insufficient food. The close association of the two and the solitary life which they led were also important factors in the case.
I would not for a moment subscribe to the doctrine that insanity is contagious and communicated from one to another, as, for instance, smallpox is, and I altogether repudiate the common idea that it is easy to become a lunatic when compelled to associate with and listen constantly to the ravings of madmen. The immunity of doctors and nurses who live among the insane and associate with them constantly is sufficient proof that under ordinary circumstances, when there is neither hereditary tendency nor neurotic temperament, there is but little danger of being affected by association with the insane. Of course, no medical superintendent would knowingly engage as a nurse one who was ignorant and superstitious, or one who was unduly nervous or inclined to insanity from hereditary influences, and that is probably the chief reason why so few cases of mental trouble occur among those whose lives are passed in the midst of the melancholy wrecks of human minds. This brings to mind the popular fallacy that an insane person is apt to be made worse by being sent to an asylum where he must associate with others who are insane. Experience proves this belief to be entirely unfounded, for as a general thing the insane, being occupied entirely by their delusions, take little notice of their surroundings, and hence the appropriateness of the French term aliené—a stranger to the world in which he lives. Of course, when recovery begins, the situation is different, but even then the associations are not generally injurious, for the convalescing patient often takes an interest in his less fortunate fellow, which does much to promote his recovery, as well as to make him realize that he himself has been insane.
But, notwithstanding my lack of belief in the contagiousness of insanity, I believe, as stated at the beginning of this article, that under certain conditions insanity may be communicated or developed by association, and this paper is written with the hope that some practical hints may be gathered from the observation of cases similar to the ones I have described. It is obvious that when insanity exists in a family it is highly injudicious to subject other members of the family, especially those who are neurotic, to the influence of the insane member. The danger is much greater when the delusions are of a persecutory character, and women are much more liable to be affected than men. Acute mania or dementia are not likely to communicate themselves, but not infrequently a mental breakdown occurs in other members of the family, due to the loss of sleep, confinement, and irregular habits which the home care of such cases involves. When insanity has spread, or communicated itself to another, as it were, the course is plain. Separation must take place at once, and it is not at all
