which his wife, Brandomi, would eat. The cake was cooked and eaten by several persons, and Gianbatista's brother-in-law coming to the house soon after found father, mother and sister ill. Suspecting poison, he drew his sword and, lunging at Gianbatista and his brother, fell in a fit and so remained some hours. The wife died, the others recovered. At the moment, doctors, not knowing of the poison, certified she died of a fever, perhaps the result of pregnancy. Soon Gianbatista, his brother Aldo, and the famulus were arrested. Cardan was told. No longer did he think of science, of fame, of immortality, but became a father fighting for his son's life. The battle broke his pride but not, till later, his endurance. I can not give an account of the trial, but people who think that only in modern times have criminals tried to avoid justice may be interested to learn that the old Italian lawyers were just as acute and just as full of tricks and appeals to sentimentalism as any of today. On April 7, 1560, a red mark on Cardan's finger had reached the tip and shone like blood and fire. In the morning the mark was gone. Gianbatista had been executed. Browning, in rugged verse and style somewhat obscure, yet worth the studying for the thought within, could have extracted a world philosophy out of this squalid, common, vulgar crime; I can not, but I think we all must feel, though inarticulate, the horror of it.

Cardan persuaded himself that he was being persecuted by pretended friends and that his son, a victim of the law, had been unjustly punished. Many acquaintances did desert him, and worse than this, gossip, ever ready, ever on the alert, ever anxious to do injury, began to concern itself with him and vague accusations about his conduct toward some of his boy students became current. These accusations died down, but he was getting morbid, growing insane, and began to have delusions of persecution, believing even that there was a conspiracy to poison him. There was a little foundation for his suspicions. Cardan had always had professional enemies and they were glad to get a chance to injure him, not by actual conspiracy, not by material poison, but by that more virulent poison, scandal

wagging tongues, but his insanity showed itself in that he confused his friends who were trying to aid him with the men who were trying to hurt him. As time passed troubles accumulated. He, for some ecclesiastical reason, was sent to jail by the church authorities and kept there quite a little time, afterward being permitted to be his own jailer, in his own house, but he was interdicted from teaching and writing. Flying, as always, to his pen for aid to give him relief, he wrote an autobiography and this was his last work. His period of grandeur was over and he passed his old age in Rome, a pensioner of the Pope, walking the streets with unsteady, awkward gait, dressed in strange garb, talking to himself, gesturing, glancing furtively around, looked at askance by passers-by and regarded by everyone as mad. He died September 20, 1576.

So much for the events of Cardan's life, the external things, the forces outside himself acting upon him. Let us for a moment look at the world of his time and see what the larger setting of his life was. No one needs to be reminded of the greatness of the sixteenth century, but I will bore you for a moment with a few dates. Columbus had opened a new world in 1492. Luther was born in 1483, Ambrose Pare in 1517, Ivan the Terrible in 1550, and Francis Bacon in 1561. The English College of Physicians was founded in 1519. The first European pharmacopoeia was published in Nuremberg in 1542. Harvey, unfortunately for Cardan, did not come into the world till 1578, though late in Cardan's life (1569) Caesalpinus published in Florence a theory of the circulation of the blood, but he was like the organic evolutionsits before Darwin: he had opinions, he did not experimentally discover facts. 1519 Magellan sailed through the straits now bearing his name into the South Sea of Discovery and so to the Philippine Islands, where he died. Michael Servetus got himself burnt at the stake because he said in 1553 that the blood, in order to get from the right to the left side of the heart, might have to pass through the lungs. Modern worshippers of the monkey goddess, freedom of academic piffle, regard him as one of their patron saints, whereat I suspect he feels, if he knows what is

In

going on in this world, but little honored. The British Empire was all unconsciously, almost accidentally, being founded. Italy had not yet dreamed of being one kingdom. The modern German Empire was still unconceived. The catalogue of things done, things thought, would fill many pages, far more than I can give. Suffice it to say that as America today could, not altogether unjustly, be described as a country ruled by the tongue, so Europe of the sixteenth century was a world of thought and action. Cardan, like all men, was influenced by his age. He, like everyone, was the product of his environment, but what the product is, good, bad, indifferent, depends upon the inherent nature of the man, the quality of his protoplasm, and heredity alone controls that. Environment can not transmute base metal into gold nor make two brain cells grow where one grew before, though it may injure or destroy or generously nourish. Hard as Cardan's youth was, it seems to have been a good environment, judging by results.

To an alienist the first question always is, was Cardan insane? In his own time many so regarded him-friends as an inspired imbecile, enemies as just an imbecile. Few held the balance even while forming judgment. For years after his death men who wrote of him also regarded him as more or less insane, but they thought him insane because of the qualities which we of today regard as proof of sanity, and sane because of things we regard as proving insanity. So changes the world's point of view. The difficulty in settling the question is to find a test of sanity. If one accepts as proof of insanity the common man's idea, namely, belief in things he disbelieves, behaving as he does not behave, and having a point of view unlike his own, then Cardan was insane, because he believed in the stars, in dreams, in his familiar spirit, etc., behaved in a very idiosyncratic way, and his point of view on everything was certainly unlike the common man's. But any such yardstick as that means that all the world is crazy save our own immediate friends in our own little parish. The test of sanity is, are the man's thoughts and acts consonant with the racial and family heredity, his epoch, his education, his environment.

In other words, whether an act or thought is sane or insane depends upon latitude, longitude, race and time. The African negro who believes in ghosts is sane, the twentieth century American who does so is not, or rather was not, because many people seem to be reverting to primitive ideas. Socrates had a demon and was sane; many who so claim today are simply humbugs. Now following our rule, Cardan was not insane till old age. He held the common beliefs of his time, though it was an age of change and those beliefs were fading out. If one once realizes that man is not a reasoning but a feeling animal, who only reasons about things which have no personal effect on him and that he is mentally an imitative animal, we cease to be surprised to find men believing all sorts of impossible things and obeying the theologic dictum that faith is believing what you know can not be true. Cardan simply followed the crowd, being among the intellectual crowd rather than the other crowd and really a little ahead of most men of his time. He was a mixture of medievalism and new learning. He could not get rid of the influence of intellectual heredity entirely; no man can, but he did mold it somewhat.

How does Cardan rank as a physician? He was not a man of science, but an artist. It was in his time almost impossible to be a man of science in medicine, because the scientific spirit was just awakening. He had some of the spirit, but not so much as other men of his time. Being an artist, his work has been of no use to physicians living after him, because art is wholly personal and if taught at all can only be taught by personal contact. His skill was not in discovering scientific laws, but in empirically finding out what to do in any given case. He was great in empiricism, not in rationalism, which is true science. He played on the sick human machine as a great musical artist plays on his instrument, but he knew nothing of the great biological laws underlying medicine. He had not the prevision that Vesalius and some others of his time had concerning the development of the science of medicine. He knew only the art of his age which was increased by his personal skill.

THIS GENERATION AND THE NEXT IN

RELATION TO MENTAL DEFECT

BY CHARLES H. FRAZIER

Professor of Clinical Surgery

In gathering information to bring before you this afternoon, I have chosen to speak entirely about the feeble-minded, because although the condition of the insane is one of mental defect and is quite as serious and important a problem as the feeble-minded, yet it is better understood and more realized by the community in general, whereas the figures I will give you as a bald introduction to my remarks on the feeble-minded are, I fear, little known or realized. These will serve to give you some idea of the magnitude of the problem.

There are at least 20,000 feeble-minded in Pennsylvania: 3,400 in feeble-minded institutions; 3,000 more going in and out of almshouses, jails, orphanages and prisons; between 13,000 and 14,000 at large without any protection.

The state now spends on the feeble-minded about $800,000 annually in maintenance alone for about one-fifth of the number who should be cared for. The cost to the state of the feebleminded in courts and prisons is probably $600,000 a year. The cost of the feeble-minded in schools is estimated to be at least $300,000. At least as much more is spent in almshouses, orphan asylums, and through private charity. If we allow the feebleminded to increase at the rate they are now reproducing their kind, consider the cost to future generations.

Almost two millions wasted every year; what will this sum be in ten years?

I come before you this afternoon not in any sense as an expert, but as a citizen, one of you, equally with you responsible for the next generation.

I believe that the most important problem we have before us is that of the prevention of mental defect. As a surgeon espe