Mental diseases: a public health problem. James Vance May
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the discussion of the various psychoses frequent references will be noted to the description of the various clinical groups contained in the manual prepared by the Committee on Statistics for the American Psychiatric Association. As is shown in the manual, these definitions and explanatory notes were formulated by Dr. George H. Kirby.
Special reference should be made to the important contributions to the literature of psychiatry of such well-known American writers as Meyer, Hoch, Kirby, White, Barrett, Campbell, Southard, Peterson, Diefendorf, Jelliffe, Paton, Salmon, Russell, Buckley, Rosanoff, Orton, Singer and many others. The work of Kraepelin, Bleuler, Nissl, Alzheimer, Freud, Jung, Stekel, Janet and others abroad has exercised an influence on the psychiatry of the day which must be recognized. We are very largely indebted to Pollock and to Furbush for the available information relating to the incidence of the various psychoses in this country. To the American Psychiatric, for many years the American Medico-Psychological, Association we owe an exhaustive historical review of the institutional care and treatment of mental diseases in the United States and Canada.
Obviously this work was not intended as a textbook, nor was it designed to serve the purpose of one. It is an appeal to those who are already familiar with the fundamental principles of psychiatry. For that reason the interpretation of mental mechanisms given so much space in textbooks has been entirely omitted and no reference is made to the treatment of the individual psychoses. Such reliable statistical data as could be gathered from recent hospital reports and publications have been utilized in full. The following institutions were represented in this study:
1. Massachusetts—fourteen hospitals (1919–1920): Boston State Hospital, Boston; Bridgewater State Hospital, State Farm; Danvers State Hospital, Hathorne; Foxborough State Hospital, Foxborough; Gardner State Colony, Gardner; Grafton State Hospital, North Grafton; McLean Hospital, Waverley; Medfield State Hospital, Harding; Monson State Hospital, Palmer; Northampton State Hospital, Northampton; State Infirmary, Tewksbury (Mental Wards); Taunton State Hospital, Taunton; Westborough State Hospital, Westborough; Worcester State Hospital, Worcester.
2. New York—thirteen hospitals (1912–1919): Binghamton State Hospital, Binghamton; Brooklyn State Hospital, Brooklyn; Buffalo State Hospital, Buffalo; Central Islip State Hospital, Central Islip; Gowanda State Homeopathic Hospital, Collins; Hudson River State Hospital, Poughkeepsie; Kings Park State Hospital, Kings Park, L. I.; Manhattan State Hospital, Ward's Island, New York City; Middletown State Homeopathic Hospital, Middletown; Rochester State Hospital, Rochester; St. Lawrence State Hospital, Ogdensburg; Utica State Hospital, Utica; Willard State Hospital, Ovid.
3. Twenty-one hospitals in fourteen other states:
Arkansas—State Hospital for Nervous Diseases, Little Rock (1917–1918).
Colorado—Colorado State Hospital, Pueblo (1917 and 1918).
Connecticut—Connecticut State Hospital, Middletown (1917 and 1918); Norwich State Hospital, Norwich (1905–1918 inclusive).
Maryland—Springfield State Hospital, Sykesville, 1919; Spring Grove State Hospital, Catonsville, 1918 and 1919.
Michigan—Pontiac State Hospital, Pontiac, 1917 and 1918; State Psychopathic Hospital, Ann Arbor, 1917 and 1918; Traverse City State Hospital, Traverse City, 1917 and 1918.
Montana—Montana State Hospital, Warm Springs, 1917 and 1918.
New Jersey—Essex County Hospital, Overbrook, 1918.
Pennsylvania—State Hospital Southeastern District of Pennsylvania, Norristown, 1919.
South Carolina—South Carolina State Hospital, Columbia, 1918.
Utah—State Mental Hospital, Provo, 1918.
Vermont—Vermont State Hospital, Waterbury, 1917 and 1918.
Virginia—Central State Hospital, Petersburg, 1919; Western State Hospital, Staunton, 1919.
Washington—Eastern State Hospital, Medical Lake, 1917 and 1918; Northern State Hospital, Sedro Woolley, 1917 and 1918.
West Virginia—Spencer State Hospital, 1917 and 1918; Weston State Hospital, Weston, 1917 and 1918.
These institutions may, I think, be looked upon as fairly representative of the hospitals of this country. Based on their official reports an analysis has been made of over seventy thousand consecutive first admissions.
There is no disposition on the part of the writer to overestimate the value of statistical studies. Our conclusions should, however, be based as fully as possible on facts rather than on abstract theories or individual observations alone. The social, economic and clinical aspects of mental diseases must all be given adequate consideration if psychiatry is to fulfill its obligation to the community and assume a dignified rôle in the advancement of modern medicine.
James V. May.
Boston, Mass.,
December 15, 1921.
PART I
GENERAL CONSIDERATIONS
MENTAL DISEASES
CHAPTER I
THE SOCIAL AND ECONOMIC IMPORTANCE OF MENTAL DISEASES
The importance of mental diseases as a factor in the social and economic welfare of the community has not been given adequate consideration, notwithstanding the remarkable progress of modern psychiatry. Nor is this influence, unfortunately, one which can be easily estimated or accurately determined. We have, as a matter of fact, no data at hand to show the prevalence of disease, either physical or mental, with any degree of exactness even under our most elaborately organized forms of government. There is no complete information available which will enable us to determine the frequency of such important conditions as appendicitis, cardiac or renal diseases, peritonitis, septic infections, diseases of the eye, ear, skin or nervous system. It is true that there are, in the majority of states, records of contagious or readily communicable diseases which are probably fairly reliable. Aside from this, the only information at our disposal is confined to mortality statistics.
This suggests a further consideration of the advisability, if not absolute necessity, of more extensive statistical studies of diseases, both mental and physical, if the welfare of the community is to be safeguarded and the future of medical science assured. Every physician should be required by law to make careful reports to the Board of Health of his state showing all medical conditions requiring treatment by him or coming to his professional notice. The value of such information to medical science would much more than compensate for the comparatively small cost of such an undertaking. Nor is this procedure more radical either in theory or practice than was the proposal to report all communicable diseases only a few years since. The data thus made available in the various states should be correlated and published by the Public Health Service.
The mortality statistics of the United States Census Bureau furnish us with a valuable index of the relative frequency of the various disease processes which determine the death rate of the community. They are based on the transcripts of death certificates received from the so-called registration area, which in 1920 had an estimated population of 87,486,713. The total number of deaths reported in 1920 was 1,142,558, a rate of 13.1 per 1,000 of the population. It is true that the epidemic of influenza was still a factor of some importance at that time. The rate for 1916, however, was fourteen, for 1917 fourteen and two-tenths, for 1918 eighteen and one-tenth and for 1919 twelve and nine-tenths per 1,000 of the population. The registration area now includes thirty-four states:—California, Colorado, Connecticut, Delaware, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey,