have solely a psychic origin. They are, however, so exceptional that, since this question pertains to social science, they would have a doubtful classification. Hence we may safely assume that, whatever may be the cause of the insanity, there is always accompanying ill-health. If, as sometimes occurs, a moral or mental shock leaves its subject in a condition termed insanity, the same storm that uproots the psychical centres disturbs also the lower nerve centres. There is a disarrangement of the nutritive and excretory functions, and it is the lessening of the bodily resistance which prevents the return of the mental balance. The treatment of these cases is directed to a re-establishment of physical health. Even what is known as moral or mental treatment would be useless, unless combined with a restoration in a large degree of the normal body resistance; in other words, the individual standard of physical health. Thus mind-shock disturbs the body functions, and is a contributing cause to ill-health and insanity.
One of the first therapeutical duties of a medical officer in an institution for the insane is to correct the excretory functions of a
newly admitted case. Almost invariably, they are found to be disordered, particularly that of the alimentary canal. Frequently the insanity is caused by a disturbance of these functions, by an imperfect throwing out of the body poisons; and, with the correction of the fault, auto-intoxication and its results pass away, and the patient is cured.
Faults of nutrition also frequently starve the brain-cells, and create an irregular morbid activity, with subsequent exhaustion. One of the most deadly mental diseases is caused by an excess of blood-supply and consequent irritation to the highest brain centres, the outermost layers of the cortex. In short, there can be no change in the nutritive fluid of the body, without affecting in some degree the nervous elements; and, although their stability may sustain an equilibrium of function, the power of resistance is weakened, and persistence of the morbid condition sooner or later disturbs mentalization, when the subject is termed insane.
The establishment, then, of healthy bodily function must be understood to be a removal of the potent cause of insanity; and a high grade of physical health is not only coincident with recovery, but its maintenance is a reasonably safe assurance of the continuance of mind stability, where structure has not been seriously affected. It is for this reason that the modern conception of an institution for the insane is that it should be a hospital as well for the body as for the mind, and the former detention places for the insane have been replaced by hospitals.
The hospital idea has changed institutions for the insane in a marked degree; and the tendency has been to improve the bodily health, to cure a greater proportion of recoverable cases, to ameliorate the condition of those who do not recover, and to lengthen the duration of the insane life. This has been accomplished mainly by replacing uninstructed attendants with trained nurses, by regulating diet, exercise, bathing and attire to suit the individual case, and by making the environment pleasing. In the construction of hospitals every hygienic requirement has been closely observed; and fresh air at all times, pure water, safe sewerage, and equable temperature receive the same careful attention in an institution for the insane that they receive in a general hospital.
The social aspect of the care of the insane who are dependent upon public care and benevolence, who now perhaps exceed in numbers all other classes of dependent defectives combined, has